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  1. Superficial cervical plexus block combined with auriculotemporal nerve block for drainage of dental abscess in adults with difficult airways
    Ling KU, Hasan MS, Ha KO, Wang CY
    Anaesth Intensive Care, 2009 Jan;37(1):124-6.
    PMID: 19157359
    We report our use of a superficial cervical plexus block to manage three adults who presented for drainage of dental abscesses. All patients had difficult airways related to severe trismus (preoperative inter-incisor distance < or = 1.5 cm). The first two patients, whose abcesses involved both the submandibular and submasseteric spaces, were managed with combined superficial cervical plexus and auriculotemporal nerve block. In a third patient, a superficial cervical plexus block alone was sufficient because the abscess was confined to the submandibular region. The blocks were successful in all three cases with minimal requirement for supplemental analgesia. We recommend the consideration of superficial cervical plexus block, and if necessary an auriculotemporal nerve block, for the management of selected patients with difficult airways who present for drainage of dental abcesses.
    Matched MeSH terms: Facial Nerve
  2. Fulltext Challenging lymphoid malignancy of primary central nervous system lymphoma: A case report
    Kasinathan G, Kori AN, Hassan N
    Ann Med Surg (Lond), 2020 Sep;57:307-310.
    PMID: 32874561 DOI: 10.1016/j.amsu.2020.08.011
    Introduction: Primary central nervous lymphoma is an aggressive disease without evidence of systemic spread with an annual incidence of 7 cases per 1,000,000 people in the United States.

    Case presentation: A 68-year-old gentleman of Malay ethnicity presented with left sided weakness associated with reduced sensation for one month. The patient was healthy and denied any constitutional symptoms, joint pains, rash or seizures. There was no recent trauma. Physical examination revealed left upper and lower limb motor grade power of 3/5 with upper motor neurone weakness of the left facial nerve. He had brisk reflexes and an upgoing extensor plantar response. Brain imaging (Magnetic Resonance Imaging) showed two lesions: one occupying the right head of the caudate nucleus and the other seen at the right side of the body of the corpus callosum. Histomorphology and immunohistochemistry confirmed Diffuse Large B-Cell Lymphoma (DLBCL) of non-germinal center type. He was treated with De Angelis protocol which involves chemoradiotherapy consisting of high dose methotrexate and whole brain radiotherapy (WBRT), followed by high dose cytarabine. Brain imaging post chemoradiation showed complete remission.

    Conclusion: Prompt detection with appropriate therapeutic protocol could significantly minimise the permanent neurological deficits in patients with this rare and challenging lymphoid malignancy.

    Matched MeSH terms: Facial Nerve
  3. Fulltext Parotid lymphoepithelial cyst: a case report
    Rahman, S., Shaari, R., Hassan, R.
    Archives of Orofacial Sciences, 2006;1(1):71-75.
    MyJurnal
    A 48 years old Malay lady with a case of painless soft fluctuant swelling of left parotid gland is reported. The lesion was found to be a cystic lesion through the pre operative examinations and investigations. The cyst was completely excised, taking care not to injure the lower division of the facial nerve. Post recovery was uneventful with no defect of the facial nerve functions. The histologic picture confirmed that the cyst was lymphoepithelial cyst which is so called “branchial cyst”. Through the literature reviews of parotid lymphoepitelial cyst the discussions on prevalence, origin, diagnosis, histological finding, investigation and the modes of treatment are made. The ultra sound was found to be valuable in the pre operative evaluation of the parotid swelling furthermore it is non-invasive, harmless, painless and relatively quick.
    Matched MeSH terms: Facial Nerve
  4. Partial superficial parotidectomy for pleomorphic adenoma of the parotid gland
    Bhattacharya A, Singh M, Shah A, Varghese LL
    BMJ Case Rep, 2021 Jun 14;14(6).
    PMID: 34127499 DOI: 10.1136/bcr-2020-238759
    Pleomorphic adenoma, otherwise called as benign mixed tumour, is the most common salivary gland tumour which accounts for 60% of all benign salivary gland tumours. The clinical, radiological and histopathological presentations are varied. The tumour occurs in diverse anatomical sites and can consist of epithelial and mesenchymal components. In this case report, the patient reported with an asymptomatic swelling on the face. CT scan with contrast was advised. The clinical, roentgenographic findings and Fine Needle Aspiration Cytology were indicative of pleomorphic adenoma of the parotid gland. Treatment included partial superficial parotidectomy under general anaesthesia using the modified Blair's incision. The facial nerve was not involved. Part of the gland along with the tumour was resected completely superficial to the facial nerve with a margin of normal tissue all around. Histopathologic examination of tissue specimen confirmed the lesion as pleomorphic adenoma. The patient was asymptomatic at 6-month follow-up.
    Matched MeSH terms: Facial Nerve
  5. Fulltext Managing a Complicated Acute Otomastoiditis at Day Four of Life
    Lim R, Zulkifli S, Hailani I, Hashim ND
    Cureus, 2021 Jan 25;13(1):e12905.
    PMID: 33654590 DOI: 10.7759/cureus.12905
    Acute mastoiditis in a newborn complicated by the presence of facial nerve palsy is an alarming finding requiring rapid assessment and further investigation. Such an early presentation should point the clinician towards an underlying systemic pathology or congenital anatomical abnormality. Facial nerve involvement indicates severe infection and possible dehiscence of the facial canal. Although more frequent in children, it is rare in neonates. We would like to share our experience in managing the youngest known presentation of otomastoiditis at four days of life. The patient presented with otorrhea and facial paralysis and progressed to meningitis. He was finally diagnosed with chronic granulomatous disease.
    Matched MeSH terms: Facial Nerve
  6. Fulltext Leptomeningeal Carcinomatosis With Optic Nerve Metastasis Secondary to Breast Cancer
    Chew C, Wan Hitam WH, Ahmad Tajudin LS
    Cureus, 2021 Mar 31;13(3):e14200.
    PMID: 33936906 DOI: 10.7759/cureus.14200
    Leptomeningeal carcinomatosis (LC) and optic nerve metastasis are uncommon occurrences in breast cancer. We report a rare case of LC with optic nerve infiltration secondary to breast cancer. A 45-year-old lady who was a known case of treated right breast carcinoma six years ago presented with a blurring of vision in both eyes, floaters, and diplopia for one month. She also had recurrent attacks of seizure-like episodes, headache, and vomiting. Examination revealed high blood pressure with tachycardia. Her right eye visual acuity was counting fingers at two feet and 6/36 in the left eye. She had right abducens nerve palsy. Fundoscopy showed bilateral optic disc swelling with pre-retinal, flame-shaped haemorrhages and macular oedema. CT scan of brain and orbit was normal. She was admitted for further investigations. While in the ward, her vision deteriorated further. Her visual acuity in both eyes was at the level of no perception to light. She also developed bilateral abducens nerve palsy and right facial nerve palsy. Subsequently, she started having bilateral hearing loss. There were few episodes of fluctuations in conscious awareness. MRI brain showed mild hydrocephalus. Both optic nerves were thickened and enhanced on T1-weighted and post-gadolinium. Lumbar puncture was performed. There was high opening pressure. Cerebrospinal fluid cytology showed the presence of malignant cells. Family members opted for palliative care in view of poor prognosis. Unfortunately, she succumbed after a month's stay in hospital. Diagnosis of LC and optic nerve infiltration presents a formidable challenge to clinicians especially in the early stages where neuroimaging appears normal and lumbar puncture has high false negatives. Multiple high-volume taps are advised if clinical suspicion of LC is high.
    Matched MeSH terms: Facial Nerve
  7. Fulltext A Rare Case of an Undiagnosed Middle Ear Tumor Due to Late Referral
    Ng JJ, Ong HY, Nasseri Z, Azmi MI, Abdullah A
    Cureus, 2021 Jan 08;13(1):e12584.
    PMID: 33457146 DOI: 10.7759/cureus.12584
    Facial nerve tumors constitute about 5% of all facial nerve paralysis. As it is relatively uncommon, it could be misdiagnosed. We encountered an 18-year-old girl who had right facial weakness since the age of four, referred to otorhinolaryngology clinic for further evaluation only when her hearing deteriorated and the facial weakness worsened. Further investigation revealed facial nerve schwannoma. Facial nerve paralysis in the pediatric age group is uncommon and should be examined in detail to rule out other possible etiologies besides Bell's palsy.
    Matched MeSH terms: Facial Nerve; Facial Nerve Diseases
  8. Vascular loop in the cerebellopontine angle causing pulsatile tinnitus and headache: a case report
    Ramly NA, Roslenda AR, Suraya A, Asma A
    EXCLI J, 2014;13:192-6.
    PMID: 26417253
    Tinnitus is a common disorder, it can be classified as pulsatile and non-pulsatile or objective and subjective. Pulsatile tinnitus is less common than non-pulsatile and can be due to vascular tumour such as glomus or vascular abnormality. We presented an interesting case of a 30 year-old Malay lady with a two-year history of pulsatile tinnitus which was worsening in three months duration. It was associated with intermittent headache. Clinical examination and tuning fork test were unremarkable. Apart from mild hearing loss at high frequency on the left ear, the pure tone audiogram (PTA) was otherwise normal. In view of the patient's young age with no risk factor for high frequency loss, a magnetic resonance imaging (MRI) was performed to look for any abnormality in the cerebellopontine angle. It revealed a single vessel looping around the left vestibulocochlear and facial nerves at the cisternal portion, likely a branch of the anteroinferior cerebellar artery (AICA). Literature review on the pathophysiology and treatment option in this condition is discussed.
    Matched MeSH terms: Facial Nerve
  9. Myeloid Sarcoma of Temporal Bone: A Rare Manifestation of Relapse Acute Myeloid Leukemia
    Goh BS, Tang CL, Tan GC
    Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1023-1026.
    PMID: 31750119 DOI: 10.1007/s12070-015-0930-8
    Myeloid sarcoma is a rare malignant extramedullary neoplasm of myeloid precursor cells. This disorder may occur in concomitance with or precede development of acute or chronic myeloid leukemia. Sometimes, it is the initial manifestation of relapse in a previously treated acute myeloid leukemia. We report a case of 11 years old boy with acute myeloid leukemia in remission state, presented with short history of right otalgia associated with facial nerve palsy. Diagnosis of right acute mastoiditis with facial nerve palsy as complication of acute otitis media was made initially. Patient underwent simple cortical mastoidectomy but histopathology from soft tissue that was sent revealed diagnosis of myeloid sarcoma. A leukemic relapse was confirmed by paediatric oncologist through bone marrow biopsy. Chemotherapy was commenced but patient responded poorly to the treatment.
    Matched MeSH terms: Facial Nerve
  10. Fulltext Bilateral facial nerve palsy secondary to an atypical presentation of Gullain-Barré syndrome
    Azarisman, S.M.S., Shahrin, T.C.A., Marzuki, A.O., Fatnoon, N.N.A., Rathor, M.Y.
    International Medical Journal Malaysia, 2009;8(1):41-44.
    MyJurnal
    Bilateral simultaneous facial nerve palsy is an extremely rare clinical entity and may occur in association with a variety of neurological, infectious, neoplastic or degenerative disorders. We describe a patient, who presented with facial diplegia and normal reflexes on examination. During the entire hospitalization, he developed no motor weakness and remained ambulatory. Whether treatment is warranted for this and other milder variants of Gullain-Barré syndrome is also discussed. Atypical presentations with preserved or brisk reflexes, can be a diagnostic dilemma.
    Matched MeSH terms: Facial Nerve
  11. Fulltext Ancient Schwannoma Of The Facial Nerve: An Unusual Histological Variant Of A Rare Disease
    Baharudin, A., Din Suhaimi, S., Omar, E.
    International Medical Journal Malaysia, 2006;5(2):1-4.
    MyJurnal
    Schwannomas are benign slow growing lesions arising from the Schwann cells that ensheath the axons of the peripheral, cranial and autonomic nervous systems. Intracranial schwannomas develop from the facial nerve much more rarely than from the vestibular or trigeminal nerves. Ancient schwannoma is an unusual histological variant of this rare disease. A 48 years old man who had recurrent facial nerve paralysis and right external auditory mass is presented in this case report.
    Matched MeSH terms: Facial Nerve
  12. Fulltext Concomitant Anomalous branching of Facial Nerve and Double Parotid Duct: A case report
    Amro Mohamed Soliman, Elvy Suhana Ramli, Srijit Das, Norzana Abd Ghafar
    International Medical Journal Malaysia, 2017;16(1):139-142.
    MyJurnal
    The facial nerve divides within the parotid gland into upper temporozygomatic and lower cervicofacial branches. The two branches further subdivide and emerge from the parotid gland as five main branches. We observed a rare anomalous branching pattern of the facial nerve along with double parotid duct on the right side of a 50-year-old male cadaver. The two parotid ducts emerged at the level of the anterior border of parotid gland then united to form one single duct thereby opened into the oral cavity. The first duct (D1) emerged from the upper one third of the anterior border of the parotid gland and traversed horizontally for 9 mm to join the second duct. Knowledge of anomalous branching pattern of facial nerve and double parotid ducts may be beneficial for maxillofacial surgeons.
    Matched MeSH terms: Facial Nerve
  13. Congenital bilateral facial nerve hypoplasia with sensorineural hearing loss: a case report
    Hamizan AW, Yean KT, Abdullah A
    Int J Pediatr Otorhinolaryngol, 2012 Mar;76(3):455-9.
    PMID: 22281372 DOI: 10.1016/j.ijporl.2012.01.002
    A 3-year-old child presented with congenital bilateral facial nerve palsy with bilateral profound sensorineural hearing loss. High Resolution Computed Tomogram (HRCT) of the temporal bones found bilateral atresia of cochlear nerve canals, incomplete partition of the cochleae and narrow facial nerve canals. Magnetic resonance imaging (MRI) revealed bilateral hypoplasia of facial nerves and aplasia of both vestibulocochlear nerves. There have been no other reported cases with this presentation. The possible aetiology and treatment options for the patient are discussed. We highlighted the review of aplasia/hypoplasia of the facial nerve and hypoplasia of cochlear nerve canal.
    Matched MeSH terms: Facial Nerve Diseases/complications*; Facial Nerve Diseases/congenital*; Facial Nerve Diseases/diagnosis
  14. Fulltext A review Of parotid tumours In Negeri Sembilan, Malaysia
    Ambu, Valuyeetham Kamaru, Ramalinggam, Ganesh, Kaur, Kirandeep
    Malaysian Journal of Medicine and Health Sciences, 2014;10(2):61-69.
    MyJurnal
    Parotid tumours represent one of many groups of tumours in the field of
    Otorhinolaryngology. However, a local demographical evaluation of parotid tumours and its annual incidences has never been undertaken. This study intends to review local demography in relation to incidence of parotid tumour seen in Otorhinolaryngology (ORL) clinic, Hospital Tuanku Ja’afar Seremban, Negeri Sembilan from the year 2007 till 2012. Methods: A retrospective demographical study on parotid cases seen in ORL clinic, Hospital Tuanku Ja’afar Seremban between 2007 till 2012 involving 56 cases. Data that was collected include patient details, facial nerve involvement on presentation, type of surgery performed, site of tumour, facial nerve injury post operation and final histopathological diagnosis. Results: An average of 10 cases per year was noted from 2007 to 2012. Male to female ratio was found to be 1.4:1. Age range of sample population were 9 to 79 years old with a mean age of 47 at time of diagnosis. Superficial lobe was found to be the most common tumour site (63%). Majority of cases consists of benign tumours in 51 out of 56 cases with Warthin’s tumour and Pleomorphic Adenoma being the most common histopathological finding. Post operative facial nerve injury were noted in 17 cases in which 13 cases were temporary while 4 others were permanent.
    Matched MeSH terms: Facial Nerve; Facial Nerve Injuries
  15. Fulltext Facial nerve palsy in a child: Bell’s palsy? Think again!
    Jo Ee Sam, Nasser Abdul Wahab, Priya Sharda
    Malays Fam Physician, 2017;12(3):30-32.
    MyJurnal
    Introduction: Half of facial paralysis in children is idiopathic at origin. However, dismissing facial
    paralysis as being idiopathic without a thorough history and meticulous examination could be
    disastrous as illustrated by this case.

    Case report: We report a case of sphenoid wing meningioma in a 4-year-old girl. She first
    presented with only facial asymmetry that was noticed by her mother. Examination suggested a
    left upper motor neuron facial nerve palsy. A sphenoid wing meningioma was found on magnetic
    resonance imaging (MRI) of her brain. She underwent craniotomy and total tumour excision.
    Histopathological examination of the tumour showed a grade 1 transitional type meningioma.
    Meningiomas in children are rare compared to the adult population. Presentations in children
    may be delayed due to their inability to recognise or communicate abnormalities. Distinguishing
    between upper and lower motor neuron facial palsy is crucial in decision making for facial paralysis
    in children.
    Matched MeSH terms: Facial Nerve
  16. Fulltext Facial nerve palsy in a child: Bell's palsy? Think again!
    Sam JE, Priya S, Nasser AW
    Malays Fam Physician, 2017;12(3):30-32.
    PMID: 29527278
    Introduction: Half of facial paralysis in children is idiopathic at origin. However, dismissing facial paralysis as being idiopathic without a thorough history and meticulous examination could be disastrous as illustrated by this case.

    Case report: We report a case of sphenoid wing meningioma in a 4-year-old girl. She first presented with only facial asymmetry that was noticed by her mother. Examination suggested a left upper motor neuron facial nerve palsy. A sphenoid wing meningioma was found on magnetic resonance imaging (MRI) of her brain. She underwent craniotomy and total tumour excision. Histopathological examination of the tumour showed a grade 1 transitional type meningioma. Meningiomas in children are rare compared to the adult population. Presentations in children may be delayed due to their inability to recognise or communicate abnormalities. Distinguishing between upper and lower motor neuron facial palsy is crucial in decision making for facial paralysis in children.
    Matched MeSH terms: Facial Nerve
  17. Fulltext Retrospective review of facial nerve schwannomas: the universiti kebangsaan malaysia medical centre experience
    Mazita, A., Zahirrudin, Z., Saim, L., Asma, A.
    Medicine & Health, 2010;5(2):86-92.
    MyJurnal
    Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.
    Matched MeSH terms: Facial Nerve
  18. Fulltext Carcinoma Ex Pleomorphic Adenoma Presented as a Gigantic Tumor: Treatment and Diagnostic Challenges
    Maruthamuthu T, Saniasiaya J, Mohamad I, Nadarajah S, Lazim NM, Wan Abdul Rahman WF
    Oman Med J, 2018 Jul;33(4):342-345.
    PMID: 30038735 DOI: 10.5001/omj.2018.62
    Parotid gland surgery can be challenging due to intricate relationship between the gland and facial nerve. Besides complete removal of the lesion, the main focus of surgery is centered on the facial nerve. Surgery can be technically demanding especially when the tumor is large or involves the deep lobe. We report a patient with a 30-year history of gigantic parotid mass, which initial fine-needle aspiration cytology reported as pleomorphic adenoma. The tumor, weighing 1.3 kg, was successfully resected with facial nerve preservation. Histopathological examination of the excised mass confirmed as carcinoma ex pleomorphic adenoma (CaExPA) of adenocarcinoma, not otherwise specified type. We describe the specific surgical and reconstruction techniques for successful removal of large parotid tumors with facial nerve preservation. To our knowledge, this is the heaviest CaExPA of the parotid gland in South-East Asian region.
    Matched MeSH terms: Facial Nerve
  19. Case Report: Ocular Tilt Reaction with Internuclear Ophthalmoplegia and Multiple Cranial Nerve Palsies
    Teo SK, Mohd Khialdin S, Yong MH, Othman O, Ami M
    Optom Vis Sci, 2020 Dec;97(12):1018-1022.
    PMID: 33252541 DOI: 10.1097/OPX.0000000000001607
    SIGNIFICANCE: Ocular tilt reaction (OTR) is an abnormal eye-head postural reaction that consists of skew deviation, head tilt, and bilateral ocular torsion. Understanding of the pathway of the vestibulo-ocular reflex (VOR) is essential because this will help to localize the pathology.

    PURPOSE: The aim of this study was to report a case of OTR with contralateral internuclear ophthalmoplegia (INO) and fifth and seventh cranial nerve palsies.

    CASE REPORT: A 51-year-old gentleman with underlying diabetes mellitus presented with sudden onset of diplopia for 3 days. On examination, his visual acuity was 20/30 bilaterally without a relative afferent pupillary defect. He had a right OTR consisting of a right head tilt, a skew deviation with a left eye hypertropia, and bilateral ocular torsion (right excyclotorsion and left incyclotorsion) with nystagmus. He also had a left adduction deficit and right abduction nystagmus consistent with a left INO. Ocular examination revealed evidence of proliferative diabetic retinopathy bilaterally. Two days after the initial presentation, the patient developed left seventh and fifth cranial nerve palsies. MRI showed left pontine infarction and multiple chronic lacunar infarctions. There was an incidental finding of a vascular loop compression on cisternal portions of the left trigeminal, facial, and vestibulocochlear nerves. Antiplatelet treatment was started on top of a better diabetic control. The diplopia was gradually resolved with improved clinical signs. In this case, the left pontine infarction had likely affected the terminal decussated part of the vestibulocochlear nerve from the right VOR pathway, medial longitudinal fasciculus, and cranial nerve nuclei in the left pons.

    CONCLUSIONS: The OTR can be ipsilateral to the lesion if the lesion is before the decussation of the VOR pathway in the pons, or it can be contralateral to the lesion if the lesion is after the decussation. In case of an OTR that is associated with contralateral INO and other contralateral cranial nerves palsy, a pathology in the pons that is contralateral to the OTR should be considered. Neuroimaging study can hence be targeted to identify the possible cause.

    Matched MeSH terms: Facial Nerve Diseases/diagnosis; Facial Nerve Diseases/etiology*; Facial Nerve Diseases/physiopathology
  20. Surgical outcomes in cystic vestibular schwannoma versus solid vestibular schwannoma
    Tang IP, Freeman SR, Rutherford SA, King AT, Ramsden RT, Lloyd SK
    Otol Neurotol, 2014 Aug;35(7):1266-70.
    PMID: 24841920 DOI: 10.1097/MAO.0000000000000435
    To review the postoperative surgical outcomes of cystic vestibular schwannomas (CVSs), especially facial nerve outcomes, and compare these results with those from matched solid vestibular schwannomas (SVS) resected during the same period at a tertiary referral center.
    Matched MeSH terms: Facial Nerve Injuries/etiology*
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