Trigeminal neuralgia is caused by compression of trigeminal nerve root and it leads to demyelination gradually. It was almost idiopathic and occurred unexpected. The upper cervical spinal cord contains the spinal trigeminal tract and nucleus. Fibers with cell bodies in the trigeminal ganglion enter in the upper pons and descend caudally to C2 level. We experienced a rare patient with facial pain, which was paroxysmal attack with severe pain after a clear event, cervical spinal injury (C2). So, this case reminds us of a possible cause of trigeminal neuralgia after a trauma of the head and neck.
Cell Body ; Cervical Cord ; Demyelinating Diseases ; Facial Pain ; Head ; Humans ; Neck ; Odontoid Process ; Pons ; Spinal Cord ; Spinal Injuries ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia

Bell's palsy is the most common form of acute facial nerve disorder, which presents as an acute peripheral unilateral facial palsy of unknown cause. Ramsay-Hunt syndrome is the second most common cause of acute facial palsy, and is known to be caused by reactivation of latent varicella zoster virus. The main goal of treatment for acute inflammatory facial nerve paralysis is to speed up recovery, to facilitate the recovery more completely and to prevent other sequelae. However, some patients may have a poor recovery with permanent, disfiguring facial asymmetry despite of many kinds of treatments. Regarding the diagnostic and therapeutic issues of the two common disorders, there still exist some controversies. This article reviewed recent evidences on several important issues in evaluation and management of acute inflammatory facial nerve paralysis, and intended to provide an evidence-based framework for decision-making in the clinic.
Bell Palsy ; Facial Asymmetry ; Facial Nerve ; Facial Nerve Diseases ; Facial Paralysis ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Humans ; Paralysis

Tolosa-Hunt syndrome is a rare self-limiting disease that's characterized by painful ophthalmoplegia. It has a relapsing and remitting course, and the pain responds promptly to systemic corticosteroid therapy. Yet it is diagnosed by the exclusion of other major causes involving the superior orbital fissure or cavernous sinus, including trauma, neoplasm, aneurysm and inflammation. Further, the associated ophthalmoplegia may follow days to weeks after the onset of orbital or hemifacial pain. Hence, this condition is often misdiagnosed as atypical facial pain, and so improper management could result in unnecessary suffering of the patient. The following case describes a patient suffering with hemifacial pain associated with ipsilateral abducens nerve palsy, which was evident 2 weeks after the onset of pain, and this was misdiagnosed as trigeminal neuralgia and atypical facial pain.
Abducens Nerve Diseases* ; Abducens Nerve* ; Aneurysm ; Cavernous Sinus ; Facial Pain ; Humans ; Inflammation ; Ophthalmoplegia ; Orbit ; Tolosa-Hunt Syndrome ; Trigeminal Neuralgia

Trigeminal neuralgia (TGN) is a relatively well-known disorder with characteristic brief attacks of shooting pain in the facial regions. Atypical signs like constant pain and/or sensory abnormalities can develop as the disease progresses. Some cases begin with atypical signs and later develop all the hallmarks of TGN. The atypical forms of TGN can be misdiagnosed as other pain disorders. We present a patient with facial pain who demonstrated a transformation in signs of glossopharyngeal neuralgia into typical trigeminal neuralgia. A 71 year-old man was referred for sharp episodic pain in his right side of the face and neck. The pain was mainly in the neck, which was worsened especially by swallowing. The condition was initially diagnosed as a glossopharyngenl neuralgia. While controlling the pain conservatively with a sympathetic blockade, the neck pain disappeared suddenly and lower jaw pain triggered by speaking and chewing became prominent, which are the characteristic signs of trigeminal neuralgia.
Aged ; Carbamazepine ; Deglutition ; Facial Pain ; Glossopharyngeal Nerve Diseases* ; Humans ; Jaw ; Mastication ; Neck ; Neck Pain ; Neuralgia ; Trigeminal Neuralgia*

Facial Nerve ; Facial Nerve Diseases ; Facial Nerve Injuries ; Facial Paralysis ; Neurology ; trends

Trigeminal neuropathy os characterized by unremitting facial pain, no evident trigger point and facial sensory change. According to Jannetta, in trigeminal neuropathy, the offending artery is not necessarily in contact with the root entry zone(REZ) but any site of the nerve. We have recently experienced a 48-year-old woman with symptoms and signs compatible with trigeminal neuropathy and explored the CP angle. SCA was crossing just anterior to the trigeminal root and one small arterial loop was lying on the pons close to the root entry zone(REZ) but neither of them was in diirect contact with the nerve. Teflon felt was inserted between the arteries and nerve and secured with silk and beriplast for fear that they should contact by changing position. Immediately after the operation the facial pain and pre-existing facial sensory change were completely gone.
Arteries ; Deception ; Facial Pain ; Female ; Fibrin Tissue Adhesive ; Humans ; Microvascular Decompression Surgery* ; Middle Aged ; Polytetrafluoroethylene ; Pons ; Silk ; Trigeminal Nerve Diseases* ; Trigeminal Neuralgia ; Trigger Points

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*

There are many theonies regarding the etiology of idiopathic facial paralysis(Bell's palsy), but none will bear close examination at the present time. Quite possibly a proportion of causes should be classified as due to the herpes virtus. Herpes zoster is commonly known as a benign viral disease affecting the sensory nerves, but less well known is that this viral infection also caused muscle paralysis, in a not significant number of patients. There is increasing evidence that sympathetic blocks performed during the acute stage of herpes zoster infection shorten the eruptive phase of the disease and decreases the incidence of post herpetic neuralgia. Early treatment is particularly important in elderly patients in whom the incidence of long standing postherpetic pain is extremely high. The aim of treatment of Bell's palsy is to reduce edema and improve circulation to be facial nerve. Stellate ganglion block resulted in abolishing cerebral vascular spasm and in increasing cerebral blood flow. Thus stellate ganglion block is effective in treatment of Bell's palsy. This patient with herpes zoster associated with idopathic complete Bell's palsy was treated by repeat stellate ganglion block with 1% lidocaine and excellent result were noted.
Aged ; Bell Palsy ; Edema ; Facial Nerve ; Facial Paralysis* ; Herpes Zoster* ; Humans ; Incidence ; Lidocaine ; Neuralgia ; Paralysis ; Spasm ; Stellate Ganglion* ; Virus Diseases

We present an unusual case of a complete type II first branchial cleft fistula that communicates between the external auditory canal and the skin near the angle of the mandible. The incomplete branchial fistula is not an uncommon congenital anomaly of branchial apparatus but a complete one is rare. It was successfully treated with complete surgical excision without facial nerve injury. It was diagnosed as the type II first branchial cleft anomaly by histological finding. We discuss the classification of first branchial cleft anomalies, with emphasis on the complete type fistula and the facial nerve.
Branchial Region ; Craniofacial Abnormalities ; Ear Canal ; Facial Nerve ; Facial Nerve Injuries ; Fistula ; Mandible ; Pharyngeal Diseases ; Skin

OBJECTIVE: To know the correlation between the grading of facial neuropathy by facial nerve conduction study (FNCS) and dysphagia severity by videofluoroscopic swallowing study (VFSS) in patients with acute peripheral facial palsy (PFP). METHOD: Twenty patients with acute PFP were recruited for this study. The causes of acute PFP were limited to idiopathic Bell's palsy and Ramsay-Hunt syndrome. The time interval from the onset of PFP to study of FNCS and VFSS was 10 to 14 days. The severity of PFP was graded according to House-Brackmann facial nerve grade (H-B FNG). Percent degeneration grade (PDG) was determined by FNCS. Baseline-to-peak amplitude of compound muscle action potentials in orbicularis oris muscle was used as an evaluation parameter. Oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT) and dysphagia limit were obtained by VFSS. RESULTS: There was a significant correlation between PDG and H-B FNG. The severity of oropharyngeal dysfunction was increased as the severity of the PDG increases. Delayed OTT, delayed PDT, and/or reduced dysphagia limit were revealed as a presentation of oropharyngeal dysfunction in acute PFP. CONCLUSION: The severity of PFP and oropharyngeal dysfunction were significantly correlated. And so we think that precise evaluation and adequate management of oropharyngeal dysfunction will be needed in acute PFP patients.
Action Potentials ; Bell Palsy ; Deglutition ; Deglutition Disorders ; Facial Nerve ; Facial Nerve Diseases* ; Facial Paralysis ; Humans