Outcomes of recurrent facial palsy in Melkersson Rosenthal syndrome.

OBJECTIVE: The objective of the study was to investigate outcomes of recurrent facial palsy in Melkersson Rosenthal syndrome (MRS). METHODS: We carried out a prospective investigation on patients who had recurrent facial palsy in MRS and visited an outpatient department of otolaryngology from January 2002 to January 2012, focusing on their facial nerve outcomes. They were followed up for 12 months. The patients who visited our department due to recurrent Bell's palsy during the same period were selected as controls. Oral prednisolone alone was given to each patient. RESULTS: A total of 22 patients with recurrent facial palsy in MRS and 73 patients with recurrent Bell's palsy were included in the study. Twelve months later, only 3 of 22 patients (13.6%) who had recurrent facial palsy in MRS recovered to House-Brackmann grade I, whereas 52 of 73 patients (71.2%) who had recurrent Bell's palsy recovered completely. The difference was statistically significant (P<.01). CONCLUSION: Compared to recurrent Bell's palsy, recurrent facial palsy in MRS had much worse prognosis.

Subtotal facial nerve decompression in preventing further recurrence and promoting facial nerve recovery of severe idiopathic recurrent facial palsy.

The objective of the study is to document the role of subtotal facial nerve decompression in preventing further recurrence and promoting facial nerve recovery of severe idiopathic recurrent facial palsy. Twenty-two cases with idiopathic recurrent facial palsy, which had over 95% degeneration of facial nerve on electroneurography, were included in the study, among which 12 accepting subtotal facial nerve decompression were involved in surgery group, and 10 who refused surgery and received prednisolone were classified into control group. The recurrence of facial palsy and facial nerve recovery was compared. The patients were followed up for 5.3 years (range 3-8 years) and 5.2 years (range 3-7 years) in surgery group and control group, respectively. Further recurrence of facial palsy occurred in none of 12 patients (0%) in surgery group in contrast to 4 of 10 cases (40%) in control group, with statistical difference (p < 0.05). 11 of 12 cases (91.7%) in surgery group recovered to Grade I or Grade II compared to 3 of 10 cases (30.0%) in control group, with significant difference (p < 0.05). Subtotal facial nerve decompression is effective to prevent further recurrence of facial palsy and promote facial nerve recovery of severe idiopathic recurrent facial palsy.

Neurolymphomatosis diagnosed after a recurrence of facial palsy.

Neurolymphomatosis (NL) is a rare complication of non-Hodgkin's lymphoma, characterized by the infiltration of lymphoma cells into the peripheral nerves. A 54-year-old woman initially presented with right facial palsy without any other significant symptoms and was diagnosed with Bell's palsy. Despite initial improvement, her condition recurred, prompting further evaluation. Magnetic resonance imaging (MRI) revealed contrast enhancement from the tympanic segment to the surface of the masseter muscle along the right facial nerve and an adjacent mass lesion. Biopsy of the mass revealed a diagnosis of T-cell/histiocyte-rich large B-cell lymphoma. Chemotherapy resulted in complete resolution of facial palsy. Follow-up MRI confirmed the absence of contrast enhancement along the facial nerve. Facial palsy was considered to be caused by NL. This case was classified as that of primary NL because the facial palsy was the first manifestation of a hematologic malignancy. Recurrent facial palsy, which is atypical in Bell's palsy, led to further evaluation with MRI, which finally resulted in the diagnosis of malignant lymphoma. In cases of recurrent facial palsy, clinicians should consider various diagnoses, including that of NL, and advocate early imaging tests and biopsy, if possible, for accurate diagnosis and improved outcomes.

Endoscopic trans-canal facial nerve decompression in Melkersson-Rosenthal syndrome: A novel approach.

Key Clinical Message: Melkersson-Rosenthal syndrome can cause recurring bilateral facial paralysis. When steroids fail, surgical decompression of facial nerve is recommended, with endoscopic trans-canal decompression as a safe, minimally invasive, and effective option. Abstract: Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder, clinically diagnosed by a triad of orofacial swelling, recurrent facial palsy, and fissured tongue. Due to the lack of a comprehensive understanding of MRS, there is no accepted standard of care. In this study we report a 30-year-old female patient, who was referred to the otolaryngology clinic of Rasool Akram Hospital, with classical triad of MRS that was managed by endoscopic trans-canal facial nerve decompression. Bilateral endoscopic trans-canal facial nerve decompression was done when we did not find any improvement with systemic steroids. Endoscopic trans-canal facial nerve decompression could be a safe, reliable minimal invasive treatment of facial paralysis in MRS patients. It needs no external incision or temporal bone drilling which makes this method more convenient for patients with shorter recovery time.

Management Strategies of Melkersson-Rosenthal Syndrome: A Review.

Melkerrson-Rosenthal syndrome is a rare disorder of unknown aetiology and characterized by the triad of oro-facial edema, facial nerve palsy, and furrowing of the tongue. Two or more of the above are essential for making a clinical diagnosis. The mainstay of treatment is corticosteroids. Intralesional triamcinolone acetonide may be used for the treatment of oro-facial edema. Another treatment option for oro-facial edema includes intralesional betamethasone, along with oral doxycycline. The review discusses the management strategies in Melkersson-Rosenthal syndrome.

Total facial nerve decompression in severe idiopathic recurrent facial palsy: its long-term follow-up results.

Background: The long-term outcomes of total facial nerve decompression (TFND) in severe idiopathic recurrent facial palsy (IRFP) are still unknown. Aims/objectives: To explore the long-term follow-up results of TFND in IRFP. Materials and methods: Twenty-eight patients suffering from severe IRFP were enrolled. Patients were offered conventional therapy or TFND and were categorized into control or operation group. The follow-up lasted for at least 6 years. Comparison was made in terms of relapse of facial palsy as well as outcomes of facial nerve. Results: There were 16 participants in operation group, whose follow-up lasted for 10.4 ± 1.3 years. In contrast, there were 12 participants in control group, who were followed up lasted for 11.2 ± 1.2 years. No participants suffered relapse in the operation group while seven out of 12 participants (58.3%) encountered relapse with regard to control group (p < .05). In terms of facial nerve results, 16 out of 18 participants (88.9%) reached satisfactory outcomes of facial nerve (HB grade I or II) while only four out of 12 participants (33.3%) achieved satisfactory outcomes in control group (p < .05). Conclusions and significance: In terms of severe IRFP, TFND can defend patients from relapse in a long period, and enhance recovery of facial nerve.

Recurrences of Bell's palsy.

INTRODUCTION: Bell's palsy in known as the most common cause of facial paralysis, determined by the acute onset of lower motor neuron weakness of the facial nerve with no detectable cause. With a lifetime risk of 1 in 60 and an annual incidence of 11-40/100,000 population, the condition resolves completely in around 71% of the untreated cases. Clinical trials performed for Bell's palsy have reported some recurrences, ipsilateral or contralateral to the side affected in the primary episode of facial palsy. Only few data are found in the literature. Melkersson-Rosenthal is a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue (lingua plicata), orofacial edema. PURPOSE: We attempted to analyze some clinical and epidemiologic aspects of recurrent idiopathic palsy, and to develop relevant correlations between the existing data in literature and those obtained in this study. METHODS & MATERIALS: This is a retrospective study carried out on a 10-years period for adults and a five-year period for children. RESULTS: A number of 185 patients aged between 4 and 70 years old were analyzed. 136 of them were adults and 49 were children. 22 of 185 patients with Bell's palsy (12%) had a recurrent partial or complete facial paralysis with one to six episodes of palsy. From this group of 22 cases, 5 patients were diagnosed with Melkersson-Rosenthal syndrome. The patients' age was between 4 and 70 years old, with a medium age of 27,6 years. In the group studied, fifteen patients, meaning 68%, were women and seven were men. The majority of patients in our group with more than two facial palsy episodes had at least one episode on the contralateral side. CONCLUSIONS: Our study found a significant incidence of recurrences of idiopathic facial palsy. Recurrent idiopathic facial palsy and Melkersson-Rosenthal syndrome is diagnosed more often in young females. Recurrence is more likely to occur in the first two years from the onset, which leads to the conclusion that we should have a follow up of patients diagnosed with Bell's palsy for at least two years from the onset, especially in children' case. The frequency of recurrent facial palsy in children was similar to that in adults. Recurrent idiopathic facial palsy is not known enough and needs further controlled studies.