Evaluation of Trigeminal Nerve Involvement Using Blink Reflex Test in Bell’s Palsy

손은진,Ki Bong Lee,김지훈,Yoon-Ah Park,박윤길,Won Sang Lee 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.3

Background and Objectives: Facial nerve dysfunction in Bell's palsy is evaluated using various parameters including physical examination and electrophysiological studies. Associated symptoms of facial numbness or paresthesia are reported by some patients with Bell's palsy. The aim of this study was to investigate trigeminal nerve involvement in Bell's palsy using blink reflex test. Subjects and Methods: Facial nerve and trigeminal nerve functions were assessed using House-Brackmann (HB) grading system, electroneuronography (ENoG) and blink reflex tests in 28 patients diagnosed as Bell's palsy. Results: HB grades correlated with degeneration ratio from ENoG (p=0.002, chi-square test). The ipsilateral R1 reponse of the blink reflex was absent or abnormal in 27/28 patients (96.4%), and ipsilateral R2 response was absent or abnormal in 26/28 patients (92.8%). Contralateral R2 was abnormal in 5/28 patients (17.8%), suggesting involvement of trigeminal nerve in a portion of patients. The results of blink reflex test showed no significant correlation to the outcome of facial nerve function (HB grade) in Bell's palsy patients. Conclusions: Blink reflex test provides information about trigeminal and facial nerve functions in addition to ENoG results. Our study suggests that subclinical involvement of trigeminal nerve may accompany facial nerve dysfunction in Bell's palsy. Introduction Bell's palsy is the most common cause etiology of acute facial nerve palsy occurring in about 10-30 per 100,000 of the general population.1) Since the facial nerve is primarily a motor nerve, dysfunction of the seventh cranial nerve is usually evident by limitation of voluntary movements by facial expression muscles. Taste disturbance from the small sensory component through the chorda tympani may be present. Some patients also complain of facial numbness or paresthesia, not confined to the postauricular area related to the auricular sensory branch, but on the lateral side of the face. Such symptoms may be related to trigeminal nerve involvement. Electrophysiological studies are widely utilized in facial palsy patients in addition to physical examination of voluntary movements. Nerve excitability test (NET) and electroneuronography (ENoG) are widely used to assess the functional status and to predict the outcome.2,3,4) The blink reflex (BR) is a polysynaptic reflex responseof the orbicularis oculi muscle elicited by electricalstimulation of the supraorbital nerve and is mediated by the afferent trigeminal nerve, the brainstem and the efferent facial nerve. The BR test can be used to evaluate the function of the involved nerves.5,6) The BR responses consist of two different temporaryresponses: early ipsilateral R1 and late bilateral R2. The R1 is generated through a reflex arc in the ipsilateral part of the brainstem with a direct connection between trigeminal pathway and the facial motor nucleus, and the R2 is presumed to be mediated through polysynaptic interneurons in the lateral reticular formation in the brainstem.7)The aim of this study was to investigate trigeminal nerve involvement in Bell's palsy patients using blink reflex test. Subjects and Methods The clinical data of patients presenting with acute onset unilateral facial nerve palsy to the Yonsei University College of Medicine Gangnam Severance Hospital from between October 2010 to June 2011 were reviewed. Twenty-eight patients who were diagnosed as Bell's palsy and followed up for more than 1 month were included in the study. Exclusion criteria were previous history of facial palsy, Ramsay-Hunt syndrome, traumatic facial palsy, diabetes mellitus, and facial palsy due to central or peripheral nervous system disorders. Bell's palsy was diagnosed when other recognizable causes were ruled out by careful history review, neurological examinations, serological and radiological studies. The facial nerve function was assessed by House-Brackmann (HB) facial nerve grading system at initial presentation and at each follow up visit. Complete recovery to HB grades I or II were considered satisfactory compared to incomplete recovery to HB grades III to IV. Electrophysiological tests were performed using performed using a Viking IV electromyographysystem (Nicolet, Madison, WI, USA) between 3 to 14 days since the onset of facial palsy. On ENoG, supramaximal stimulation of 0.2-ms duration at a rate of 1 Hz was provided through bipolar surface electrodes. Electrodes were placed with the anode just outside the stylomastoid foramen and the cathode in front of the ear lobe and manipulated to obtain the maximal compound action potential amplitude on the display. For recording, the surface disc electrodes were placed in the nasolabial fold. The ground electrode was placed on the lower jaw. Peak-to-peak amplitudes of ENoG response on the affected side were compared with those on the unaffected side. Percentage of response amplitude on the affected side compared with that on the unaffected side was designated the degeneration ratio (DR) value for the patient. For evaluation of trigeminal nerve function, BR tests were performed. In BR testing, 18-mA stimulation of 0.2-ms duration was applied via the supraorbital margin, and responses of the orbicularis oculi muscles were recorded through surface disc electrodes. The responses of both sides were recorded (i...

적외선 체열진단법을 이용한 Bell's palsy의 임상적 예후 진단 연구

송범용,Song, Beom-Yong 대한침구의학회 2001 대한침구의학회지 Vol.18 No.1

The Background and Purpose : Most diagnostic method for the facial palsy were invasive and complex. And we don't know very well prognosis for the recovery of facial palsy in the first stage after the onset. But the Digital Infrared Thermal Image(DITI) isn't invasive and complex diagnostic method for the facial palsy. So we should study on the clinical prognostic diagnosis of Bell's palsy among facial palsy with the DITI. Objective and Methods : This study researched into the clinical statistics for 89 case who are in Bell's palsy, and they are treated with oriental medical care at the Woosuk university during 2 years form November 1998 to October 2000. All objectives have the Grade 6(Zero state) of Bell's palsy in first week after the onset. It takes a patient's facial temperature after the onset. Group A is taken from 1 day to 4 days after the onset. Group B is taken from 5 day to 8 days after the onset. And group C is taken from 9 day to 12 days after the onset. Results and Conclusions : The Digital Infrared thermal image technique showed the more high temperature, the more rapid cure and short treatment period on TE23, B2, S3, S6 in abnormal site of Bell's palsy. But it showed the more low temperature, the more rapid cure and short treatment period on TE17 of abnormal site of Bell's palsy. As a conclusion, we could think that the prognostic diagnosis of Bell's palsy closely related with the thermal difference normal and abnormal site of Bell's palsy that were took picture after the onset.

Bell's Palsy의 경과에 대한 예후인자 분석

민영광,안창범,장경전,윤현민,김철홍,송춘호,김수민,김정은,박재흥,Min, Young-Kwang,An, Chang-Beohm,Jang, Kyung-Jun,Yoon, Hyun-Min,Kim, Cheol-Hong,Song, Choon-Ho,Kim, Soo-Min,Kim, Jeong-Eun,Park, Jae-Heung 대한침구의학회 2008 대한침구의학회지 Vol.25 No.3

Objectives : This study was designed to evaluate clinical prognosis factors of Bell's palsy patients. Methods : The 100 subjects were chosen from 262 patients over 20years old who was diagnosised Bell's palsy through Acupuncture & Moxibustion and ENT medical specialist after visiting the hospital within 8days of onset of peripheral facial palsy and after Oriental-Western Medicine Treatment, recovered completely or had over three months cares because of incomplete recovery Oriental-Western Medicine Treatment included Acupuncture Treatment, Herb med treatment, medicines treatment, Physical therapy and Electrodiagnostic Test was operated after 7 to 10days after outbreaks of the disease. Clinical prognosis factors were analyzed using House-Brackmann grading system(HBGS) as a measurement of the degree of Facial Palsy. Collected data were analyzed as Chi-Square test, ANOVA test, Independent-Samples t-test regression analysis using SPSS 12.0 WIN Program. Results : 1. There was a significant difference in the results of treatment according to site of palsy, degree of initial palsy, time of initial recovery and existence of recovery after 3weeks from onset as clinical prognosis factors of Bell's Palsy, However, a statistically significant difference was not shown in the results of treatment according to gender, age, existence of Post Auricular Pain, Hypertension, Diabetes and existence of relapse. 2. As a result of overall treatment, 85% of patients were recovered almost entirely and 15% were not recovered completely. 3. There was a significant difference in the onset of Post Auricular Pain and duration of Post Auricular Pain according to the degree of Post Auricular Pain. 4. There was a significant difference in the degree of initial palsy and degree of palsy after 3weeks from onset according to the existence of Post Auricular Pain. However, a statistically significant difference was not shown in the period of time until initial treatment, The time of initial recovery, (H-B), The period from onset to recovey, ENoG value. Conclusions : Based on the above results, prognosis of Bell's palsy was affected by degree of initial palsy, time of initial recovery and existence of recovery after 3weeks from onset.

벨마비 입원환자 35례에 대한 임상보고 조기 한방치료가 벨마비에서 House-Brackmann grade에 미치는 영향을 중심으로

양현주,주현아,백상철,박진수,홍석훈,Yang, Hyun-Ju,Joo, Hyun-A,Baek, Sang-Chul,Park, Jin-Soo,Hong, Seok-Hoon 대한한방안이비인후피부과학회 2011 한방안이비인후피부과학회지 Vol.24 No.3

Objective : This study was designed to evaluate the influence of time from onset of Bell's palsy until commenced Oriental medicine therapy on Bell's palsy. Methods : We investigated 35 cases of patients with peripheral facial palsy who visited Wonkwang University Oriental Hospital from 10th, December 2010 to 31st August, 2011 and classified them as time from onset of Bell's palsy until commenced Oriental medicine therapy. Time from onset of Bell's palsy until commenced Oriental medicine therapy of Group A was within 3 days. Group B was from 4 days to 8 days. We evaluate the treatment effect of each group by House-Brackmann grade before treatment and 1,3 week treatment. Results : 1. There was a statistical difference in period from onset of Bell's palsy until commenced Oriental medicine therapy between Group A and Group B. 2. There was a statistical difference after 1 week treatment in Group B. 3. There was a statistical difference after 3 weeks treatment in both Group A and B.3. After 3 week treatment, there was statistical significant difference in decreased value of House-Brackmann grade between Group A and Group B. Group A showed more recovery compared with Group B. Conclusions : 1. These results suggest that early oriental medicine treatment could be more effective in recovery of Bell's palsy. 2. Further studies will be required to identify the beneficial effect of early oriental medicine treatment in bell's palsy.

Effect of Age and Severity of Facial Palsy on Taste Thresholds in Bell’s Palsy Patients

박정민,김명구,정준양,김성수,정아라,김상훈,여승근 대한청각학회 2017 Journal of Audiology & Otology Vol.21 No.1

Background and Objectives: To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell’s palsy. Subjects and Methods: This study included 29 patients diagnosed with Bell’s palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House- Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests. Results: EGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell’s palsy patients than in controls (p<0.05). In contrast, chemical taste tests showed no significant differences in taste thresholds between the two groups (p>0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests (p>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell’s palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (p<0.05). In older individuals, however, no significant differences in taste thresholds were observed between Bell’s palsy patients and healthy subjects (p>0.05). Conclusions: Electrical taste thresholds were higher in Bell’s palsy patients than in controls. These differences were observed in younger, but not in older, individuals

안면신경마비 환자에서 마비점수표와 성상신경절 차단의 치료효과

구길회 중앙대학교 의과대학 의과학연구소 1994 中央醫大誌 Vol.19 No.4

Bell's palsy(idiopathic facial paralysis) is characterized by the sudden onest of facial muscle weakness or paralysis without specific causes. Bell's palsy is usually innocuous and spontaneous recovery within about 12 weeks but ofter the duration of recovery of facial muscle function is very long, and it is very serious condition to patients bacause of cosmetic problems and psychological distress. In 1952, Dr. Swan reported the treatment of the facial palsy with stellate ganglion block. And Dr. Brackman(1974) also reported the therapeutic effects of stellate gagnlision block in patients with Bell's palsy. In 1973, Dr. Wakasugi introduce the "Facial Palsy Score" and classified the degree of paralysis of facial muscle. I investigate the effects of stellate ganalion block in 66 Bell's palsy patients with the "Facial Palsy Score" from September 1993 to march 1994 at pain clinics of Chung-Ang University Yong-San Hospital. Results are follows 1. Sexual difference in incidence of facial palsy was not noted. 2. In age, the onset of facial palsy was noted in all age groups, but 6th decades of age group were high incidence and 7th decade and 5th decades were followed. 3. There was no difference of incidence of facial palsy in right and left side of face. 4. Prodromal symptom of facial palsy were noted in 25.5% of patients, the symptom were periauricular pain, dizziness, hearing difficulty, visual difficulty, and nausea. 5. The mean durations from the time of development of facial palsy to came the pain clinics were about 3 1/2 months. 6. At first time to visit to the pain clinics, lower than 30 of Facial Palsy Score was noted in 84.8% of patients, but after the 5 times of stellate ganglion block it was decreased to 66.7%, and after 30 times of SGB only 15.4% of patients were below than 30.

벨마비 환자의 동반 증상 분석

이호윤,류은웅,박수완,김수진,여승근,박문서 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.10

Background and Objectives We aimed to evaluate associated symptoms in patients with Bell’s palsy and prognosis according to associated symptoms. Subjects and Method Seventy-four patients with Bell’s palsy were enrolled in this study. We evaluated the degree of facial palsy with Facial Nerve Grading System 2.0. The grade of facial palsy was determined as initial facial palsy at admission and as final facial palsy at visit after 3 months. Afterwards, we examined symptoms (such as otalgia, facial numbness, taste disturbance, eye problems, hyperacusis, and tinnitus) and co-morbid diseases (such as diabetes mellitus and hypertension) associated with facial palsy. After 3 months of the onset of facial palsy, we examined the changes in the associated symptoms. Results At admission, 71.6 percent of all patients had symptoms associated with facial palsy. Of the associated symptoms, facial numbness and taste disturbance were the most common, which were still found in 23% of the patients after 3 months of the onset of facial palsy. Patients with a high initial grade of facial palsy were accompanied by taste disturbance and hyperacusis more than by other symptoms. Also patients who had auricular pain during the recovery period of Bell’s palsy showed poor prognosis. Compared to non-hypertension patients, for patients with hypertension, taste disturbance was more common during the early period whereas eye problems were more common during the recovery period. Conclusion Patients with Bell’s palsy had diverse symptoms associated with facial palsy. During the early period of Bell’s palsy, we concluded that there was no correlation between the symptoms and the prognosis. However, patients with pain around the ear during the recovery period showed poor recovery of facial palsy.

발병초기 벨마비 환자의 진단에서 순목 반사(blink reflex)의 유용성

석정임,이동국,김창형 대한임상신경생리학회 2012 Annals of Clinical Neurophysiology Vol.14 No.1

Background: Bell’s palsy is the most common disease of cranial nerve. While most electrodiagnostic tests can detect the abnormality of facial nerve several days later in Bell’s palsy, blink reflex usually reveals the abnormality earlier than other tests. Therefore, we investigated the diagnostic usefulness of blink reflex in the early stage of Bell’s palsy. Methods: We performed a prospective investigation in patients with facial palsy. We enrolled patients with Bell’s palsy who were evaluated within 7 days of symptom onset and excluded patients with secondary causes of facial palsy. We analyzed the findings of blink reflex according to age, sex, evaluation time, and severity of facial palsy. Results: Of 320 consecutive patients with facial palsy, a total of 204 patients were enrolled. Blink reflex was normal for 10 patients and abnormal for 194 patients. The time interval between the symptom onset and the evaluation time was not associated with the result of blink reflex,but House-Brackmann grade was significantly related to the result of blink reflex (P<0.001). Patients with mild Bell’s palsy often showed normal blink reflex. Conclusions: Our study shows that blink reflex is useful diagnostic test regardless of evaluation timing in the early stage of Bell’s palsy, although it could be normal in patients with mild Bell’s palsy.

Effect of Age and Severity of Facial Palsy on Taste Thresholds in Bell's Palsy Patients

Park, Jung Min,Kim, Myung Gu,Jung, Junyang,Kim, Sung Su,Jung, A Ra,Kim, Sang Hoon,Yeo, Seung Geun The Korean Audiological Society 2017 Journal of Audiology & Otology Vol.16 No.2

<P><B>Background and Objectives</B></P><P>To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell's palsy.</P><P><B>Subjects and Methods</B></P><P>This study included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House-Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests.</P><P><B>Results</B></P><P>EGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls (<I>p</I><0.05). In contrast, chemical taste tests showed no significant differences in taste thresholds between the two groups (<I>p</I>>0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests (<I>p</I>>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (<I>p</I><0.05). In older individuals, however, no significant differences in taste thresholds were observed between Bell's palsy patients and healthy subjects (<I>p</I>>0.05).</P><P><B>Conclusions</B></P><P>Electrical taste thresholds were higher in Bell's palsy patients than in controls. These differences were observed in younger, but not in older, individuals.</P>

The Impact of the COVID-19 Pandemic on Bell’s Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study

Kwak Min Young,Lee Ho Yun,Lee Se A,Jeong Junhui,Chung Jae Ho,Kim Jin,Jun Beom Cho,Yeo Seung-Geun,Kim Sang Hoon,Lee Jong Dae 대한의학회 2024 Journal of Korean medical science Vol.39 No.16

Background: This article presents a comprehensive review of data on the impact of facial palsy during the coronavirus disease 2019 (COVID-19) pandemic. The possible causes and pathophysiological mechanisms of changes in the epidemiology of facial palsy during the COVID-19 pandemic are also discussed. Methods: This multicenter retrospective cohort study included 943 patients diagnosed with Bell’s palsy or Ramsay Hunt syndrome. This study compared patient demographics, comorbidities, symptoms, and treatments before the COVID-19 pandemic (from 2017 to 2019) and during the COVID-19 pandemic, from 2020 to 2022). Results: Following the COVID-19 outbreak, there has been a significant increase in the number of cases of Bell’s palsy, particularly among elderly individuals with diabetes. Bell’s palsy increased after the COVID-19 outbreak, rising from 75.3% in the pre-COVID-19 era to 83.6% after the COVID-19 outbreak. The complete recovery rate decreased from 88.2% to 73.9%, and the rate of recurrence increased from 2.9% to 7.5% in patients with Bell’s palsy. Ramsay Hunt syndrome showed fewer changes in clinical outcomes. Conclusion: This study highlights the impact of the COVID-19 pandemic on the presentation and management of facial palsy, and suggests potential associations with COVID-19. Notably, the observed increase in Bell’s palsy cases among elderly individuals with diabetes emphasizes the impact of the pandemic. Identifying the epidemiological changes in facial palsy during the COVID-19 pandemic has important implications for assessing its etiology and pathological mechanisms of facial palsy disease.