1/26. Physical therapy for facial paralysis: a tailored treatment approach.BACKGROUND AND PURPOSE: bell palsy is an acute facial paralysis of unknown etiology. Although recovery from bell palsy is expected without intervention, clinical experience suggests that recovery is often incomplete. This case report describes a classification system used to guide treatment and to monitor recovery of an individual with facial paralysis. CASE DESCRIPTION: The patient was a 71-year-old woman with complete left facial paralysis secondary to bell palsy. signs and symptoms were assessed using a standardized measure of facial impairment (Facial Grading System [FGS]) and questions regarding functional limitations. A treatment-based category was assigned based on signs and symptoms. rehabilitation involved muscle re-education exercises tailored to the treatment-based category. OUTCOMES: In 14 physical therapy sessions over 13 months, the patient had improved facial impairments (initial FGS score= 17/100, final FGS score= 68/100) and no reported functional limitations. DISCUSSION: Recovery from bell palsy can be a complicated and lengthy process. The use of a classification system may help simplify the rehabilitation process.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/26. Not all facial paralysis is Bell's palsy: a case report.Bell's palsy or idiopathic facial paralysis is the most common cause of unilateral facial paralysis. This case report describes a patient referred for physical therapy evaluation and treatment with a diagnosis of Bell's palsy. On initial presentation in physical therapy the patient had unilateral facial paralysis, ipsilateral regional facial pain and numbness, and a history of a gradual, progressive onset of symptoms. The process of evaluating this patient in physical therapy, as well as the recognition of signs and symptoms typical and atypical of Bell's palsy, are described. This report emphasizes the importance of early recognition of the signs and symptoms inconsistent with a diagnosis of Bell's palsy, and indications for prompt, appropriate referral for additional diagnostic services.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
3/26. facial paralysis secondary to acute otitis media.We describe a case of facial paralysis in a 19-month-old male recently diagnosed with acute otitis media. Results of his physical examination was remarkable for left-sided peripheral facial nerve palsy with an associated middle ear infection. physicians should understand the etiology, pathophysiology, treatment options, and prognosis of facial palsy in association with otitis media.- - - - - - - - - - ranking = 8.2065551563681keywords = physical examination, physical (Clic here for more details about this article) |
4/26. facial nerve palsy secondary to internal carotid artery dissection.We report facial palsy as the sole cranial neuropathy complicating an ipsilateral internal carotid artery dissection. A previously healthy 44-year-old man developed retro-orbital and temporal headache with associated nausea while engaged in modest physical exercise. On the following morning he noticed a left ptosis and miotic pupil. One week later he woke with a left facial weakness. On the same day he had a 90-minute episode of expressive dysphasia. magnetic resonance imaging and angiography demonstrated left internal carotid artery dissection. The temporal association between our patient's facial nerve palsy and typical features of spontaneous internal carotid artery dissection suggests a common aetiology. We suggest that involvement of the VII cranial nerve in isolation followed disruption of an anomalous nutrient artery. The delay in clinical manifestation may imply extension of the dissection.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/26. Mobius and Mobius-like patients: etiology, diagnosis, and treatment options.The surgical goal in Mobius patients is far more modest and differs from patients with unilateral developmental facial paralysis. It is impossible to restore a true smile in these mask-like, expressionless faces. Despite sophisticated microneurovascular transplantations, movement can only be restored along one vector and enhanced firmness in the cheeks, thus multiple differentiated facial animation is not achievable. A detailed neurological evaluation can identify possible motor donors or residual function, which can be used for additional dynamic restorations. Due to the multiple cranial nerve involvement a thorough clinical and electrophysiological examination is mandatory. In addition, electromyographic survey of the potential motor donors is very helpful to avoid weak wasted regeneration and prevent further downgrading of function. Because of the variety of cranial nerves involved in Mobius' syndrome, a standard procedure for dynamic restoration cannot and should not be promoted; instead, a careful preoperative objective and quantitative assessment should guide the reconstructive surgeon to the optimal reconstruction strategy. Useful movement can be restored in afflicted patients that may signal physical and psychological rehabilitation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/26. Otomastoiditis-related facial nerve palsy.A 9-year-old girl with persistent otitis media, despite antibiotic therapy developed a facial nerve palsy. Computed tomography (CT) scan revealed ipsilateral mastoiditis, prompting admission for intravenous antibiotic and steroid therapies. Acute mastoiditis, uncommon in the post-antibiotic era, is usually diagnosed on physical examination findings, but two variants, masked mastoiditis or silent mastoiditis, may be difficult to appreciate clinically. patients who present with facial nerve palsy in the setting of persistent otitis media should undergo CT scan for evaluation of intracerebral or extracerebral pathology, including mastoiditis. Failure to identify associated concomitant pathology may result in treatment failure or persistent neurological deficit.- - - - - - - - - - ranking = 8.2065551563681keywords = physical examination, physical (Clic here for more details about this article) |
7/26. Free proximal gracilis muscle and its skin paddle compound flap transplantation for complex facial paralysis.Gracilis functioning free-muscle transplantation for the correction of pure facial paralysis has been a preferred method used by many reconstructive microsurgeons. However, for complex facial paralysis, the deficits include facial paralysis along with soft-tissue, mucosa, and/or skin defects. No adequate solution has been proposed. Treatment requests in those patients are not only for facial reanimation but also for correction of the defects. Of 161 patients with facial paralysis treated with gracilis functioning free-muscle transplantation from 1986 to 2002, eight patients (5 percent) presented with complex deficits requiring not only facial reanimation but also aesthetic correction of tissue defects. The tissue defects included an intraoral defect created following contracture release (one patient), infra-auricular radiation dermatitis with contour depression (one patient), temporal depression following a temporalis muscle-fascia transfer (one patient), ear deformity (two patients), and infra-auricular atrophic tissue with contour depression (three patients). A compound flap, consisting of a gracilis muscle with its overlying skin paddle separated into two components, was transferred for simultaneous correction of both problems. The blood supply to the gracilis and to the skin paddle originated from the same source vessel and therefore required the anastomosis of only one set of vessels. The versatility of this compound flap allows for a wide arc of rotation of the skin paddle around the muscle. All flaps were transferred successfully without complications. Satisfactory results of facial reanimation were recorded in five patients after all stages were completed. The remaining three patients are undergoing physical therapy and waiting for revision of the skin paddle.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/26. Post-traumatic bilateral facial palsy: a case report and literature review.Bilateral facial paralysis due to basilar skull fracture involving the temporal bone is rare and, unlike unilateral facial palsy, it can be difficult to recognize because of a lack of facial asymmetry. Thorough clinical history and physical exam, high-resolution CT scan and electrodiagnostic tests can help to make the diagnosis of bilateral facial nerve palsy and early detection, evaluation and intervention may be important for optimal functional recovery. A 16-year-old male sustained closed head injury after motor vehicle collision. The initial head CT scan showed bilateral temporal bone fractures. On admission to the neurotrauma intensive care unit, his Glasgow coma Score was 9T. On post-injury day 4, the patient was noted to have incomplete closure of both eyes and 3 days later he had difficulty with bilateral facial muscle movement during a feeding trial. Electrodiagnostic testing confirmed the diagnosis of bilateral facial nerve injury without evidence of significant distal axonal degeneration. A high-resolution CT scan showed bilateral temporal bone fractures without involvement of the fallopian canals. There was no surgical intervention based on the high-resolution CT scan and the delayed onset of facial palsy. A short course of prednisone was administered. By 10 months, the patient showed nearly complete recovery of his bilateral facial nerve function. Early detection, evaluation and intervention are important for optimal functional recovery after facial nerve injury. When the temporal bone is fractured, high suspicion for facial nerve injury, either unilateral or bilateral, is warranted.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/26. "Moebius syndrome": a case report.Moebius syndrome is an extremely rare disorder characterized by a lifetime facial paralysis, involving sixth and seventh cranial nerves with malformations of orofacial structures and the limbs. In this case, an 8 year old girl with Moebius syndrome is presented, clinical findings are described and management aspects are discussed. Early dental evaluation and parental counselling as a part of preventive dental regimen can go a long way in providing complete psychosocial rehabilitation for such physically disabled children.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/26. Delayed presentation of traumatic facial nerve (CN VII) paralysis.facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell's palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5-10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.- - - - - - - - - - ranking = 8.2065551563681keywords = physical examination, physical (Clic here for more details about this article) |
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