1/48. Alternating Bell's palsy associated with diabetes mellitus. A report of four cases.Four diabetic patients are presented with alternating facial palsy. The term alternating is meant to imply facial nerve paralysis, the onset of which occurs at different points in time on both sides of the face. Clinical findings are presented and a short review of the literature is summarized. The authors conclude that alternating facial palsy is often associated with diabetes mellitus. Alternating facial palsy is an infrequent finding. This is in marked contrast to the unilateral form. Approximately every 13 minutes someone in the united states incurs idiopathic facial paralysis or Bell's palsy (20 persons per 100,000 per year). It is apparent that the majority of unilateral facial palsies fall into the idiopathic category. The alternating form of facial paralysis, however, appears to be an unusual finding in a symptom complex of several diseases which will be discussed. It is the diagnostic significance of this alternating facial paralysis and its occasional association with diabetes mellitus that prompts this report.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/48. endolymphatic sac tumor: a case report.Papillary tumors of the temporal bone are aggressive neoplasms which may occur sporadically or as a part of von hippel-lindau disease. The term 'endolymphatic sac tumor' identifies the origin of these rare tumors. The clinical manifestations are sensorineural hearing loss, facial paralysis, cerebellar disorders and vertigo. The tumor is locally invasive, destructive and hypervascular exhibiting consistent imaging and histopathologic features. The treatment of choice is the total removal of the lesion although complete excision of the advanced lesion is nearly impossible due to the anatomic complexity of the endolymphatic sac and distinct patterns of extension. We present a 50-year-old male patient with endolymphatic sac tumor with left sided sensorineural hearing loss and review the literature.- - - - - - - - - - ranking = 6.9432092713841keywords = neoplasm, complex (Clic here for more details about this article) |
3/48. facial paralysis with an inflammatory parotid mass.facial paralysis in association with a parotid mass is usually associated with a diagnosis of malignancy. Benign parotid neoplasms and inflammatory processes resulting in facial paralysis are extremely rare. This report describes such a case and highlights some of the difficulties surrounding the diagnosis and management of these cases.- - - - - - - - - - ranking = 5.9432092713841keywords = neoplasm (Clic here for more details about this article) |
4/48. Functional reconstruction of the lateral face after ablative tumor resection: use of free muscle and musculocutaneous flaps.BACKGROUND: Wide resection of tumors of the middle third of the face often results in complex three-dimensional defects and facial paralysis either due to removal of the facial nerve within the tumoral tissue or to extensive resection of the facial muscles. methods: We report the cases of three patients who underwent wide excision of tumors of the cheek region, operations that resulted in tissue defects and facial palsy. Defect reconstruction and facial reanimation was accomplished in one stage through functional muscle transplantation. RESULTS: Follow-up of more than 1 year showed good symmetry at rest and reanimation of the corner of the mouth in all cases, but one patient, in which the ipsilateral facial main trunk was used as motor nerve supply to the transplanted muscle, developed significant muscle contracture and binding of the cheek skin. CONCLUSIONS: Every effort should be made to optimize the functional and cosmetic outcomes of neurovascular muscle transfers through precise planning and careful execution of the intricate details of the surgical technique for muscle transplantation.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/48. Bilateral peripheral facial palsy secondary to lymphoma in a patient with hiv/AIDS: a case report and literature review.Neurological complications represent one of the most important causes of morbidity and mortality in patients with hiv/AIDS. However, peripheral neuropathy comprises only 5% to 20% of the total neurological complications and facial nerve palsy, especially when it is bilateral, is a less common manifestation. Peripheral facial palsy has been considered as a possible neurological complication of the early stage of hiv infection but the number of reported cases in the literature is limited. Histological findings of nervous tissue in peripheral facial palsy at an early stage of hiv infection include a degenerative and not suppurative inflammatory process, but its etiology remains obscure. Peripheral facial palsy in the late stage of hiv infection is characterized by an advanced immunological deficit and generally it is secondary to an opportunistic infection of the CNS, such as neurotoxoplasmosis and lymphoma. However, this peripheral attack of the facial nerve is not very common at this late stage of hiv infection. Bilateral peripheral facial palsy as a complication of non-Hodgkin s lymphoma is considered an extremely rare entity. There are no published reports of bilateral peripheral facial palsy secondary to lymphomas or other neoplasms of the CNS in immunosuppressed patients. Non-Hodgkin s lymphoma (NHL) has been considered a late and relatively common manifestation of hiv infection, but an exact cause for the higher incidence of this malignant neoplasm in hiv/AIDS patients is still uncertain.- - - - - - - - - - ranking = 11.886418542768keywords = neoplasm (Clic here for more details about this article) |
6/48. facial paralysis caused by malignant skull base neoplasms.OBJECT: bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis. methods: The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 and September 2001 and who presented with acute facial nerve paralysis mimicking bell palsy. All patients were subsequently found to harbor an occult skull base neoplasm. A delay in diagnosis was demonstrated in all cases. Seven patients died of their disease, and four patients are currently free of disease. CONCLUSIONS: Although bell palsy remains the most common cause of peripheral facial nerve paralysis, patients in whom neoplasms invade the facial nerve may present with acute paralysis mimicking bell palsy that fails to resolve. Delays in diagnosis and treatment in such cases may result in increased rates of mortality and morbidity.- - - - - - - - - - ranking = 35.659255628304keywords = neoplasm (Clic here for more details about this article) |
7/48. Recurrent facial palsy occurring with metastatic thymic carcinoid and nonarteritic ischemic optic neuropathy.A 74-year-old man was diagnosed with thymic carcinoid metastatic to the mediastinum. Two years later, he developed left and then right facial palsy. Four additional episodes of facial palsy developed within 2 years, followed by an occurrence of nonarteritic ischemic optic neuropathy. While recurrent facial palsy is uncommon, it may occur in the presence of various systemic conditions such as carcinoid, diabetes, infection, and neoplasm. The presence of recurrent facial palsy logically warrants an evaluation for systemic disease.- - - - - - - - - - ranking = 5.9432092713841keywords = neoplasm (Clic here for more details about this article) |
8/48. Candidal abscess of the parotid gland associated with facial nerve paralysis.facial nerve paralysis associated with parotid gland mass is usually caused by malignant neoplasms and facial nerve dysfunction due to parotid infection is exceedingly rare. A review of the literature revealed approximately 15 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess. We report the first case of candidal abscess of the parotid gland associated with facial nerve paralysis in a 74-year-old insulin-dependent diabetic patient. The differential diagnosis in these unusual cases occurring in diabetic, immunodeficient patients should include candida albicans infection.- - - - - - - - - - ranking = 5.9432092713841keywords = neoplasm (Clic here for more details about this article) |
9/48. Reconstruction of complex parotidectomy defects using the lateral arm free tissue transfer.OBJECTIVES: The study goal was to show that the lateral arm flap is a viable reconstructive option for complex parotidectomy defects.Study design and setting We studied a case series at a tertiary care medical center from March 1997 to March 2002. The lateral arm flap was used to reconstruct parotidectomy defects that included a composite resection of adjacent tissue in 30 patients. There were 19 men and 11 women (mean age, 62 years; mean follow-up, 19 months). The mean flap area was 114 cm(2), and the mean flap volume was 172 cm(3). The posterior cutaneous nerve of the forearm (PCNF) was used as a facial nerve cable graft in 14 patients. Facial disability outcomes were measured using the Facial Clinimetric Evaluation scale. RESULTS: The major and minor complication rates with use of this reconstructive approach were low: 16.7% (5 of 30) and 26.7% (8 of 30), respectively. Donor site morbidity was minimal, with no patient having a major donor site complication and 23.3% (7 of 30) having minor complications. Functional recovery of the facial nerve occurred in 6 of 8 evaluable patients who underwent facial nerve grafting using the PCNF. Controlling for degree of facial nerve paralysis, Facial Clinimetric Evaluation scale scores of our patients were not statistically different than those of a historic population with a facial paralysis and no surgical defect. CONCLUSIONS: The lateral arm free flap effectively restores facial appearance when used for reconstruction of complex parotidectomy defects. The PCNF, a nerve harvested with the lateral arm flap, can be used as a facial nerve cable graft with a high rate of success. SIGNIFICANCE: The lateral arm flap is successful as a single donor site for reconstructing facial contour and the facial nerve after major ablative defects in the parotid region.- - - - - - - - - - ranking = 6keywords = complex (Clic here for more details about this article) |
10/48. 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 = 6keywords = complex (Clic here for more details about this article) |
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