PURPOSE: To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who were referred to an ophthalmic clinic for various conditions like Bell's palsy, trauma, and brain tumor. METHODS: A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited a clinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed. RESULTS: The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ± 37.5 months. The causes of facial palsy were as follows: Bell's palsy, 13 cases; trauma, six cases; brain tumor, five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos, 24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12 eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including the third, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) were conducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin type A injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated using invasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos, 90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement for all signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy. CONCLUSIONS: The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition, and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixty cranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facial palsy. Understanding these differences will help the ophthalmologist take care of patients with facial nerve palsy.
Bell Palsy ; Brain Neoplasms ; Cerebrovascular Disorders ; Cranial Nerve Diseases ; Cranial Nerves ; Epithelium, Corneal ; Eyelids ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Paralysis ; Prognosis ; Retrospective Studies ; Strabismus ; Tears

OBJECTIVE: To heighten the awareness of the facial nerve tumors. METHOD: The clinical data of twenty-three patients complaining of facial paralysis who were diagnosed postoperatively as facial nerve tumors were analyzed. The hearing assessment of all patients was based on pure tone audiometry at the frequency of 0. 5, 1, 2, 4 kHz. Temporal bone high resolution CT scan and temporal bone MRI with gadolinium enhancement were conducted on all patients. Facial nerve function was assessed with the House-Brackmann (HB) grading system. Facial electroneurography (ENoG) was conducted on 20 patients to quantify the degree of nerve degeneration preoperatively. The pathological types of tumor were determined by postoperative pathological reports. RESULT: Nineteen out of 23 cases presented hearing loss (82.6%), 10 cases suffered from tinnitus (43.5%), otalgia (17.4%) affected 4 cases, 3 cases manifested otorrhea (13.0%), and 2 cases presented vertigo (8.7%). Geniculate ganglion was the most commonly involved site (20 cases, 87.0%), followed by tympanic segments (18 cases, 78.3%), pyramid segment (16 cases, 69.6%), mastoid segment (10 cases, 43.5%), labyrinthine segment (9 cases, 39.1%), internal auditory canal segment and parotid gland segment (5 cases, 21.7%, respectively). Twenty-one cases (91.3%) of schwannomas, 1 case (4.3%) of neurofibroma and 1 case (4.3%) of hemangiomas were identified with histopathology postoperatively. The tumors were all completely excised, and the facial nerve function could recovered to HB III at the best after facial nerve repairment. CONCLUSION Facial nerve tumor is a rare and often misdiagnosed disease which was commonly manifested as facial nerve paralysis. Temporal bone CT and MRI can help to clarify the diagnosis preoperatively. Pure tone audiometry and electroneurography also plays a some certain roles in the diagnosis of facial nerve tumors. The tumors should be completely resected and the surgical approaches were determined based on tumor size, facial nerve function and preoperative auditory function.
Cranial Nerve Neoplasms ; complications ; Facial Nerve ; pathology ; Facial Nerve Diseases ; complications ; Facial Paralysis ; etiology ; Hearing Loss ; Hemangioma ; Humans ; Neurilemmoma ; Temporal Bone

Cranial Fossa, Middle ; pathology ; Cranial Nerve Neoplasms ; diagnosis ; pathology ; Facial Nerve Diseases ; diagnosis ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurilemmoma ; diagnosis ; pathology ; Tomography, X-Ray Computed

Isolated cranial nerve palsy without long tract signs such as contralateral hemiparesis, hemihypoesthesia and ataxia is often reported as brainstem infarction. But most of them are accompanied by oculomotor or abducens nerve palsy. Isolated cranial nerve palsy involving the facial nerve and vestibulocochlear nerve is very rare in brainstem infarction. We report, with a review of literature, a case of right caudal pontine infarct on the dorsolateral portion of the middle cerebellar peduncle with isolated 7th and 8th cranial nerve palsies.
Abducens Nerve Diseases ; Ataxia ; Brain Stem Infarctions* ; Brain Stem* ; Cranial Nerve Diseases ; Facial Nerve ; Facial Paralysis ; Hearing Loss ; Paralysis* ; Paresis ; Vertigo ; Vestibulocochlear Nerve*

OBJECTIVE: 10 summarize tne clinical features of the facial nerve tumors involving the internal auditory canal and promote the management of facial nerve tumor. METHOD: We retrospectively reviewed the clinical manifestations, the experiences of diagnosis and treatment of the facial nerve tumor involving the internal auditory canal. All these 5 cases were enrolled during January 2013 to Apr 2015. RESULT: Among the 5 cases, 3 cases were facial neurilemmoma and the others were facial neurofibroma. The main symptoms of facial nerve tumors involving the internal auditory canal most commonly were facial paralysis companied with hearing loss. All the patients accepted the surgical treatment with various approaches, 3 cases of translabyrinthine approach, 1 case of middle fossa approach, and 1 case of combination of translabyrinthine and transotic approach. Total tumor resection were achieved in all 5 cases. Facial-hypoglossal nerve anastomosis was performed in one case, another case was undergone great auricular nerve graft. CONCLUSION Surgical intervention for patients with facial neuroma involving internal auditory canal should be considered when facial weakness has deteriorated to grade 4. The management should be based on the patient's hearing, facial nerve function, tumor size and invasive extension to select the appropriate surgical procedures.
Anastomosis, Surgical ; Cranial Nerve Neoplasms ; diagnosis ; surgery ; Facial Nerve ; pathology ; surgery ; Facial Nerve Diseases ; diagnosis ; surgery ; Facial Paralysis ; complications ; Hearing Loss ; complications ; Humans ; Hypoglossal Nerve ; surgery ; Neurilemmoma ; diagnosis ; Neurofibroma ; diagnosis ; Retrospective Studies

The Onyx liquid embolic system is a relatively safe and commonly used treatment for vascular malformations, such as arteriovenous fistulas and arteriovenous malformations. However, studies on possible complications after Onyx embolization in patients with vascular malformations are limited, and the occurrence of cranial nerve palsy is occasionally reported. Here we report the progress of two different types of cranial nerve palsy that can occur after embolization. In both cases, Onyx embolization was performed to treat vascular malformations and ipsilateral oculomotor and facial nerve palsies were observed. Both patients were treated with steroids and exhibited symptom improvement after several months. The most common types of neuropathy that can occur after Onyx embolization are facial nerve palsy and trigeminal neuralgia. Although the mechanisms underlying these neuropathies are not clear, they may involve traction injuries sustained while extracting the microcatheter, mass effects resulting from thrombi and edema, or Onyx reflux into the vasa nervorum. In most cases, the neuropathy spontaneously resolves several months following the procedure.
Arteriovenous Fistula ; Arteriovenous Malformations ; Cranial Nerve Diseases* ; Cranial Nerves* ; Edema ; Facial Nerve ; Humans ; Paralysis ; Steroids ; Traction ; Trigeminal Neuralgia ; Vasa Nervorum ; Vascular Malformations*

Herpes zoster oticus is a common inflammatory disease caused by reactivation of varicella zoster virus in the dorsal root ganglia. Its symtpoms include unilateral distribution of the vesicular eruptions, neuralgia and various type of cranial nerve palsy depending on the involving site of head and neck region. Most commonly affected cranial nerves are facial nerve (VII) and vestibulocochelar nerve (VIII), but on rare occasions cranial nerves V, IX, X, XI are affected as well. Although neurologic symptom of herpes zoster was commonly reported, zoster associated hiccups is very rare. We experienced one case of herpes zoster oticus involving multiple cranial nerve palsy with intractable hiccups. We report our case with a review of literature.
Cranial Nerve Diseases ; Cranial Nerves ; Facial Nerve ; Ganglia, Spinal ; Head ; Herpes Zoster ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Hiccup ; Neck ; Neuralgia ; Neurologic Manifestations

OBJECTIVE: To analyze the clinical manifestations and the diagnosis of the facial nerve tumor according to the clinical information, and evaluate the different surgical approaches depending on tumor location. METHOD: Twenty-seven cases of facial nerve tumors with general clinical informations available from 1999.9 to 2006.12 in the Shanghai EENT Hospital were reviewed retrospectively. RESULT: Twenty (74.1%) schwannomas, 4 (14.8%) neurofibromas ,and 3 (11.1%) hemangiomas were identified with histopathology postoperatively. During the course of the disease, 23 patients (85.2%) suffered facial paralysis, both hearing loss and tinnitus affected 11 (40.7%) cases, 5 (18.5%) manifested infra-auricular mass and the others showed some of otalgia or vertigo or ear fullness or facial numbness/twitches. CT or/and MRI results in 24 cases indicated that the tumors originated from the facial nerve. Intra-operative findings showed that 24 (88.9%) cases involved no less than 2 segments of the facial nerve, of these 24 cases 87.5% (21/24) involved the mastoid portion, 70.8% (17/24) involved the tympanic portion, 62.5% (15/24) involved the geniculate ganglion, only 4.2% (1/24) involved the internal acoustic canal (IAC), and 3 cases (11.1%) had only one segments involved. In all of these 27 cases, the tumors were completely excised, of which 13 were resected followed by an immediate facial nerve reconstruction, including 11 sural nerve cable graft, 1 facial nerve end-to-end anastomosis and 1 hypoglossal-facial nerve end-to-end anastomosis. Tumors were removed with preservation of facial nerve continuity in 2 cases. CONCLUSION Facial nerve tumor is a rare and benign lesion, and has numerous clinical manifestations. CT and MRI can help surgeons to make a right diagnosis preoperatively. When and how to give the patients an operation depends on the patients individually.
Adolescent ; Adult ; Aged ; Child ; Cranial Nerve Neoplasms ; diagnosis ; surgery ; Facial Nerve Diseases ; diagnosis ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Cranial mononeuropathies, manifesting particulary as opthalmoplegia or facial palsy, are common entities in the dia-betic population. However, sequential multiple cranial neuropathies due to diabetes are much less common. It is often associated with other conditions such as a brain tumor or head trauma. A 61-year-old diabetic man presented with ptosis, opthalmoplegia, and facial palsy which were manifestations of multiple cranial neuropathies involving the left 3rd, 4th, 6th, and 7th cranial nerves throughout five weeks. The pupils were not involved. The neurologic evaluation included a CSF study and a brain MRI with MRA. None of them produced any significant results. Blink reflexes revealed evidence of a left facial nerve lesion. The blood glucose was strictly controlled and steroid therapy was administered. The ptosis of the patientanjx left eyelid improved during treatment and he was discharged after 13 days. In a follow-up examination 3 months after onset, focal neurological deficits including opthalmoplegia and facial palsy on the left side were greatly improved and barely noticeable.
Blinking ; Blood Glucose ; Brain ; Brain Neoplasms ; Cranial Nerve Diseases* ; Cranial Nerves ; Craniocerebral Trauma ; Diabetes Mellitus* ; Eyelids ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mononeuropathies ; Pupil

PURPOSE: Mobius syndrome is a rare congenital disorder characterized by facial diplegia and bilateral abducens palsy, which occasionally combines with other cranial nerve dysfunction. The inability to show happiness, sadness or anger by facial expression frequently results in social dysfunction. The classic concept of cross facial nerve grafting and free muscle transplantation, which is standard in unilateral developmental facial palsy, cannot be used in these patients without special consideration. Our experience in the treatment of three patients with this syndrome using transfer of muscles innervated by trigeminal nerve showed rewarding results. METHODS: We used bilateral temporalis muscle elevated from the bony temporal fossa. Muscles and their attached fascia were folded down over the anterior surface of the zygomatic arch. The divided strips from the attached fascia were passed subcutaneously and anchored to the medial canthus and the nasolabial crease for smiling and competence of mouth and eyelids. For the recent 13 years the authors applied this method in 3 Mobius syndrome cases- 45 year-old man and 13 year-old boy, 8 year-old girl. RESULTS: One month after the surgery the patients had good support and already showed voluntary movement at the corner of their mouth. They showed full closure of both eyelids. There was no scleral showing during eyelid closure. Also full closure of the mouth was achieved. After six months, the reconstructed movements of face were maintained. CONCLUSION: Temporalis muscle transfer for Mobius syndrome is an excellent method for bilateral reconstruction at one stage, is easy to perform, and has a wide range of reconstruction and reproducibility.
Adolescent ; Anger ; Child ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Cranial Nerves ; Eyelids ; Facial Expression ; Facial Nerve ; Facial Paralysis ; Fascia ; Female ; Happiness ; Humans ; Male ; Mental Competency ; Middle Aged ; Mobius Syndrome* ; Mouth ; Muscles ; Paralysis ; Reward ; Smiling ; Transplants ; Trigeminal Nerve ; Zygoma