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Evidence-Based Diagnosis and Management of Facial Nerve Disorders

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 28064

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Special Issue Editors

Dr. Gerd Fabian Volk

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Guest Editor

Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany; Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany
Interests: facial nerve disorders; rehabilitation; functional electrostimulation; ultrasound; electromyography; quantification of nerve regeneration; mri; 3D-imaging; cochlea implants; otorhinolaryngology; vocal fold palsy

Prof. Dr. Steffen U. Eisenhardt

E-Mail Website
Guest Editor

Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
Interests: plastic, reconstructive and aesthetic surgery; hand surgery; Dupuytren's disease

Prof. Dr. Shai M. Rozen

E-Mail Website
Guest Editor

University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
Interests: microsurgery; plastic and reconstructive surgery; reconstructive surgery; aesthetic surgery; microvascular surgery; facial plastic surgery; head and neck surgery; nerve regeneration; surgical flaps; free tissue flaps

Special Issue Information

Dear Colleagues,

With increasing speed, new diagnostic and therapeutic approaches for the management of facial nerve disorders are being published. Many of them have improved decision making, pharmacological and surgical treatment, and the rehabilitation of patients. Unfortunately, there is often a lack of high-quality studies that prove long-term effect or identify subgroups that are of particular benefit. Even a reliable characterization of patients with facial nerve disabilities is often complicated. Therefore, evidence-based management remains challenging.

Novel clinical and technological solutions, such as Patient-Related Outcome Measures (PROMs), telemedicine, 3D motion-capture systems, multi-channel electromyography, ultrasonographic and magnetic resonance imaging, app-based patient follow-up, big-data analysis and machine learning, practice guidelines, or classification based on decision trees, among others, as well as basic research to better understand the pathomechanism might not only enhance our knowledge about impacts of facial nerve disorders, ability to characterize patients, and interventional effects, but might also pave the way towards more evidence-based paradigms.

Therefore, this Special Issue aims to provide an overview of the clinical and technological applications which hold promise to improve diagnosis, clinical characterization, therorecial understanding, and treatment of facial nerve disabilities.

Dr. Gerd Fabian Volk
Prof. Dr. Steffen U. Eisenhardt
Prof. Dr. Shai M. Rozen
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

facial nerve disorders
facial palsy
facial paralysis
facial impairment
non-verbal communications
surgery
rehabilitation
functional electrostimulation
ultrasound
MRI
3D-imaging
machine learning
evidence-based medicine
telemedizin

Published Papers (13 papers)

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Editorial

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2 pages, 166 KiB

Open AccessEditorial

Special Issue: Evidence-Based Diagnosis and Management of Facial Nerve Disorders

by Gerd Fabian Volk, Caroline Cora Kraus, Steffen U. Eisenhardt and Shai Rozen

Diagnostics 2023, 13(19), 3056; https://doi.org/10.3390/diagnostics13193056 - 26 Sep 2023

Viewed by 612

Abstract

Although there has been a rapid increase in the number of new publications and studies in relation to the diagnostics, impacts and rehabilitation methods of facial nerve disorders, a general structure in evidence-based medicine is still difficult to establish [...] Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

Research

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8 pages, 847 KiB

Open AccessArticle

Intratemporal Facial Nerve Schwannomas: A Review of 45 Cases in A Single Center

by Tsubasa Kitama, Makoto Hosoya, Masaru Noguchi, Takanori Nishiyama, Takeshi Wakabayashi, Marie N. Shimanuki, Masaki Yazawa, Yasuhiro Inoue, Jin Kanzaki, Kaoru Ogawa and Naoki Oishi

Diagnostics 2022, 12(8), 1789; https://doi.org/10.3390/diagnostics12081789 - 23 Jul 2022

Cited by 8 | Viewed by 1382

Abstract

There are no established indications for facial nerve schwannoma treatment, including surgery, radiation and follow-up observation, and it is difficult to determine treatment policy uniformly. The treatment policy was examined from each treatment course. Data of patients with facial nerve schwannomas at our hospital from 1987 to 2018 were retrospectively examined. Their age, sex, clinical symptoms, tumor localization, treatment policies and outcomes were reviewed. In total, 22 patients underwent surgery and 1 patient underwent radiotherapy; 22 patients were followed up without treatment. After total resection, there were no tumor recurrences, and most patients had grade 3 or 4 postoperative facial paralysis. After subtotal resection, tumor regrowth was observed in four patients and reoperation was required in two patients. Facial nerve function was maintained in four patients and was decreased in two patients. During follow-up, six patients showed tumor growth. Only one patient had worsening facial nerve paralysis; four patients underwent facial nerve decompression owing to facial nerve paralysis during follow-up. If the tumor compresses the brain or it is prone to growth, surgery may be indicated, and when the preoperative facial nerve function is grade ≤ 3, consideration should be given to preserving facial nerve function and subtotal resection should be indicated. If the preoperative facial nerve function is grade ≥ 3, total resection with nerve grafting is an option to prevent regrowth. If there is no brain compression or tumor growth, the follow-up is a good indication, and decompression should be considered in facial nerve paralysis cases. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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22 pages, 1723 KiB

Open AccessArticle

Is There a Difference in Facial Emotion Recognition after Stroke with vs. without Central Facial Paresis?

by Anna-Maria Kuttenreich, Harry von Piekartz and Stefan Heim

Diagnostics 2022, 12(7), 1721; https://doi.org/10.3390/diagnostics12071721 - 15 Jul 2022

Cited by 3 | Viewed by 1617

Abstract

The Facial Feedback Hypothesis (FFH) states that facial emotion recognition is based on the imitation of facial emotional expressions and the processing of physiological feedback. In the light of limited and contradictory evidence, this hypothesis is still being debated. Therefore, in the present study, emotion recognition was tested in patients with central facial paresis after stroke. Performance in facial vs. auditory emotion recognition was assessed in patients with vs. without facial paresis. The accuracy of objective facial emotion recognition was significantly lower in patients with vs. without facial paresis and also in comparison to healthy controls. Moreover, for patients with facial paresis, the accuracy measure for facial emotion recognition was significantly worse than that for auditory emotion recognition. Finally, in patients with facial paresis, the subjective judgements of their own facial emotion recognition abilities differed strongly from their objective performances. This pattern of results demonstrates a specific deficit in facial emotion recognition in central facial paresis and thus provides support for the FFH and points out certain effects of stroke. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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12 pages, 6867 KiB

Open AccessArticle

Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis—Machine Settings and Technical Aspects for Facial Surgeons

by Andreas Kehrer, Marc Ruewe, Natascha Platz Batista da Silva, Daniel Lonic, Paul Immanuel Heidekrueger, Samuel Knoedler, Ernst Michael Jung, Lukas Prantl and Leonard Knoedler

Diagnostics 2022, 12(7), 1650; https://doi.org/10.3390/diagnostics12071650 - 07 Jul 2022

Cited by 8 | Viewed by 3026

Abstract

Background: Synkinesis of the facial musculature is a detrimental sequalae in post-paralytic facial palsy (PPFP) patients. Detailed knowledge on the technical requirements and device properties in a high-resolution ultrasound (HRUS) examination is mandatory for a reliable facial muscle assessment in PPFP patients. We therefore aimed to outline the key steps in a HRUS examination and extract an optimized workflow schema. Methods: From December 2020 to April 2021, 20 patients with unilateral synkinesis underwent HRUS. All HRUS examinations were performed by the first author using US devices with linear multifrequency transducers of 4–18 MHz, including a LOGIQ E9 and a LOGIQ S7 XDclear (GE Healthcare; Milwaukee, WI, USA), as well as Philips Affinity 50G (Philips Health Systems; Eindhoven, the Netherlands). Results: Higher-frequency and multifrequency linear probes ≥15 MHz provided superior imaging qualities. The selection of the preset program Small Parts, Breast or Thyroid was linked with a more detailed contrast of the imaging morphology of facial tissue layers. Frequency (Frq) = 15 MHz, Gain (Gn) = 25–35 db, Depth (D) = 1–1.5 cm, and Focus (F) = 0.5 cm enhanced the image quality and assessability. Conclusions: An optimized HRUS examination protocol for quantitative and qualitative facial muscle assessments was proposed. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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17 pages, 2996 KiB

Open AccessArticle

Automatic Facial Palsy Diagnosis as a Classification Problem Using Regional Information Extracted from a Photograph

by Gemma S. Parra-Dominguez, Carlos H. Garcia-Capulin and Raul E. Sanchez-Yanez

Diagnostics 2022, 12(7), 1528; https://doi.org/10.3390/diagnostics12071528 - 23 Jun 2022

Cited by 8 | Viewed by 2260

Abstract

The incapability to move the facial muscles is known as facial palsy, and it affects various abilities of the patient, for example, performing facial expressions. Recently, automatic approaches aiming to diagnose facial palsy using images and machine learning algorithms have emerged, focusing on providing an objective evaluation of the paralysis severity. This research proposes an approach to analyze and assess the lesion severity as a classification problem with three levels: healthy, slight, and strong palsy. The method explores the use of regional information, meaning that only certain areas of the face are of interest. Experiments carrying on multi-class classification tasks are performed using four different classifiers to validate a set of proposed hand-crafted features. After a set of experiments using this methodology on available image databases, great results are revealed (up to

95.61 %

of correct detection of palsy patients and

95.58 %

of correct assessment of the severity level). This perspective leads us to believe that the analysis of facial paralysis is possible with partial occlusions if face detection is accomplished and facial features are obtained adequately. The results also show that our methodology is suited to operate with other databases while attaining high performance, even though the image conditions are different and the participants do not perform equivalent facial expressions. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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21 pages, 1539 KiB

Open AccessArticle

Facial Emotion Recognition in Patients with Post-Paralytic Facial Synkinesis—A Present Competence

by Anna-Maria Kuttenreich, Gerd Fabian Volk, Orlando Guntinas-Lichius, Harry von Piekartz and Stefan Heim

Diagnostics 2022, 12(5), 1138; https://doi.org/10.3390/diagnostics12051138 - 04 May 2022

Cited by 2 | Viewed by 1703

Abstract

Facial palsy is a movement disorder with impacts on verbal and nonverbal communication. The aim of this study is to investigate the effects of post-paralytic facial synkinesis on facial emotion recognition. In a prospective cross-sectional study, we compared facial emotion recognition between n = 30 patients with post-paralytic facial synkinesis (mean disease time: 1581 ± 1237 days) and n = 30 healthy controls matched in sex, age, and education level. Facial emotion recognition was measured by the Myfacetraining Program. As an intra-individual control condition, auditory emotion recognition was assessed via Montreal Affective Voices. Moreover, self-assessed emotion recognition was studied with questionnaires. In facial as well as auditory emotion recognition, on average, there was no significant difference between patients and healthy controls. The outcomes of the measurements as well as the self-reports were comparable between patients and healthy controls. In contrast to previous studies in patients with peripheral and central facial palsy, these results indicate unimpaired ability for facial emotion recognition. Only in single patients with pronounced facial asymmetry and severe facial synkinesis was an impaired facial and auditory emotion recognition detected. Further studies should compare emotion recognition in patients with pronounced facial asymmetry in acute and chronic peripheral paralysis and central and peripheral facial palsy. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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12 pages, 2674 KiB

Open AccessArticle

Kabat Rehabilitation in Facial Nerve Palsy after Parotid Gland Tumor Surgery: A Case-Control Study

by Ciro Emiliano Boschetti, Giorgio Lo Giudice, Chiara Spuntarelli, Carmine Apice, Raffaele Rauso, Mario Santagata, Gianpaolo Tartaro and Giuseppe Colella

Diagnostics 2022, 12(3), 565; https://doi.org/10.3390/diagnostics12030565 - 23 Feb 2022

Cited by 8 | Viewed by 5360

Abstract

Temporary facial nerve palsy after parotid tumor surgery ranges from 14 to 65%, depending on surgery, tumor type, and subsite. The study aimed to evaluate the role of Kabat physical rehabilitation in the outcomes of patients affected by severe facial nerve palsy following parotid gland surgery. The results and clinical data of two groups, Kabat and non-Kabat (control), were statistically compared. Descriptive statistics, the multiple linear regression model, difference in difference approach, and the generalized linear model were used. F-Test, Chi-square test, McFadden R-squared, and adjusted R-squared were used to assess the significance. The results showed that the House–Brackmann (HB) stage of patients who had physiotherapy performed were lower than the control group. The decrease of HB staging in the Kabat group at 3 months was −0.71 on average, thus the probability of having a high HB stage decreased by about 13% using Kabat therapy. The results are statistically significant, and indicated that when the Kabat rehabilitation protocol is performed, mainly in the cases of a high-grade HB score, the patients showed a better and faster improvement in postoperative facial nerve palsy. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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10 pages, 922 KiB

Open AccessArticle

Electromyography of Extrinsic and Intrinsic Ear Muscles in Healthy Probands and Patients with Unilateral Postparalytic Facial Synkinesis

by Hanna Rüschenschmidt, Gerd Fabian Volk, Christoph Anders and Orlando Guntinas-Lichius

Diagnostics 2022, 12(1), 121; https://doi.org/10.3390/diagnostics12010121 - 05 Jan 2022

Cited by 4 | Viewed by 1690

Abstract

There are currently no data on the electromyography (EMG) of all intrinsic and extrinsic ear muscles. The aim of this work was to develop a standardized protocol for a reliable surface EMG examination of all nine ear muscles in twelve healthy participants. The protocol was then applied in seven patients with unilateral postparalytic facial synkinesis. Based on anatomic preparations of all ear muscles on two cadavers, hot spots for the needle EMG of each individual muscle were defined. Needle and surface EMG were performed in one healthy participant; facial movements could be defined for the reliable activation of individual ear muscles’ surface EMG. In healthy participants, most tasks led to the activation of several ear muscles without any side difference. The greatest EMG activity was seen when smiling. Ipsilateral and contralateral gaze were the only movements resulting in very distinct activation of the transversus auriculae and obliquus auriculae muscles. In patients with facial synkinesis, ear muscles’ EMG activation was stronger on the postparalytic compared to the contralateral side for most tasks. Additionally, synkinetic activation was verifiable in the ear muscles. The surface EMG of all ear muscles is reliably feasible during distinct facial tasks, and ear muscle EMG enriches facial electrodiagnostics. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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Other

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2 pages, 174 KiB

Open AccessReply

Reply to Nduka et al. Comment on “Kehrer et al. Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis—Machine Settings and Technical Aspects for Facial Surgeons. Diagnostics 2022, 12, 1650”

by Andreas Kehrer, Lukas Prantl, Samuel Knoedler and Leonard Knoedler

Diagnostics 2022, 12(10), 2432; https://doi.org/10.3390/diagnostics12102432 - 08 Oct 2022

Viewed by 707

Abstract

We thank Dr. Nduka et al. for this interesting article [...] Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

2 pages, 178 KiB

Open AccessComment

Comment on Kehrer et al. Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis—Machine Settings and Technical Aspects for Facial Surgeons. Diagnostics 2022, 12, 1650

by Charles Nduka, Ruben Yap Kannan, Gerd Fabian Volk and Orlando Guntinas-Lichius

Diagnostics 2022, 12(10), 2431; https://doi.org/10.3390/diagnostics12102431 - 08 Oct 2022

Cited by 1 | Viewed by 821

Abstract

In “Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis—Machine Settings and Technical Aspects for Facial Surgeons”, Andreas Kehrer et al. present ultrasound (US) device settings for facial muscle examination to be used by facial surgeons to improve their workflow and enhance their image [...] Read more.

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

11 pages, 2799 KiB

Open AccessCase Report

Reanimation of the Smile with Neuro-Vascular Anastomosed Gracilis Muscle: A Case Series

by Helen Abing, Carina Pick, Tabea Steffens, Jenny Shachi Sharma, Jens Peter Klußmann and Maria Grosheva

Diagnostics 2022, 12(5), 1282; https://doi.org/10.3390/diagnostics12051282 - 21 May 2022

Cited by 4 | Viewed by 2684

Abstract

Background: The aim of our manuscript was to evaluate the time course of clinical and electromyographical (EMG) reinnervation after the reanimation of the smile using a gracilis muscle transplant which is reinnervated with the masseteric nerve. Methods: We present a case series of five patients with a longstanding peripheral facial palsy, who underwent a reanimation of the lower face using a gracilis muscle transplant with masseteric nerve reinnervation from June 2019 to October 2020. Trial-specific follow-up examinations were carried out every three months using clinical assessment and EMG, up to 12 months after the surgery. The grading was carried out using the House–Brackmann scale (HB), the Stennert Index, and a self-designed Likert-like scale for graft reinnervation and smile excursion. Results: The surgery was feasible in all of the patients. The reanimation was performed under general anesthesia in an inpatient setting. Postoperative complications which resulted in prolonged hospitalization occurred in two of the five patients. All of the patients showed a preoperative flaccid facial palsy. The first single reinnervation potentials were detected 3.1 ± 0.1 months after surgery. After 5.6 (±1.4) months, in three (3/5) patients, clear reinnervation patterns were present. Clinically, the patients obtained symmetry of the face at rest after 5.6 (±1.4) months, and could spontaneously smile without the co-activation of the jaw after an average time of 10.8 (±1.8) months. All of the patients were able to express a spontaneous emotion-stimulated smile after one year. Conclusion: Micro-neurovascular gracilis muscle transfer reinnervated with a masseteric nerve is a sufficient and reliable rehabilitation technique for the lower face, and is performed as a single-stage surgery. The nerve supply via the masseteric nerve allows the very rapid and strong reinnervation of the graft, and results in a spontaneous smile within 10 months. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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7 pages, 3180 KiB

Open AccessCase Report

Osteoradionecrosis of the Temporal Bone as a Rare Cause of Facial Nerve Palsy

by Florian Schmidt, Katy Bradley and Gerd Fabian Volk

Diagnostics 2022, 12(5), 1021; https://doi.org/10.3390/diagnostics12051021 - 19 Apr 2022

Cited by 1 | Viewed by 2153

Abstract

We present a case of a 69-year-old male who presented with acute left facial nerve palsy, serous bloody otorrhea, otalgia, and exposed necrotic bone on the floor of his left ear canal. His medical history revealed a left canal wall-down (CWD) mastoidectomy thirty years ago. Subsequently, twenty years later, he received primary chemoradiotherapy for tonsil cancer on the same side. The patient’s medical history, the typical clinical picture, and a comprehensive diagnostic workup, including imaging modalities and electrophysiology, finally led to a diagnosis of osteoradionecrosis of the temporal bone (ORNTB), with secondary facial nerve palsy. The facial nerve, unfortunately, did not recover and treatment remained conservative, as per the patient’s preference. ORNTB is a rare, delayed complication after radiotherapy for head and neck cancer, which occurs after about 8 years and a minimum of 41.8 Gray of radiation to the affected area. Facial nerve palsy in ORNTB is rare, with only 2.9% of patients experiencing it, but, in our particular case, the patient had undergone an additional CWD mastoidectomy. The treatment options need to be personalized and aimed at symptom control. There should be awareness of the condition among ENT specialists, especially during head and neck cancer follow-ups, and in patients who have had mastoidectomy and radiotherapy affecting the ipsilateral temporal bone. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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7 pages, 655 KiB

Open AccessCase Report

Diagnostic Value of Preoperative Electrodiagnostic Analysis in a Patient with Facial Palsy and a Large Vestibular Schwannoma: Case Report

by Myung Chul Yoo

Diagnostics 2022, 12(2), 542; https://doi.org/10.3390/diagnostics12020542 - 20 Feb 2022

Cited by 3 | Viewed by 2112

Abstract

Although radiologic methods confirm the diagnosis of patients with large vestibular schwannomas, these methods usually indicate only the size of the tumor and its possible nerve compression. Electrodiagnostic methods can reveal the functional state of the nerves, particularly the trigeminal and facial nerves, as well as providing a basis for objectively evaluating nerve injury. Due to the lack of an established objective evaluation method, electrodiagnostic methods were utilized to assess injury to the cranial nerve in a patient with a large vestibular schwannoma. A 79-year-old woman presented with a one-month history of right facial palsy, vertigo, dizziness, right postauricular pain, and right-sided hearing disturbance. Physical examination suggested injuries to the facial and vestibulocochlear nerves. Magnetic resonance imaging identified a vestibular schwannoma and showed that the tumor mass was affecting the brainstem, including the fourth ventricle, resulting in mild obstructive hydrocephalus. Preoperative electrodiagnostic evaluation identified asymptomatic trigeminal neuropathy accompanying a vestibular schwannoma. The patient underwent surgery, consisting of a suboccipital craniotomy with additional gamma knife radiosurgery. Postoperatively, she demonstrated significant recovery from right facial palsy and partial improvement of her neurologic symptoms. Large vestibular schwannomas with facial paralysis may be accompanied by additional entrapment neuropathy. Routine preoperative electrophysiological evaluation is recommended to establish a definitive diagnosis and evaluate the function of the trigeminal nerve, facial nerve, and brainstem in patients with large and compressive vestibular schwannomas. Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Management of Facial Nerve Disorders)

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