scholarly journals Presentation of Bilateral Facial Paralysis in Melkersson–Rosenthal Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Gustavo Gaitan-Quintero ◽  
Loida Camargo-Camargo ◽  
Norman López-Velásquez ◽  
Miguel González
Keyword(s):  
Facial Paralysis ◽  
Clinical Case ◽  
Sickle Cell Trait ◽  
Granulomatous Inflammation ◽  
Moderate Intensity ◽  
Peripheral Facial Paralysis ◽  
History Of ◽  
The Right ◽  
Classic Symptom ◽  
Fissured Tongue

Introduction. Melkersson–Rosenthal syndrome (MRS) is a neuromucocutaneous disorder characterized by the following classic symptom triad: peripheral facial paralysis, orofacial edema, and scrotal or fissured tongue. It is rare, and since most of the patients are oligo- or monosymptomatic, it makes it difficult to diagnose. Clinical Case. We present a 26-year-old male patient with a history of sickle cell trait, untreated snoring, and left peripheral facial paralysis when he was 11 years old. This was an overall 20-day clinical profile that started with left peripheral facial paralysis, which was accompanied by moderate-intensity occipital pulsatile headaches. Additionally, the patient experienced paresthesias in the tongue and feelings of labial edema. After one week, he manifested peripheral facial paralysis on the right side. Physical examination revealed bilateral peripheral facial paralysis, mild labial edema, and a scrotal or fissured tongue. The patient received corticosteroids, which resulted in improvement of the edema and facial paralysis. Discussion. MRS is a rare disorder that predominantly affects women, typically starting in their 20s or 30s. The etiology is unknown. However, a multifactorial origin that involves environmental factors and a genetic predisposition has been proposed, which causes a dysfunction of the local immune system and autonomic nervous system (ANS) and an appearance of granulomatous inflammation in the lips and tongue. Facial paralysis usually appears later on; however, it can occur from its clinical debut. There are no curative treatments. Therapy is focused on modulating the patient's immune response, and relapses are frequent.

scholarly journals Tuberculosis of the Temporomandibular Region

2018 ◽  
Vol 33 (2) ◽  
pp. 41-44
Author(s):  
Jesusa M. Santos ◽  
Elias T. Reala
Keyword(s):  
Temporal Bone ◽  
Facial Paralysis ◽  
Extrapulmonary Tuberculosis ◽  
Mandibular Condyle ◽  
Mouth Opening ◽  
Granulomatous Inflammation ◽  
Health Seeking ◽  
Initial Symptoms ◽  
The Right ◽  
Osteolytic Destruction

Objective: To describe a unique case of extrapulmonary tuberculosis (TB) of the temporomandibular area focusing on its insidious and destructive course over a 2-year period with insights into the diagnostic and therapeutic pitfalls encountered throughout its clinical development.   Methods:             Study Design:            Case Report             Setting:                       Tertiary Government Hospital             Patient:                       One   Results: A 33-year old man initially presented with right pre-auricular swelling and trismus that were unresponsive to antibiotic therapy. On subsequent follow-ups, initial symptoms were accompanied by a non-healing right pre-auricular wound, right ear discharge, trismus, and right facial paralysis (House-Brackmann III).  Cranial and temporal bone computed tomography scans revealed osteolytic destruction of the right temporomandibular region extending to the auditory canal and of the right mastoid bone extending to the right mandibular condyle and parotid. Infected malignancy of the parotid, mandible and temporal bone were considered, but definitive diagnosis from an incision biopsy revealed caseating granulomatous inflammation consistent with tuberculosis. He was started on anti-tuberculosis medications with significant resolution of pre-auricular swelling, non-healing pre-auricular wound, facial paralysis and ear discharge but minimal improvement in mouth opening.   Conclusion: Tuberculosis of temporomandibular region is rare and is associated with nonspecific manifestations. Delay in diagnosing and initiating appropriate treatment can lead to morbidity and serious complications involving destruction of the temporal bone, middle ear, mandible and parotid gland over its progression. A high index of suspicion by the physician and awareness of the patient’s health seeking behaviors could have aided in the early diagnosis and treatment of this extrapulmonary TB.   Keywords: tuberculosis, temporomandibular region, pre-auricular swelling, trismus, antituberculosis therapy, facial paralysis, chronic mastoiditis, ear discharge  

scholarly journals Bilateral Diffuse Uveal Melanocytic Proliferation Presenting as Small Choroidal Melanoma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
J. N. Ulrich ◽  
S. Garg ◽  
G. K. Escaravage ◽  
T. M. Meredith
Keyword(s):  
Visual Acuity ◽  
Clinical Picture ◽  
Clinical Case ◽  
Radioactive Iodine ◽  
Palliative Chemotherapy ◽  
Choroidal Melanoma ◽  
Orange Pigment ◽  
History Of ◽  
Choroidal Nevus ◽  
The Right

Purpose. To describe a patient with Bilateral Diffuse Uveal Proliferation who presented initially with a clinical picture consistent with choroidal melanoma.Methods. Presentation of a clinical case with fundus photos, fluorescein angiography, and optical coherence tomography.Results. A 70-year-old Caucasian male with history of esophageal cancer presented with an asymptomatic pigmented choroidal lesion in his left eye initially diagnosed as choroidal nevus. This lesion enlarged over the course of a year and developed orange pigment and increased thickness. A metastatic workup was negative, and a radioactive iodine plaque was placed on the left eye. Over the next six months, the visual acuity in his left eye decreased. His clinical picture was consistent with unilateral Diffuse Uveal Proliferation. A recurrence of his esophageal carcinoma with metastasis was discovered and palliative chemotherapy was initiated. Although his visual acuity improved in the left eye, similar pigmentary changes developed in the right fundus. His visual acuity in both eyes gradually decreased to 20/200 until his death a year later.Conclusion. BDUMP should always be considered in the differential diagnosis of patients with pigmented fundus lesions and a history of nonocular tumors.

scholarly journals Adalimumab: Another Medication Related to Osteonecrosis of the Jaws?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Andrea Cassoni ◽  
Umberto Romeo ◽  
Valentina Terenzi ◽  
Marco Della Monaca ◽  
Oriana Rajabtork Zadeh ◽  
...  
Keyword(s):  
Clinical Case ◽  
Biologic Therapy ◽  
Disease Patient ◽  
Osteonecrosis Of The Jaw ◽  
Rank Ligand ◽  
Osteonecrosis Of The Jaws ◽  
Adalimumab Therapy ◽  
Chron's Disease ◽  
History Of ◽  
The Right

Objective.The acronym MRONJ has been created in order to identify “Medication-Related Osteonecrosis of the Jaw,” observed after the use of Bisphosphonates, RANK ligand inhibitor, and antiangiogenic medications. Only a case of osteonecrosis of the jaw in a Chron’s disease patient following a course of Bisphosphonate and Adalimumab therapy has been recently described, so that it has been supposed that also this medication could promote manifestation of osteonecrosis.Clinical Case. On August, 2014, a 63-year-old female with a history of idiopathic arthritis treated with medical treatment with Adalimumab from 2010 to 2013 presented referring pain in the right mandible.Results. This patient presented with nonexposed osteonecrosis of the jaw after placement, on September, 2010, of four titanium fixtures in the mandible.Conclusions. The authors suggest that the biologic therapy with an anti-TNF-αantibody might promote the manifestation of osteonecrosis and compromise oral healing capacity of the bone.

scholarly journals Complete Ramsay Hunt Syndrome: a rare case

2021 ◽  
Author(s):  
Maurus Marques de Almeida Holanda Filho ◽  
Maurus Marques de Almeida Holanda ◽  
Camila Maria Bezerra Holanda
Keyword(s):  
Herpes Zoster ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Rare Case ◽  
Partial Recovery ◽  
Peripheral Facial Paralysis ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome ◽  
Complete Condition ◽  
The Right

Background: Ramsay Hunt syndrome or herpes zoster oticus is a disorder caused by the reactivation of the varicella zoster virus in the geniculate ganglion, a bundle of nerve cells in the facial nerve. Symptoms include acute facial nerve palsy, otalgia, loss of taste in the anterior 2/3 of the tongue, dry mouth and eyes, and erythematous vesicular rash in the ear canal, tongue and / or palate. Objectives and Methods: Describe the case of a male patient, 26 years old, with complete Ramsay Hunt syndrome, reporting pain in the right ear with tinnitus, difficult to close his right eye, odynophagia and pain in the anterior 2/3 of the tongue at right side. Results: On examination, the presence of vesicles with erythema was observed in the region of the right external auditory canal and the ear, as well as on the right palate and tongue. Upon inspection, he had peripheral facial paralysis on the right, associated with loss of taste in the anterior 2/3 of the tongue. The patient was treated with antiviral and corticosteroids, followed for 3 months, obtaining partial recovery from facial paralysis. The anatomy of the facial nerve and its pathophysiology due to the involvement of herpes zoster will be discussed. Conclusion: Ramsay Hunt syndrome is often described as the presence of peripheral facial paralysis and vesicles in the auditory canal and the ear. However, this rare case presented the complete condition with the presence of vesicles on the palate and the tongue.

Recurrent and Progressive Facial Baroparesis on Flying Relieved by Eustachian Tube Dilation

2019 ◽  
Vol 128 (8) ◽  
pp. 778-781
Author(s):  
Tracy Z. Cheng ◽  
David M. Kaylie
Keyword(s):  
Facial Paralysis ◽  
Eustachian Tube ◽  
Balloon Dilation ◽  
Work Related ◽  
Seventh Cranial Nerve ◽  
Commercial Airline ◽  
Appropriate Treatment ◽  
The Face ◽  
History Of ◽  
The Right

Objectives: Facial baroparesis is a rare phenomenon of seventh cranial nerve palsy traditionally reported in divers, with only 11 cases reported in aviation so far. It is important to correctly diagnose facial baroparesis given the differential diagnosis of stroke and decompression disease and offer appropriate treatment for recurrent cases. Methods: The authors present the case of a patient with recurrent and progressive facial baroparesis treated with Eustachian tube balloon dilation. Institutional medical records were reviewed, and analysis of the current literature was performed. Results: A 37-year-old woman experienced recurrent and progressive left facial paralysis on descent from altitude on commercial airline flights, with resolution between flights. The patient flew frequently for work-related trips and for the past 7 years had noted facial paralysis that began with mild asymmetry of the face and progressed to an inability to close her left eye. She denied any otologic symptoms other than ear fullness and pressure causing left otalgia. The right side was not involved. After treatment with Eustachian tube dilation, the patient has been on numerous flights with complete resolution of symptoms. Conclusions: This study presents a rare case of facial baroparesis on commercial flight descent that resolved after left Eustachian tube dilation. Although unilateral facial palsy can be concerning for stroke, a history of ear fullness and pressure may suggest facial baroparesis instead. For recurrent and progressive cases, Eustachian tube dilation should be considered for treatment.

scholarly journals Gerbode defect in a dog

2019 ◽  
Vol 64 (No. 03) ◽  
pp. 138-143
Author(s):  
CF Agudelo ◽  
M Crha ◽  
B Lukač ◽  
Z Yilmaz
Keyword(s):  
Thoracic Trauma ◽  
Clinical Case ◽  
Exercise Intolerance ◽  
Chronic Exercise ◽  
Human Beings ◽  
Rare Finding ◽  
Gerbode Defect ◽  
History Of ◽  
The Right ◽  
Yorkshire Terrier

An intracardiac communication between the left ventricle and the right atrium (Geborde defect) was diagnosed in a 9-year Yorkshire Terrier with a history of chronic exercise intolerance. The history, clinical examination, and diagnostic imaging confirmed the diagnosis and did not reveal evidence of trauma or endocarditis which could lead to this special type of left-to-right shunting. A Gerbode defect is a very rare finding in human beings and animals. In the veterinary literature all reports about this condition were related to thoracic trauma or valvular infection. According to the authors, this would be the first clinical case of congenital Geborde defect in a dog.

The Bicentenary of Bell’s Description of the Neuroanatomical Basis of Facial Paralysis: Historical Remarks

2021 ◽  
pp. 019459982110321
Author(s):  
Giovanna Cantarella ◽  
Riccardo F. Mazzola
Keyword(s):  
Facial Expression ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Royal Society ◽  
Cranial Nerves ◽  
Bell’S Palsy ◽  
Peripheral Facial Paralysis ◽  
History Of ◽  
Historical Remarks

Charles Bell was a talented and versatile Scottish anatomist, neurophysiologist, artist, and surgeon. On July 12, 1821, he reported his studies regarding facial innervation in the essay “On the Nerves,” read before the Royal Society in London. Since then, idiopathic peripheral facial paralysis has been named “Bell’s palsy.” He was the first author to describe the neuroanatomical basis of facial paralysis, in an essay enriched by beautifully self-made illustrations. The aim of this article is to trace the history of Bell’s description of the neuroanatomy of the facial nerve, reexamining his 1821 article, in which he stated that the lower facial expression muscles were dually innervated by both the fifth and seventh cranial nerves. In 1829, he rectified this conclusion, recognizing the exclusive role of the facial nerve, which he defined as the “respiratory nerve.” We offer a tribute to this polymath scientist on the bicentenary of his 1821 publication.

scholarly journals Can COVID-19 Cause Peripheral Facial Nerve Palsy?

2021 ◽  
Author(s):  
Oguz Kadir Egilmez ◽  
Mahmut Emre Gundogan ◽  
Mahmut Sinan Yilmaz ◽  
Mehmet Guven
Keyword(s):  
Facial Paralysis ◽  
Facial Nerve Palsy ◽  
Rt Pcr ◽  
Peripheral Facial Paralysis ◽  
Initial Finding ◽  
Peripheral Facial Palsy ◽  
History Of ◽  
Peripheral Facial Nerve Palsy ◽  
Polymerase Chain ◽  
The Relationship

Abstract Background/Objective: The aim of our study is to evaluate the relationship between peripheral facial paralysis and the patients who had a contact with a Coronavirus Disease 2019 (COVID-19) patient or had COVID-19.Methods: Patients with a history of contact with a COVID-19 patient or having COVID-19 disease, who were admitted to the emergency department for peripheral facial paralysis in the last 6 months were included in the study. Facial paralysis grade at first presentation, treatment modality, treatment duration, post-treatment facial paralysis grade, and additional findings were analyzed.Results: A total of 34 patients, 20 females and 14 males, were included into the study. Nasal-oropharyngeal Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) test taken from patients with a history of contact, and patients having COVID-19 disease were determined as positive in 5 and 3 patients, respectively. Peripheral facial paralysis was detected as an initial finding in 5 of these 8 patients, and paralysis developed in 7 to 12 days after the diagnosis of the COVID-19 disease in the remaining 3 patients. The grade of first admission paralysis did not change in one patient in the (+) group, while improvement was observed in all patients in the (-) group.Conclusion: Neuroinvasive potential of COVID-19 in central and peripheral nervous system was reported in current literature. Our study indicates peripheral facial palsy can also be encountered during the clinical course of COVID-19 and should be considered as a finding of this disease.

scholarly journals The Contribution of Surface Electromyographic Assessment for Defining the Stage of Peripheral Facial Paralysis: Flaccid or Sequelae Stage

2017 ◽  
Vol 22 (04) ◽  
pp. 348-357 ◽  
Author(s):  
Daniele Bernardes ◽  
Ricardo Bento ◽  
Maria Goffi Gomez
Keyword(s):  
Facial Paralysis ◽  
Sensitivity And Specificity ◽  
High Sensitivity ◽  
Cutoff Point ◽  
Control Group ◽  
Electromyographic Activity ◽  
Peripheral Facial Paralysis ◽  
Primary Activity ◽  
Significant Difference ◽  
History Of

Introduction Surface electromyographic activity may not be symmetric, even in subjects with no facial paralysis history. Objective To evaluate the contribution of the index of electromyographic (IEMG) activity in the identification of the two extremes of the facial paralysis course. Methods Thirty-four subjects with unilateral peripheral facial paralysis were selected. A control group was composed of volunteers without a history of facial paralysis. The electromyographic assessment of the facial muscle was performed by placing surface electrodes during movements of the forehead, eyes and lips using MIOTEC equipment, such as the MIOTOOL (Miotec, Porto Alegre, Brazil) software. The electromyographic activity was also recorded in other channels during the primary activity to identify the presence of synkinesis. The statistical analysis was performed using the Statistical Package for Social Sciences for Macintosh (SPSS Inc, Chicago, IL, USA). The IEMG activity was obtained from the division of the electromyographic activity root mean square (RMS) values on both sides. Results There was a statistically significant difference among the groups in all the analyzed indexes. The ocular-oral synkinesis in all patients must be correctly identified (with 100% sensitivity and specificity) using an IEMG activity of 1.62 as a cutoff point. The oral-ocular synkinesis must be correctly identified (93.3% sensitivity and 95.9% specificity) using the IEMG activity of 1.79 as a cutoff point. Conclusion The IEMG activity is below the normal scores in patients in the flaccid stage, whereas patients in the sequelae stage can either show normal values or values above or below the normal scores. The IEMG activity was shown to have high sensitivity and specificity in the identification of synkinesis.

scholarly journals Ramsay Hunt syndrome affecting the vagus nerve with epiglottic ulcers as the first manifestation: a case report

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095227
Author(s):  
Jie Zhang ◽  
Xuemei Wei
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Vagus Nerve ◽  
Facial Paralysis ◽  
Alcohol Intoxication ◽  
Peripheral Facial Paralysis ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome ◽  
Face Pain ◽  
The Right

Ramsay Hunt syndrome involving the vagus nerve is very rare. We herein describe a 53-year-old man who developed severe pharyngeal pain after alcohol intoxication. Antibiotic treatment was ineffective. Laryngoscopy showed an ulcer on the right side of the epiglottis. As the condition progressed, the patient developed hoarseness. He then gradually developed multiple herpes lesions on the right side of the head, face, and neck along with right peripheral facial paralysis. Corticosteroid, analgesic, antiviral, and nutritional nerve therapy resulted in disappearance of the herpes lesions, epiglottis ulcer, pharyngeal pain, and right head and face pain. The facial paralysis slightly improved, but the hoarseness did not improve. The patient was discharged with an unsatisfactory outcome, and he attempted treatment with acupuncture. After 6 months, the right facial paralysis and hoarseness disappeared. Our case emphasizes the importance of early diagnosis and treatment of atypical Ramsay Hunt syndrome as well as timely communication, enhancement of trust, and reduction of disputes between doctors and patients.

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