Facial palsy and Wegener's granulomatosis

Facial palsy can occur as a result of various pathological processes, which are not always amenable to early diagnosis. This article is a case presentation of a patient with facial palsy, after an acute otitis media manifestation, as a first symptom of Wegener's granulomatosis. The clues leading to diagnosis consist of the practitioner's clinical suspicion of the disease, the use of the appropriate serological measurements (c-antineutrophil cytoplasmic autoantibody), and the histological confirmation. The early initiation of treatment leads to high rates of remission of an otherwise lethal disease.     

Facial palsy: Interpretation of neurologic findings.

A review of the otoneurologic findings in 500 patients with facial paralysis revealed their importance for diagnosis, prognosis, and understanding the pathophysiology of Bell's palsy. Diagnosis. The presence of simultaneous bilateral palsy, facial paralysis associated with lateral rectus palsy, slowly progressive facial weakness with or without hyperkinesis, and facial paralysis that showed no recovery after six months excluded Bell's palsy from the diagnosis. Ipsilateral recurrent palsies were another indication to suspect an underlying cause, since a tumor of the facial nerve caused the paralysis in 30% of the patients with this finding. Signs such as intact forehead movement, alterations in facial sensation, and corneal hypesthesia — although often associated with lesions in the cerebral cortex, cerebellopontine angle, or internal auditory canal — were also found in patients with Bell's palsy. Prognosis. A spontaneous complete recovery following Bell's palsy occurs in about 70% of the patients; but in the presence of a dry eye or dysacousis, the prognosis for a complete recovery drops to 10 and 25%, respectively. Pathophysiology. It is proposed that the wide range of neurologic findings associated with Bell's palsy is due to a viral polyneuropathy. This is a disorder that primarily involves sensory nerves, and the facial motor deficit results from involvement of the sensory fibers carried with the facial nerve within the fallopian canal.     

Facial palsy and regional trauma

A 28 year old female with Melkersson-Rosenthal syndrome developed an acute, peripheral facial paralysis following mucosal biopsy of the ipsilateral upper lip. The sole, previous facial palsy had occurred 24 years earlier. Immunological and virological studies were non-contributory. The occurrence of facial palsy secondary to regional trauma is briefly reviewed, and the possible influence of autonomic dysfunction discussed.     

Facial palsy in acute otitis media

During the 17-year period from 1977 to 1994 a total of 23 patients in Copenhagen County were admitted to hospital with facial palsy, developed during acute otitis media. This corresponds to an annual incidence of 2.3 per million inhabitants. In the pre-antibiotic era it was estimated that 0.5% of patients with acute otitis media developed facial palsy. Our figures indicate a decrease of this complication by a factor of 100, to 0.005%. Although fourteen of the patients were children, the risk of an acute otitis media being complicated by facial palsy seems to be highest in adults (who have a low incidence of acute otitis media). All the children were ≤3 years of age and 2/3 of the adults ≥50 years of age. Complete remission was seen in all patients, except one. The time interval to complete remission was correlated significantly with the degree of the facial palsy on admission, as it was longest in the most severe facial palsies.     

Facial palsy: Bell's versus parotid vascular malformation: Case report

The occurrence of facial paralysis in a patient with a parotid vascular malformation is reported. Topographic diagnostic tests suggested a lesion in the tympanomastoid portion of the nerve. Subsequent surgical exploration confirmed the benign nature of the parotid mass. Although extremely rare, in view of the possible relationship of the parotid lesion with the facial paralysis, the authors suggest that this case be classified as peripheral facial paralysis associated with a benign parotid vascular anomaly.     

Facial palsy following stapedectomy: (a case report)

A case of peripheral facial palsy which appeared 8 days following ipsilateral stapedectomy, was diagnosed as Bell's palsy. We stress the uncommon coincidence of the two events and the important implications in the treatment of a palsy appearing after middle ear surgery. Bell's palsy is an unusual but real possibility which should be borne in mind before deciding on extended surgical exploration.     

Facial palsy after neck arteriovenous fistula embolization

Facial palsy after embolization of neck arteriovenous fistula is an extremely rare complication. In our case, complete facial palsy occurred after embolization and was successfully treated with superficial parotidectomy, vessel ligation, and plug removal. We report the first case of unusual facial palsy that developed 13 days after neck arteriovenous fistula embolization. As a result of our findings, we recommend, when a patient suffers from acute ipsilateral facial palsy after arteriovenous fistula embolization, the clinician should consider the possibility of complications of embolization, and immediate and appropriate management should be performed. Laryngoscope, 125:2125–2128, 2015