Acute peripheral facial palsy: Is there a trigeminal nerve involvement?

The aim of this study was to investigate trigeminal nerve involvement in patients with peripheral facial palsy. In total, 25 patients with facial nerve palsy and 19 controls were tested by electrophysiological methods regarding their facial and trigeminal nerve functions within 1 month after disease onset. The presence of an abnormal blink reflex was determined in patients with peripheral facial palsy by comparing paralytic and non-paralytic sides (12.3 ± 1.1 and 10.8 ± 1.3, respectively; p = 0.001). However, the average masseter inhibitory reflex difference between the paretic and non-paralytic sides of patients compared with the corresponding side-to-side comparison for controls was not statistically significant. The masseter inhibitory reflex response was abnormal in some cases. These findings suggest that the masseter inhibitory reflex, a trigemino–trigeminal reflex, was normal in most of our patients with peripheral facial palsy, but may be abnormal in individual cases. Our study showed that subclinical disorders affecting the trigeminal pathways occur in individual patients with idiopathic facial palsy, while the majority of patients have no trigeminal nerve involvement.     

特发性面神经麻痹病变部位与神经电生理检测关系探讨

目的：探讨特发性面神经麻痹病变部位与电生理检测结果的关系。方法：对发病20d内的109例特发性面神经麻痹患者,根据临床表现进行面神经病变定位,分为4个组：膝状神经节病变组、面神经管镫骨神经以上病变组、面神经管镫骨神经以下病变组、茎乳孔以外病变组,并行面神经电生理检查,各组数据进行统计学处理。结果：109例患者中膝状神经节病变组15例,面神经管镫骨神经以上病变组21例,面神经管镫骨神经以下病变组38例,茎乳孔以外病变组35例;患侧瞬目反射、面神经复合肌肉动作电位（CMAP）潜伏期、波幅及患侧波幅下降比、F波消失率各组比较差异有统计学意义。结论：面神经麻痹电生理指标波幅下降比、瞬目反射、F波与其病变部位有关。     

Anatomical consideration of the temporal bone as a pathogenesis of Bell's palsy

Much controversy surrounds the etiology and management of Bell’s palsy, and the pathogenetic mechanisms underlying Bell’s palsy remain obscure despite the extensive body of relevant research. The pathological condition of Bell’s palsy is almost an inflammatory reaction compressing the facial nerve in the fallopian canal, particularly in the narrowest labyrinthine segment, followed by demyelinating neural change. As one of the best method for the visualization of the inflamed facial nerve in the intratemporal segment, temporal bone CT enable us not only to measure the exact length and thickness of individual segments of the facial nerve canal but also to view variable anatomic variations in the intratemporal facial canal. Some suggest that anatomical variation may predispose the nerve to inflammatory processes and also there can be peculiar structures of the temporal bone that are vulnerable to inflammation or neural compression injury.     

Somatosensory eye blink reflex in peripheral facial palsy

To investigate the association between somatosensory blink reflex (SBR) and peripheral facial palsy (PFP) severity and trigeminal blink reflex (BR) changes in cases with PFP and subsequent postparalytic facial syndrome development (PFS). One hundred and twenty subjects with peripheral facial palsy and post-facial syndrome and 44 age and gender matched healthy volunteers were enrolled to this study. Blink reflexes and somatosensory blink reflex were studied in all. The association between R1 and R2 responses of the BR and SBR positivity was investigated. SBR was elicited in 36.3% of normal subjects, in 18.3% of PFP and in 65.3% of PFS patients. In the paralytic side, the frequency of SBR positivity was significantly lower in PFP group compared to controls and SBR was most frequently observed in patients with PFS. Compared to PFP and control groups, SBR positivity on the non-paralytic side significantly revealed a higher rate in PFS patients. SBR positivity of patients in whom R1 or R2 were absent, was significantly lower than those subjects with prolonged or normal R1 or R2 responses. PFP and successive PFS are good models for the sensory motor gate mechanisms and/or excitability enhancement of brainstem neurons responsible for SBR.     

Goldenhar's Syndrome (oculo-auriculo-vertebral dysplasia) with congenital facial nerve palsy

Goldenhar's Syndrome (oculo-auriculo-vertebral dysplasia) is a wide spectrum of congenital anomalies that involves structures arising from the first and second branchial arches. In this report, a case of a male infant, with the features of hemi facial microsomia, anotia, vertebral anomalies, congenital facial nerve palsy and lagophthalmos is described. Although the syndrome itself is not uncommon, the presence of congenital facial nerve palsy, which has been reported in rare cases, prompted this case report.     

Presurgical electrophysiological findings in acoustic nerve tumours.

The clinical involvement of the facial nerve is a rare finding among the initial symptoms of acoustic neurinomas. However, compression of the facial nerve is a common intraoperative finding. Blink reflex was recorded in 20 patients affected by cerebellar-pontine angle tumor confirmed at surgery. Recordings were also made of the M-response of the facial nerve from the naso-labial folds. In 6 cases jaw reflex was also recorded. In summary, these electrophysiological studies revealed a facial nerve damage in 13 and a trigeminal nerve dysfunction in 2 out of 18 clinically unaffected patients. The combined study of the 3 tests proved to be useful when the blink reflex showed an isolated R1 delay, that is, in cases in which the level of damage along the trigemino-facial reflex arc cannot be defined by the recording of the blink reflex alone.     

Electrophysiological findings of acute peripheral facial palsy in diabetic and non-diabetic patients

The aim of this study is to investigate the role of diabetes mellitus on the clinical and electrophysiological findings of peripheral facial palsy (PFP), the effect of the diabetes duration and polyneuropathy on the electrophysiological parameters. A total of 32 diabetic and 40 non-diabetic patients with peripheral facial palsy were included. All patients were divided into two subgroups based on the time of electrophysiological examinations: within the first 15 days versus within 16–30 days. Neuropathy symptoms and the results of neurological examinations and electrophysiological findings were recorded. The findings of electroneurography (EnoG), blink reflex (BR) evaluation, and needle electromyography (EMG) indicated statistically significant blink reflex abnormalities in diabetic patients compared to non-diabetics. Delay in the latency was more remarkable in the R2 component than in the R1 (p < 0.001). The delay in the R1 latency was also observed in the non-affected side for diabetic patients. The longer duration of the diabetes caused significant delay on the blink reflex latency on both the affected and non-affected sides for R1 component (p = 0.019, p = 0.041, respectively). In contrary, neither the diabetes duration nor the age of the patients correlated with the clinical severity of facial palsy, fiber loss, fibular nerve compound muscle action potential amplitudes, and the nerve conduction velocities.     

Brainstem evaluation in children with primary nocturnal enuresis

We investigated the brainstem integrity in children with primary nocturnal enuresis (PNE) using auditory brainstem responses (ABR), blink reflex and exteroceptive suppression of the masseter muscle. We examined 23 children with PNE (16 male, 7 female; mean age: 10.4 years) and 19 control subjects (11 male, 8 female; mean age: 11.8 years). ABR parameters such as wave latencies, amplitudes and interpeak latencies and blink reflex parameters such as R1 and R2 amplitude and latencies were not significantly different between the 2 groups. Although S2 parameters of the exteroceptive suppression of the masseter muscle were easily and completely obtained from the control subjects, in the PNE group S2 onset latency and duration were not recorded in 26% of the study children (n = 6) (P = 0.01). S2 duration time was significantly lowered in the enuretic group (left side: P = 0.001 and right side: P = 0.003). S2 duration time changes in the enuretic group supports a possible brainstem dysfunction in children with PNE.     

Metastatic hepatocellular carcinoma presenting as facial nerve palsy and facial pain

Facial nerve palsy due to temporal bone metastasis of hepatocellular carcinoma (HCC) has rarely been reported. We experienced a rare case of temporal bone metastasis of HCC that initially presented as facial nerve palsy and was diagnosed by surgical biopsy. This patient also discovered for the first time that he had chronic hepatitis B and C infections due to this facial nerve palsy. Radiation therapy greatly relieved the facial pain and facial nerve palsy. This report suggests that hepatologists should consider metastatic HCC as a rare but possible cause of new-onset cranial neuropathy in patients with chronic viral hepatitis.     

Acute facial paralysis due to primary squamous cell carcinoma of the parotid gland

The incidence of primary squamous cell carcinoma in salivary gland tumours is rare. The first presenting symptom of a salivary gland tumour is usually a painless lump. Acute facial paralysis is uncommon to be the initial presentation. This case report describes a patient of acute facial paralysis due to primary squamous cell carcinoma of parotid gland who was initially incorrectly labelled as a case of Bell's palsy. He was managed successfully with total parotidectomy, neck dissection, facial nerve sacrifice with immediate cable graft reconstruction and fascia lata sling followed by postoperative radiotherapy. The sacrifice of the extra-temporal part of the facial nerve in rare cases can be unavoidable during parotid resections for malignancy when the nerve is grossly involved by the tumour. It is important in this situation that some form of nerve repair and/or facial rejuvenation is undertaken to avoid the unpleasant sequele of facial paralysis. His postoperative facial symmetry improved at rest and one year later he regained satisfactory eye closure and smile. Not all facial paralysis is Bell's palsy. All patients who are labelled as Idiopathic facial paralysis or Bell's palsy should have adequate clinical evaluation with detailed history and proper physical examination.     

Sclerosteosis: report of a case in a black African man

Sclerosteosis is a rare genetic disorder of bone modelling, similar to, but distinct from, van Buchem disease; it has been described almost exclusively in Afrikaners of South Africa, a white population of Dutch ancestry. Isolated cases have been reported in a girl in Japan, a boy in Spain, and in multiracial families in Brazil and USA.
Here we report a case of sclerosteosis in a black man born in Senegal. He presented with the full features of the disease: tall stature; syndactyly; nail dysplasia; massive sclerosis of the long tubular bones, the ribs, the pelvis and the skull; multiple cranial nerve involvement: optic atrophy, facial palsy and trigeminal neuralgia. Radiologic examination, visual and brainstem auditory evoked potentials, computerized tomography and magnetic resonance imaging of the skull were performed. This seems to be the first case of the disease in a black African individual, with no known relationship with Dutch ancestry.     

偏头痛患者发作期脑干听觉诱发电位和瞬目反射检测

目的：观察偏头痛患者发作期脑干听觉诱发电位(BAEP)和瞬目反射(BR)改变。方法：对45例偏头痛发作期患者进行BAEP、BR检测。结果：BR和BAEP联合检测提示脑干病变者31例，占69％；BAEP、BR检测提示听神经、三叉神经传入通路功能障碍和面神经传出通路功能障碍共26例，占58％，其中三叉神经传入通路障碍21例，占81％。结论：偏头痛发作期存在着以脑干和三叉神经为主的神经功能障碍．与血管舒缩功能障碍很可能互为因果、相互影响。     

椎基底动脉供血不足和脑干梗死患者的瞬目反射检测

目的：探讨瞬目反射(BR)对椎基底动脉供血不足(VBI)及脑干梗死的临床应用价值。方法：用表面电极刺激三叉神经眶上支，在双侧眼轮匝肌进行记录。对BR异常者治疗1、3、6个月后复查。结果：VBI组80例治疗前BR异常者58例(72．5％)，治疗一个月后复查BR恢复正常者39例，BR正常或治疗后恢复正常者近期都能获得基本痊愈，而BR持续异常者则预后较差。脑干梗死组26例，：BR全部异常且异常程度重于VBI组。结论：在对VBI及脑干梗死诊断、疗效观察及预后评价中，BR是一项极为客观有用的指标。     

Excitability recovery curves of blink reflexes in patients with athetotic cerebral palsy

We evaluated the brainstem function or its excitability by the blink reflex evoked with the electrical stimulation to the supraorbital nerve in 10 patients with athetotic cerebral palsy compared with 10 normal subjects and 7 spastic type patients. There were no differences in stimulus intensity, latency of R1 and R2 components, and duration and area of EMG activity of the R2 component of the blink reflex elicited by single stimulation among the two patients' groups and normal subjects. R1 recovery cycle to paired stimuli in the athetotic group showed a facilitation of the test responses by the conditioning stimuli at 100 and 200 ms intervals, but were not significantly different from those in the normals. On the other hand, the R2 recovery curve in the athetotic group showed a significant hyperexcitability at all intervals from 100 to 600 ms compared to the normals. Our results from the R2 hyperexcitable recovery to paired stimuli are indicative of increased brainstem interneuronal excitability in athetotic patients and similar to the results reported in the disorders of the basal ganglia, i.e. Parkinson's disease, dystonia and blepharospasm. We suggest that this hyperexcitability might be caused by abnormal input possibly from the basal ganglia upon these brainstem interneurons.     

Prepulse modulation of the startle reaction and the blink reflex in normal human subjects

Blink reflexes are usually considered the most representative and consistent response of the auditory startle reaction (ASR), and they are often the only response evaluated in human psychophysiological studies. However, auditory stimuli also induce an auditory blink reflex (ABR), the physiological characteristics and brainstem circuitry of which may be different from those of the ASR. This study aimed to investigate whether there were differences between the orbicularis oculi (OOc) responses elicited with the ABR (OOcABR) and those elicited with the ASR (OOcASR) regarding their behavior to prepulse modulation. For comparison, we also examined the OOc responses to supraorbital nerve stimulation (OOcEBR). Electromyographic responses were simultaneously recorded from the OOc, masseter (MAS) and sternocleidomastoid (SCM) muscles. ABRs were considered when auditory stimuli induced responses limited to the OOc, and ASRs were considered when responses were induced in all muscles recorded from. Prepulse stimuli were either a weak electrical stimulation at the third finger (somatosensory prepulse) or a weak acoustic tone (auditory prepulse) that preceded the response-eliciting stimuli by intervals ranging from 0 to 200 ms. Prepulse effects differed according to prepulse modality, but the OOcABR and the OOcASR were always modulated in the same way. In both responses, somatosensory prepulses induced facilitation from 20 to 50 ms, followed by inhibition beyond 75 ms, and auditory prepulses induced no facilitation but a significant inhibition beyond 30 ms. In the OOcEBR, both somatosensory and acoustic prepulses induced facilitation of R1 and inhibition of R2 beyond 30 ms. Our results suggest that the OOcABR and the OOcASR exhibit the same physiological behavior regarding prepulse modulation. It is hypothesized that prepulse facilitation is due to direct impingement of subthreshold excitatory inputs onto the facial motoneurons while prepulse inhibition results from the engagement of a presynaptic inhibitory circuit in the brainstem. Received: 9 October 1998 / Accepted: 29 April 1999     

面神经炎病人神经电生理检查和面肌运动评分的相关性

目的：探讨神经电生理检查和面肌运动功能评分在面神经炎诊断和面肌功能评估中的相关性。方法：选取符合入选标准的面神经炎病人37例,在发病第7、28天分别予以神经电生理检查和面肌运动功能评分。神经电生理检查选用瞬目反射和面神经电图;面肌运动功能评分采用House Brackmann分级量表（HB）评分和Nottingham面神经分级量表评分（选用VMG指数）,比较不同评分标准对面神经炎评估的异同,并应用Pearson相关分析法探讨不同评分标准之间的相关性。结果：与神经电图评分法相比较,瞬目反射评分法和HB评分法更为一致。Pearson相关性分析结果显示VMG指数与HB评分法相关性最强（r=-0．925）,神经电图评分法和HB评分法相关性相对较差。结论：针对面神经炎病人的评估应将面神经运动功能评估和神经电生理学评估结合起来,才能达到最好的客观性和准确性。HB评分、VMG指数联合以瞬目反射为最优指标的神经电生理检测是较为理想、科学的面神经炎的诊断和评估方法,可以较为可信地应用到临床诊治和科学研究工作中。     

Correlation between MRI and operative findings in Bell's palsy and Ramsay Hunt syndrome

PURPOSE: To investigate the correlation between gadolinium enhanced magnetic resonance image (MRI) results and surgical findings of facial nerves in Bell's palsy and Ramsay Hunt syndrome. MATERIALS AND METHODS: From 1995 to 2004, MRI was performed on 13 patients with Bell's palsy or Ramsay Hunt syndrome, who were offered with surgical decompression of the facial nerve through the middle cranial fossa approach. Gadolinium enhanced MRI was performed on all patients and the enhancement of the facial nerve was evaluated by radiology specialists. Operative findings including the degree of the facial nerve segment swelling were examined. Furthermore, the time interval from the onset of palsy to surgery was evaluated. RESULTS: Swelling of facial nerve segments was found in patients with enhanced facial nerves from MRI. The swelling of the facial nerve in the labyrinthine segment in particular was identified in all patients with enhanced labyrinthine segments in MRI. The intraoperative swelling of geniculate ganglion of facial nerve was found in 78% of patients with enhanced facial segment in MRI (p=0.01). The intraoperative swelling of tympanic segment was observed from fourth to ninth weeks after the onset of palsy. CONCLUSION: MRI enhancement of facial nerves in Bell's palsy and Ramsay Hunt syndrome is associated with the extent of intratemporal lesions of facial nerves, especially in the labyrinthine segment.     

Auditory-evoked masseter inhibitory reflex

We aimed to investigate auditory-evoked masseter inhibitory reflex and discuss possible auditory-trigeminal pathways in brainstem. Our study population consisted of 21 healthy volunteers (age-matched 7 males and 14 females). Bilateral electrical blink reflex (BR), auditory blink reflexes (ABR) and electrical MIR (MIR) were studied. After obtaining normal potentials, auditory MIR (AMIR) was studied. Electrical blink reflexes had two components as R1 and R2, and ABR had one evoked potential in all volunteers. There was no significant difference between gender, nor between right- and left-sided BR and ABR. The mean latency of ABR responses were shorter than latencies of R2 phase of BR (p = 0.013 for left-sided responses, p = 0.035 for right-sided responses). Electrical stimulation revealed two suppression periods (SP1 and SP2) in MIR responses bilaterally in all volunteers. Auditory stimulation evoked typical two suppression periods only in 11 subjects (5 males, 6 females). The mean latency of SP1 component of AMIR was significantly longer than those of MIR bilaterally in both males and females, while the SP2 component had a shorter onset. The durations of SP1, SP2 and total SP were always shorter than those obtained in MIR with smaller degree of suppressions. None of the MIR or AMIR responses showed significance difference between sexes. We assume that auditory-evoked MIR might share the similar interneurons as with other electrical or nociceptive stimulation, which connects cochlear-trigeminal neurons via pontine reticular system to premotor area for masseter muscle.     

Inadequacy of transcranial magnetic stimulation in the neurophysiologic assessment of Bell's palsy.

Transcranial magnetic stimulation is a non-invasive procedure which to stimulate the brain cortex and the peripheral nerve pathways. A new technique was recently introduced to record the muscle action potential of facial muscles by means of transcranial magnetic stimulation of the facial nerve. The experimental data that was obtained indicate that this technique allows to stimulate the facial nerve above the stylomastoid foramen: a greater tract of the nerve can therefore be explored than what was possible with the traditional electrical stimulation at the mastoid. Until now no comparison data was available on the clinical usefulness of the two methods. We decided to study 14 normal controls and 26 patients suffering from unilateral idiopathic facial palsy (Bell's palsy) and to submit these two groups to magnetic transcranial stimulation and electrical stimulation of the facial nerve in the mastoid region, to the purpose of observing where the nerve is stimulated by the magnetic impulse and which of the two techniques can be of accurate prognostic value in the study of the evolution of the clinical lesion. The electromyographic responses were elicited by the electrical stimulation at the mastoid and by transcranial stimulation after positioning the coil on the parieto-occipital scalp. A recording was taken from the ipsilateral orhicularis oculi muscle utilising two cupped electrodes. The latency and the amplitude of the compound muscle action potential were measured bilaterally in order to compare the results obtained on both the affected and the healthy sides. The patients were scheduled to two neurophysiological and clinical evaluations at about 30 days interval one from the other: the first test was not carried out before 20 days from the onset of the deficit; further clinical examination was carried out only 6 months later. The analysis of the results obtained in the normal controls submitted to transcranial magnetic stimulation indicate that the nerve is activated at the point where it originates from the brainstem. The study carried out showed that transcranial magnetic stimulation of the facial nerve, does not provide data which can be correlated to the clinical situation observed at the time of the study; furthermore, transcranial magnetic stimulation does not supply any prognostic data on the clinical evolution of the lesion.     

正常学龄儿童瞬目反射的初步研究

应用电刺激法研究４０例正常学龄儿童的瞬目反射。通常能诱发出刺激侧快反应（Ｒ１）、迟反应（Ｒ２）及对侧迟反应（Ｒ２＇）。分析Ｒ１的形态、各波的潜伏期、时程、波幅，制定出正常值。瞬目反对的检查结果可作为诊断多种脑干障碍和三叉神经、面神经病变的方法。