1/37. Hypertrophic neuropathy of the facial nerve.Hypertrophic neuropathy is a peripheral nerve lesion that is histologically characterized by onion bulb formations around axons. This histologic picture, which is usually seen in generalized hypertrophic neuropathies, can occasionally be observed in single nerves as localized hypertrophic neuropathy. Cranial involvement of such localized hypertrophic neuropathy represents a very rare entity; only a few cases have been reported in the literature. We report the history of a progressive facial paralysis with a tumorous enlargement of the seventh cranial nerve that was clinically suspected of being a schwannoma. Pathological examination permitted the diagnosis of hypertrophic neuropathy.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
2/37. The crucial role of imaging in detection of facial nerve haemangiomas.facial nerve haemangioma is a rare benign neoplasm accounting for 0.7 per cent of all tumours involving the temporal bone. The diagnosis of a facial nerve tumour is often missed or delayed. early diagnosis is imperative as it influences the eventual outcome for facial nerve function. prognosis is related to the size of the tumour, the severity and the duration of pre-operative paralysis. The definitive diagnosis of a facial nerve tumour rests exclusively with high resolution imaging of the temporal bone using enhanced magnetic resonance imaging (MRI) and thin-sectioned computed tomography (CT). This case emphasizes the crucial role that high quality imaging can play in the diagnosis of facial nerve tumours, and elegantly illustrates the imaging features of facial nerve haemangiomas.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
3/37. Transtemporal facial nerve schwannoma without facial nerve paralysis.Facial schwannoma is a relatively rare but well documented lesion, presenting either as a mass or with facial nerve symptoms. In this report, an extensive facial schwannoma, extending from the brain stem to the periphery with minimal facial nerve symptoms and normal facial function is presented.- - - - - - - - - - ranking = 4keywords = paralysis (Clic here for more details about this article) |
4/37. Objective facial motion analysis in patients with facial nerve dysfunction.OBJECTIVES/HYPOTHESIS: To objectively measure facial motion at various facial landmarks using a video-computer interactive system. STUDY DESIGN: Clinical, prospective, non-randomized. methods: A video-computer interactive system, The Peak Motus motion Measurement System, was used to study linear displacement at preselected facial landmarks in the normal and abnormal face. Subjects with normal facial function (n = 34) and patients with abnormal facial function (n = 26) from various etiologies were studied. The sites studied were marked with reflective beads. Of a larger repertoire of expressions, two expressions (eyes closed and closed-lip smile) were studied in all subjects. The percent asymmetry in facial displacement between the sides of the face was calculated. The sensitivity of this measurement to facial dysfunction was evaluated. The presence of synkinesis was examined by quantifying the displacement at facial sites that were remote to the sites primarily involved in a given facial expression. Test-retest reliability of the percent asymmetry measurement was evaluated with the paired t test. RESULTS: The video-computer interactive approach used accurately detected and quantified gross and subtle changes in facial function. The sensitivity of the percent asymmetry measurement was 95% (both expressions) for patients with apparent facial dysfunction (House-Brackmann rating >I/VI). In patients with facial nerve dysfunction, displacement on the presumably normal side was significantly excessive in 27% to 35%, depending on the expression. With this interactive computer-video system, synkinesis was detected in 58% of the pathologic subjects during the eyes closed or closed-lip smile expressions. The paired t test indicated strong test-retest reliability (r = 0.73-0.99) of the percent asymmetry measurement. CONCLUSIONS: The present report indicates that this approach to the assessment of facial motion is sensitive to facial dysfunction. This computer-video interactive system is able to quantify synkinesis. A grading system for the magnitude of synkinesis, based on the magnitude of the displacement at remote facial sites, is proposed. The common occurrence of excessive facial motion on the presumably normal side of affected individuals indicates that patients with facial paralysis often overcompensate by exaggerating the normal side in an effort to move the affected side. This system is of value in the objective measurement of normal facial function and may prove a useful tool to quantify the outcomes of various medical and surgical treatments for facial nerve dysfunction.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
5/37. Diagnosis of bell palsy with gadolinium magnetic resonance imaging.bell palsy is a condition resulting from a peripheral edematous compression on the nervous fibers of the facial nerve. This pathological condition often has clinical characteristics of no importance and spontaneously disappears in a short time in a high percentage of cases. Facial palsy concerning cranial nerve VII can also be caused by other conditions such as mastoid fracture, acoustic neurinoma, tumor spread to the temporal lobe (e.g., cholesteatoma), neoformation of the parotid gland, melkersson-rosenthal syndrome, and Ramsay-Hunt syndrome. Therefore, it is important to adopt an accurate diagnostic technique allowing the rapid detection of bell palsy and the exclusion of causes of facial paralysis requiring surgical treatment. magnetic resonance imaging (MRI) with medium contrast of the skull shows a marked increase in revealing lesions, even of small dimensions, inside the temporal bone and at the cerebellopontine angle. The authors present a clinical case to show the important role played by gadolinium MRI in reaching a diagnosis of bell palsy in the differential diagnosis of the various conditions that determine paralysis of the facial nerve and in selecting the most suitable treatment or surgery to be adopted.- - - - - - - - - - ranking = 2keywords = paralysis (Clic here for more details about this article) |
6/37. A rare case of a facial-nerve neurofibroma in the parotid gland.The incidence of solitary neurofibroma of the facial nerve originating in the parotid region is extremely low. We report a case of a solitary neurofibroma in a 30-year-old male, who initially presented with a parotid mass without facial paresis or paralysis. A chain of small nodules had been palpable in the right parotid region for the previous 2-3 years. MRI and CT scans revealed several small ovoid lesions extending from the frontal margin of the parotid gland to the retromandibular region. The lesions were surgically removed. The main trunk of the facial nerve was adherent to the dorsal side of the largest nodule; however, this mass was resected atraumatically. Histopathological examination indicated neurofibroma. The incidence, presentation, diagnosis and surgical treatment of intraparotid neurofibroma are discussed and compared with those of Schwannoma.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
7/37. Bell's palsy as an early manifestation of acute lymphoblastic leukemia.A 20-year-old man with the complaints of malaise, fever, and tooth gum bleeding presented at a hospital. He was found to have generalized lymphadenopathy, thrombocytopenia, and leukocytosis. Ensuing bone marrow biopsy led to a diagnosis of acute lymphoblastic leukemia (ALL). He also had a sense of "facial stretching" and difficulty during eating. After clinical examination, he was diagnosed with right-sided peripheral type facial nerve paralysis (Bell's palsy). The magnetic resonance imaging studies demonstrated bilateral facial nerve involvement, predominantly on the right side. The patient received steroid treatment and local facial radiotherapy for Bell's palsy. A concurrent facial exercise program was ordered. Seemingly a less significant diagnosis in a leukemia patient, we considered our case notable since an ALL patient presenting with Bell's palsy, especially at the very beginning of the disease, is not that common. The cases of relapsing ALL reported in the literature initially presenting with the same scenario further strengthen the significance.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
8/37. Intratemporal facial nerve neurinoma without facial paralysis.A 38-year-old man was referred by his general practitioner to our department on 28 October 1991, with a 2-week history of vertigo. A left aural polyp was identified. The audiogram showed a moderate conductive loss on the left side. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of the expanding lesion in the descending portion of the facial nerve. However, there was no seventh nerve paresis. At operation, the neurinoma (Schwannoma) filled the middle ear cleft and extended from the genu to the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb. facial nerve paresis is the usual presenting feature of a facial neurinoma. The case is presented for the reason that the absence of facial palsy as a presenting feature is rather rare, especially in the cases with large tumor and extensive bone erosion.- - - - - - - - - - ranking = 4keywords = paralysis (Clic here for more details about this article) |
9/37. Amyloid of the facial nerve.Although facial nerve paralysis has been reported in association with amyloidosis, histologic confirmation of facial nerve involvement with amyloid has not been previously demonstrated. A case of localized primary amyloidosis of the facial nerve is presented, and a new magnetic resonance technique for imaging the facial nerve is described.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
10/37. The different faces of facial nerve schwannomas.facial nerve schwannomas are rare benign tumors. The tumor can arise anywhere along the course of the facial nerve. The most common presentation for this tumor is a slowly progressive facial nerve paralysis. Sensorineural hearing loss (SNHL) and tinnitus are later symptoms. The symptoms and signs depend on the site of tumor along the nerve. We report three cases of facial nerve schwannomas with different clinical presentations. Appropriate management of a facial nerve schwannoma should be based on the site and extent of the tumor and status of the nerve function.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
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