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US of the normal and abnormal facial nerve. (A) The white arrow shows the normal facial nerve. The green arrow shows the acoustic shadow of the mastoid process, and the red one shows the posterior part of the masseter muscle. The blue arrow shows the homogenous hyperechogenicity of the parotid gland. The orange arrow shows the bright hyperechoic shadow of the ear lobule. B, Normal facial nerve in zoomed view. C, Abnormal facial nerve swollen with loss of hyperechoic appearance. A ¼ anterior, P ¼ posterior.
Source publication
Purpose:
Bell palsy is the most common cause of acute facial nerve paralysis. Ultrasound has proved its ability in detecting structural lesions along the course of the affected nerves.The current work aimed at studying the accuracy of ultrasound to predict the prognosis of Bell palsy in correlation to the clinical scale and nerve conduction studie...
Context in source publication
Context 1
... The facial nerve diameter is then measured inside the hyperechoic neurolemmal borders. The normal facial nerve has a relatively hyperechoic neurolemma compared with the surrounding masseter muscle (which lies below and anterior to the nerve) and exhibits a linear mono-fascicular appearance. By contrast, the abnormal facial nerve is often swollen (Fig. 1). 5,9 The three diameters were taken 3 times, and the mean was calculated to be used in the statistical ...
Citations
... Despite treatment, there are still some patients with sequelae like hemifacial spasm, impaired communication and dysgeusia. 24,25 Therefore, it is crucial to identify patients with poor prognosis early in the clinical diagnosis and treatment process. Studies have shown that the abnormal rate of blink reflex in patients with facial nerve palsy can reach 100%, and it can appear in the early stage of the disease, which is helpful for early prognosis of the disease. ...
Objective
This study aims to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in patients with idiopathic facial nerve palsy.
Methods
The clinical data of patients with idiopathic facial nerve palsy were retrospectively analyzed. After three months of follow-up, patients were divided into good prognosis and poor prognosis, and the correlation between NLR, CRP and idiopathic facial nerve palsy was analyzed.
Results
Negative correlation of NLR with Portmann score in idiopathic facial nerve palsy (r=−0.788, P<0.05); In contrast to the group with poor prognosis, patients in good prognosis group had low levels of body mass index (BMI), NLR, and C-reactive protein (CRP), and high Portmann score (P<0.05); Multivariate logistic regression analysis showed Portmann score (OR=1.268, 95% CI (1.005–1.616)), NLR (OR=0.262, 95% CI (0.128–0.533)) and CRP levels (OR=0.949, 95% CI (0.895–0.989)) were risk factors of poor prognosis for patients with idiopathic facial nerve palsy. The area under the receiver operator characteristic (ROC) curve of NLR and CRP levels in predicting poor facial nerve function was 0.764 and 0.697, the specificity was 85.5% and 75.0%, and the sensitivity was 74. 0% and 76.0%, respectively. The ROC curve of the combined diagnosis was 0.829, the specificity was 80.7%, and the sensitivity was 82.0%.
Conclusion
Elevated NLR and CRP are associated with a poor prognosis of idiopathic facial nerve palsy and can serve as an indicator for clinical prognosis, and can be widely used in clinical.
... It also extends beyond diagnosis, providing dynamic, real-time evaluations of facial nerves and muscles. When used alongside established tests like facial nerve grading scales and electrodiagnostic studies, ultrasonography enhances diagnostic accuracy and treatment efficacy [17]. ...
... Three of the included eight cross-sectional studies were of good quality 19,25,26 , and five were of fair quality. 16,[22][23][24]27 Two of the included six case-control studies were of good quality, 18,20 and four were of moderate quality. 2,4,6,10 , as shown in Supplementary Tables 3, 4, and 5. ...
... In contrast, others have reported that facial nerve diameter correlates with the initial grading of the acute stage but is inefficient in predicting the outcome. 6,20 Lo et al 4 reported that ultrasound is superior to NCS as a prognostic factor, in contrast to the findings of Zaki et al. 20 In contrast, no superiority was reported by Li et al. 21 Given this lack of agreement and limited data, more studies focusing on the clinica l relevance of the facial nerve ultrasound in Bell's palsy are needed. ...
... In contrast, others have reported that facial nerve diameter correlates with the initial grading of the acute stage but is inefficient in predicting the outcome. 6,20 Lo et al 4 reported that ultrasound is superior to NCS as a prognostic factor, in contrast to the findings of Zaki et al. 20 In contrast, no superiority was reported by Li et al. 21 Given this lack of agreement and limited data, more studies focusing on the clinica l relevance of the facial nerve ultrasound in Bell's palsy are needed. ...
Introduction/aims:
Ultrasonography of the cranial nerves has recently gained attention in assessing inflammatory, compressive or degenerative neuropathies. However, sonographic reference values of cranial nerves have received less attention than those of peripheral nerves. This systematic review and meta-analysis aimed to provide current evidence of sonographic reference values for cranial nerve size.
Methods:
By searching Medline (via PubMed), Scopus, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science, we conducted a systematic review and meta-analysis of studies that reported ultrasound measurements of the facial, spinal accessory, and hypoglossal nerves in healthy adults. We included studies that reported either the sonographic cross-sectional area (CSA) or the nerve diameter; the included nerves were sub-grouped according to the site of nerve measurement.
Results:
Fourteen studies with a total of 661 participants and 1437 ultrasound nerve measurements met the inclusion criteria. The anatomical sites for each nerve were combined to provide single nerve mean measurements. We found an overall mean nerve diameter of 0.80 mm for the facial nerve, 0.63 mm for the spinal accessory nerve, and 1.82 mm2 for the hypoglossal nerve CSA.
Discussion:
This meta-analysis provides reference values for the diameter and cross-sectional area of the facial, spinal accessory, and hypoglossal nerves at different sites, which can be used as guidance in clinical practice to detect pathological changes in cranial nerve size in cranial neuropathies. We recommend further validation in large-scale studies as well as standardization of the scanning protocols.
... The difference between the affected and unaffected sides was statistically significant (P < 0.05), which was consistent with the results of previous studies. [21][22][23][24] Most of the healthy lateral nerves showed intrathecal isoechoic, hypoechoic in the injured side. ...
... However, when the three points were re-examined with ultrasonography at 1 month after disease onset, the diameter at the mid-point and CMAP amplitude were associated with prognosis. [24] However, Li et al. reported that no association was found between the two examinations. [23] In our study, facial nerve diameter was measured outside the stylomastoid foramen, specifically at the proximal end, with observation made on five patients with poor prognoses. ...
Repetitive Peripheral Magnetic Stimulation [rPMS] is a non-invasive tool that has a potential therapeutic role in many musculoskeletal disorders. We aimed to demonstrate the therapeutic efficacy of high frequency [rPMS] in acute Idiopathic Facial Nerve Palsy [IFP]. And to study the role of neuromuscular ultrasonography in acute idiopathic facial palsy.
Forty patients, aged above 18 years, diagnosed with unilateral acute [within 7 days of onset] idiopathic facial palsy were enrolled and randomly divided into intervention group [20 patients] and control group. Both groups underwent clinical examination, assessment of facial nerve disability by House-Brackmann grading [HBG] score and Facial Disability Index [FDI] score, ultrasonography of facial nerve of both normal and affected sides at baseline and after 6 weeks, medical treatment and routine rehabilitation therapy. The intervention group were subjected to 10 sessions of high frequency r PMS [5/week for 2 successive weeks] on the affected side.
Both [HBG] and [FDI] showed more significant improvement in the intervention group in comparison to the control group after 6 weeks follow up. Ultrasonographic measures of facial nerve in the affected side were significantly larger than non-affected side at baseline. However, those measures significantly decreased after 6 weeks follow up. Surprisingly, the intervention group showed more significant decrease in facial nerve dimeter at proximal portion [without sheath] in comparison to control group.
high frequency r PMS have an adjuvant role in treatment of acute idiopathic facial palsy. Also, ultrasonography has beneficial role in evaluation and prognosis of [IFP].
Objective
This study aimed to investigate the utility of facial nerve ultrasonography in the functional and structural assessment of early-stage Bell’s palsy and the prognostic value of facial nerve ultrasonography in Bell’s palsy.
Study Design
Prospective longitudinal study.
Setting
Single center, a university-affiliated neurology clinic.
Subjects and Methods
Patients with unilateral Bell’s palsy who had visited our clinic within 3 days of symptom onset were enrolled in this study. Demographic information and House-Brackmann grade were collected. Electrophysiologic studies and facial nerve ultrasonography were then performed. The facial nerves on each side were scanned longitudinally with a 5- to 12-MHz probe. The diameter of the facial nerves with and without the sheath was measured at the proximal and distal portions. Follow-up examinations, including House-Brackmann grade analysis, electrophysiologic studies, and facial nerve ultrasonography, were performed after 2 months.
Results
Fifty-four patients with unilateral Bell’s palsy were enrolled, and 22 underwent the follow-up examinations. The diameters of the facial nerves were larger on the affected side than on the unaffected side at the proximal and distal portions ( P < .01). On the affected side, the enlarged facial nerve at the proximal portion had decreased in size after 2 months ( P < .05). The initial ultrasonography findings were positively correlated with the initial severity of Bell’s palsy, but they did not predict prognosis.
Conclusion
Ultrasonography could be a useful tool for evaluating the facial nerve in Bell’s palsy. Nevertheless, further studies are needed to demonstrate its prognostic value.
