Bell's palsy in children: relationship between electroneurography findings and prognosis in comparison with adults.

OBJECTIVES: To investigate the correlation between electroneurography (ENoG) findings and the prognosis of Bell's palsy in children compared with adults. METHODS: Twenty-two children and 92 adults with Bell's palsy who underwent ENoG between 8 days and 4 weeks from the onset of symptoms were retrospectively enrolled. The time to maximal recovery and rate of favorable recovery (House-Brackmann grade I or II) was assessed. Children (C) and adults (A) were further subdivided into low (<10%) or high (≧10%) subgroups according to their ENoG values (affected versus unaffected side) at initial evaluation. The numbers in each subgroup were as follows: C-low (n = 8), A-low (n = 21), C-high (n = 14), and A-high (n = 71). RESULTS: Of the 22 children assessed, 2 of the 4 patients who showed a total loss of evoked potentials on the affected side (0% ENoG value) exhibited an unfavorable recovery. The remaining 20 patients achieved a favorable recovery eventually. Patients in group C-low reached a maximal recovery of facial movement significantly later than those in group C-high (p < 0.001). Time to maximal recovery of facial movement in group A-low was later than that in group C-low, although the difference was not statistically significant (p = 0.15). The patients in group A-high reached a maximal recovery significantly later than those in group C-high (p < 0.05). CONCLUSION: Bell's palsy seems to recover earlier in children than adults when matched for severity. The presence of an identifiable response in ENoG, irrespective of its amplitude, may indicate a favorable recovery of facial movement in children.

Utility of elastography for differential diagnosis of benign and malignant thyroid nodules.

OBJECTIVE: 1) To classify the appearance of thyroid nodules displayed on ultrasound elastography; 2) to explore the sensitivity and specificity of this examination for differentiating benign and malignant nodules, with histopathologic analysis as the reference standard; and 3) to evaluate its utility for avoiding unnecessary procedures. STUDY DESIGN: Diagnostic test assessment. SETTING: Community hospital. SUBJECTS AND METHODS: Forty-seven thyroid nodules in 44 consecutive patients were examined with ultrasound elastography. The images we obtained were classified into four patterns. In addition, the mean strain index of the thyroid nodule and that of the sternocleidomastoid muscle were measured, and the nodule-to-muscle strain ratio was calculated. As the reference findings, the presence or absence of calcification, irregular margins, and hypoechogenicity of the thyroid nodules were examined using B-mode ultrasound. RESULTS: Elastography patterns 3 and 4 were predictive of malignancy, with 73 percent sensitivity (95% confidence interval [CI]: 39%-94%) and 64 percent specificity (95% CI: 46%-79%). Additionally, all nodules without calcification and those that presented with patterns 1 or 2 were benign. A strain ratio greater than 1.5 was set as the predictor of thyroid malignancy. This criterion showed 90 percent sensitivity (95% CI: 59%-100%) and 50 percent specificity (95% CI: 33%-67%). CONCLUSION: Although elastography can assist in the differential diagnosis of thyroid nodules, its diagnostic performance is not ideal at present. Further improvements in the technique and the diagnostic criteria are necessary for this examination to provide a useful contribution to diagnosis.

Recovery of facial movement and facial synkinesis in Bell's palsy patients.

OBJECTIVE: We examined the relationship between the time course of development of facial synkinesis in patients with Bell's palsy and the severity of facial nerve damage. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: Thirty-nine consecutive patients with Bell's palsy who developed synkinesis. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Subjects were divided into groups A (electroneurographic [ENoG] value, <10%; n = 31) and B (ENoG value, > or =10%; n = 8). Development of facial synkinesis was assessed based on the appearance of synkinetic potentials from the orbicularis oris muscle on the blink reflex test. Times to appearance of facial synkinesis in groups A and B were compared. The proportion of patients who developed facial synkinesis after complete recovery of facial movement was also assessed in 14 patients whose facial movement recovered completely. RESULTS: The mean time to maximal recovery of facial movement was significantly longer in group A than in group B (p < 0.001), whereas the duration between the appearance of facial synkinesis and the onset of facial paralysis did not differ significantly between the 2 groups (p = 0.72). The proportion of patients who developed facial synkinesis after complete recovery of facial movement was significantly greater in group B than in group A (p = 0.015). CONCLUSION: During the course of recovery from Bell's palsy, the patients with an ENoG value of 10% or greater have a higher risk of developing facial synkinesis after complete recovery of facial movement.

Prediction of the prognosis of Bell's palsy using multivariate analyses.

OBJECTIVES: This study aimed to establish more reliable formulae for predicting the prognosis for patients with Bell's palsy at initial examination. PATIENTS: One hundred four consecutive patients with Bell's palsy whose facial movement was either completely recovered or unchanged for more than 6 months. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Multivariate analyses were performed using the following variables: Age, House-Brackmann score (H-B), electroneuronography (ENoG), nerve excitability test (NET), blink reflex, and stapedial muscle reflex on initial examination. RESULTS: Duration to maximal recovery can be predicted with the adjusted coefficient of 0.51 using H-B, ENoG, stapedial muscle reflex, and NET. Whether complete recovery would be achieved can be predicted with the Nagelkerke coefficient of determination of 0.72 using age, H-B, ENoG, and NET. CONCLUSION: This study suggested that the prognosis of patients who recovered early can be predicted more precisely; however, the prognosis of patients who recovered late and incomplete could not be predicted easily.

+ - Reconstruction of the intratemporal facial nerve using interposition nerve graft: time course of recovery in facial movement and electrophysiological findings.

CONCLUSIONS: Data about the recovery course of facial function after intratemporal facial nerve reconstruction using interposition nerve graft would provide useful information for clinicians to understand the regenerative process of the facial nerve after this type of surgery. It would also enable them to obtain informed consent from the patients by preoperatively explaining the predicted outcome of the postoperative facial paralysis. OBJECTIVE: The purpose of this study was to describe the recovery course of facial movement and electrophysiological findings after intratemporal facial nerve reconstruction using interposition graft. PATIENTS AND METHODS: Five patients who underwent reconstruction of the facial nerve using interposition nerve graft immediately after facial nerve excision during surgery for temporal bone lesions were included in this study. Each patient was evaluated for facial movement (Yanagihara score), blink reflex (BR), and electroneurography (ENoG) preoperatively and postoperatively. RESULTS: Improvement in facial movement began 8-10 months postoperatively. The score then gradually increased, and reached a plateau level by 2 years following surgery. The final score in four of the five patients ranged from 20 to 24 points, while the facial score of one patient only reached 12 points even at 3 years after surgery. All patients demonstrated moderate to severe synkinesis. The reappearance of R1 in BR occurred 7-10 months postoperatively, almost simultaneously with the beginning of recovery of facial movement. The latency of R1 on the operated side became shortened with increasing postoperative time, although it remained considerably longer than that on the unoperated side, even after 2 postoperative years. The onset of recovery of ENoG value (10-12 months postoperatively) was always delayed compared with the actual facial movement recovery and never returned to the level in the unoperated side.

Peritonsillar abscess with parapharyngeal and retropharyngeal involvement: incidence and intraoral approach.

CONCLUSION: This study illustrates common sites of infection seen in peritonsillar abscesses with involvement of the pharyngeal space and retropharyngeal space. Abscesses behind and/or inferior to the tonsil were encountered more frequently than expected. In these cases, the drainage had to be placed in the inferior pole of the tonsil and these types were frequently seen in older patients. OBJECTIVES: The aim of this study was to assess to what extent abscesses spread in patients with peritonsillar abscess and to determine to what extent pus can be drained intraorally. PATIENTS AND METHODS: The clinical charts of 45 patients with peritonsillar abscess involvement of the parapharyngeal space and/or retropharyngeal space were retrospectively reviewed. RESULTS: In 45 cases, 21 patients were diagnosed with the superior type, and we could drain the pus intraorally in 90% of the patients. On the other hand, 24 cases were diagnosed with the inferior type and they were drained intraorally in 58% of the cases.