When pharmacological treatments are inadequate, facial nerve paralysis from various etiologies, including Bell\'s palsy, Hunt syndrome, and trauma, often requires surgical intervention. Facial nerve decompression surgery aims to relieve nerve compression and restore function, with preserving hearing function, especially in pediatric cases, being crucial. Conventional methods, like the transmastoid approach, risk affecting auditory function due to ossicle manipulation. Herein, we describe the case of a 12-year-old boy with left facial palsy diagnosed with zoster sine herpete (ZSH) syndrome. Despite medical treatment, the patient\'s condition did not improve, prompting facial nerve decompression surgery. Employing the intact transmastoid ossicle (ITO) swaying technique, we minimized ossicular manipulation, preserving auditory function while effectively achieving facial nerve decompression. The patient demonstrated improvement postoperatively in auditory and facial nerve functions. Furthermore, audiometric assessments demonstrated no substantial deterioration in hearing thresholds, and the facial nerve function improved from Grade V to Grade II on the House-Brackmann scale. The ITO technique provides a less invasive alternative compared to conventional approaches, lowering the chance of the ossicular chain and the risk of postoperative hearing loss. This case highlights the significance of customized surgical approaches in pediatric facial nerve decompression surgery, resulting in improved patient outcomes. Further research is required to validate the efficacy and safety of this method across various clinical contexts.

Odontogenic space infections are common in dental practice, characterized by localized abscess formation with potential to spread to adjacent anatomical spaces. Neurogenic involvement in odontogenic infections is primarily found to be associated with sensory nerve branches, however involvement of motor nerves in odontogenic space infection leading to facial asymmetry has not been widely reported. In this case report, the authors present an unusual finding of facial asymmetry due to isolated marginal mandibular nerve weakness in a patient with a submandibular space infection.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12663-023-02019-x.

Concomitant chemoradiotherapy (CCRT) treated patients experience various complications. We present a rare case of post-CCRT Bell\'s palsy and describe its various possible causes, so as to increase awareness among clinicians about Bell\'s palsy being a CCRT-associated adverse effect. The patient was a 48-year-old man diagnosed with squamous cell carcinoma who presented with post-CCRT Bell\'s palsy. After radiotherapy for 6 weeks (overall 67.5 Gy) and four rounds of cisplatin chemotherapy, he complained of paralysis of the entire left face. A test was performed 33 days after the last CCRT session to differentiate Bell\'s palsy from other causative factors. Based on magnetic resonance imaging findings, facial nerve invasion due to tumor size increase was determined to not cause Bell\'s palsy. Inflammation of the left Eustachian tube was observed. Hence, steroids and famciclovir were administered, which markedly improved the facial paralysis symptoms within 56 days after facial paralysis development. In conclusion, patients can develop Bell\'s palsy owing to complex effects of various CCRT mechanisms. Although the exact cause of Bell\'s palsy has not been identified and the effectiveness of drug treatment was questionable in this case, unlikely causative factors should be excluded through various tests and appropriate and timely measures must be adopted.

The internal capsule (IC) is a vital brain structure housing descending and ascending fiber tracts, with traditional assumptions about the corticobulbar and corticospinal tracts descending through the genu and anterior third of the posterior limb of internal capsule (PLIC), respectively. However, observations of IC infarctions reveal that symptoms often deviate from the expected fiber pattern, prompting a deeper exploration of these complexities. The posterior limb of the IC receives its blood supply from the lenticulostriate branches of the middle cerebral artery and the anterior choroidal artery (AChA). AChA infarctions present a diverse array of symptoms beyond the classic triad, reflecting the intricate vascular supply and lesion patterns within this region. We present a case of a 74-year-old male farmer with right-hand dominance, who experienced a fall resulting in head and right lower limb injuries. Subsequently, he developed weakness in his left upper and lower limbs, facial deviation, slurred speech, and swelling in the right lower limb. Following these symptoms, his family promptly brought him to the hospital on November 30, 2023. Extensive investigations, including magnetic resonance imaging (MRI), revealed a hyper-acute infarct in the posterior limb of the left IC. The patient was admitted to the intensive care unit (ICU) for three days and later shifted to the neurology ward where medical management was commenced, including physiotherapy protocol that was started on December 2, 2023. Physiotherapy interventions were designed to address the patient\'s weakness, altered sensation, and diminished reflexes. Therapeutic goals focused on preventing complications, improving posture, enhancing range of motion (ROM), and mitigating breathing difficulties and mobility issues. The physiotherapy aimed to enhance the patient\'s overall physical and mental well-being, emphasizing independence and improved quality of life. Regular assessments and adjustments to the therapeutic interventions were made based on the patient\'s progress. This case underscores the importance of tailored physiotherapy interventions in addressing the diverse manifestations of IC infarctions, contributing to a comprehensive understanding of rehabilitation strategies in neurologically compromised individuals.

Acute pancreatitis is associated with multiple local or systemic complications in response to systemic inflammation that may eventually result in multi-organ failure. Neurological complications are uncommon in acute pancreatitis. Examples include cerebral hemorrhage, infarction, cerebral fat embolism, Wernicke encephalopathy, and cranial nerve (CN) palsy. Facial nerve palsy is a rare event in the setting of acute pancreatitis, with various theories about its etiology and pathophysiology. We report the case of a 46-year-old female who presented with acute pancreatitis secondary to hypertriglyceridemia. She developed right-sided facial palsy on the third day of admission. Her clinical condition improved with standard conservative medical management of acute pancreatitis. Facial nerve palsy improved after a short course of oral glucocorticoids, supportive measures, and physiotherapy. This case demonstrates a rare occurrence of facial nerve palsy in the setting of acute pancreatitis, although the etiopathology behind this manifestation remains unclear.

The varicella-zoster virus (VZV), a member of the Herpesviridae family, causes both the initial varicella infection and subsequent zoster episodes. Disorders of the eighth cranial nerve are common in people with herpes zoster oticus (HZO). We performed a review of the literature on different databases including PubMed and SCOPUS, focusing on cochlear and vestibular symptoms; 38 studies were considered in our review. A high percentage of cases of HZO provokes cochlear and vestibular symptoms, hearing loss and vertigo, whose onset is normally preceded by vesicles on the external ear. It is still under debate if the sites of damage are the inferior/superior vestibular nerves and cochlear nerves or a direct localization of the infection in the inner ear. The involvement of other contiguous cranial nerves has also been reported in a few cases. We report the case of a patient with single-side HZO presenting clinical manifestations of cochleo-vestibular damage without neurological and meningeal signs; after 15 days, the patient developed a new episode of vertigo with clinical findings of acute contralateral vestibular loss. To our knowledge, only three other such cases have been published. An autoimmune etiology may be considered to explain these findings.

BACKGROUND: Ramsay Hunt syndrome (RHS) is an uncommon neurological complication resulting from the reactivation of latent herpes zoster virus. The condition often presents with facial paralysis, palatal ulcers, dysphagia, and altered taste sensation, leading to reduced quality of life. Standard therapeutic options for RHS have limitations, prompting the exploration of alternative treatments with improved prognostic outcomes. This case report aims to present a noteworthy clinical observation of RHS managed with individualized homeopathic treatment, emphasizing its potential therapeutic effect.
METHODS: A 24-year-old female patient exhibited left-sided facial weakness, along with palatal ulcers, dysphagia, and ageusia, prompting the diagnosis of RHS. Following the principles of homeopathy, a personalized therapeutic regimen was formulated, consisting tailored administration of Rhus toxicodendron, Spigelia anthelmia, and Sulfur. The House-Brackmann scale was employed to objectively assess the severity of facial palsy, while photographic documentation tracked the progression of palatal ulcers and facial paralysis. Over a carefully monitored observation period of 14 days, the patient demonstrated notable therapeutic response. There was a significant reduction in the extent of palatal ulceration and left-sided facial palsy exhibited marked improvement. Subsequent days of follow-up witnessed a consistent amelioration of the patient\'s condition, substantiating the effect of the individualized homeopathic treatment.
CONCLUSIONS: This case report highlights an exceptional instance of RHS recovery within a relatively short timeframe, achieved through the administration of individualized homeopathic therapy. The favorable outcomes observed in this case underscore the potential of homeopathy as a promising intervention for RHS management. Nevertheless, further systematic investigations are imperative to comprehensively evaluate the scope and applicability of homeopathy in the treatment of RHS.
Das Ramsay‐Hunt‐Syndrom (RHS) ist eine seltene neurologische Komplikation, die durch die Reaktivierung einer latenten Herpes‐Zoster‐Virusinfektion verursacht wird. Die Krankheit manifestiert sich häufig mit Gesichtslähmung, Ulcerationen am Gaumen, Dysphagie und verändertem Geschmacksempfinden und ist mit einer Einschränkung der Lebensqualität verbunden. Die Standardtherapieoptionen für RHS sind begrenzt, weshalb nach alternativen Behandlungsmöglichkeiten mit besseren prognostischen Ergebnissen gesucht wird. Im vorliegenden Fallbericht wird eine interessante klinische Beobachtung bei RHS vorgestellt, das mit individualisierter Homöopathie behandelt wurde, und deren potenzielle therapeutische Wirksamkeit wird hervorgehoben.Eine 24-jährige Patientin zeigte eine linksseitige Gesichtsschwäche in Verbindung mit Ulcerationen am Gaumen, Dysphagie und Ageusie, so dass die Diagnose RHS gestellt wurde. Gemäß den Prinzipien der Homöopathie wurde ein personalisiertes Therapieschema formuliert, das die individuell zugeschnittene Gabe von Rhus toxicodendron, Spigelia anthelmia, und Sulphur umfasste. Die objektive Bewertung des Schweregrads der Gesichtslähmung erfolgte mithilfe der House-Brackmann-Skala, wohingegen das Fortschreiten der Gaumenulcerationen und der Gesichtslähmung fotografisch dokumentiert wurde. Während eines sorgfältig überwachten Beobachtungszeitraums von 14 Tagen zeigte die Patientin ein deutliches therapeutisches Ansprechen. Das Ausmaß der Gaumenulcerationen ging signifikant zurück, und die linksseitige Gesichtslähmung besserte sich deutlich. In den folgenden Tagen besserte sich der Zustand der Patientin kontinuierlich, was die Wirkung der individualisierten homöopathischen Behandlung untermauert.Dieser Fallbericht beleuchtet einen ungewöhnlichen Fall von Genesung nach einem RHS innerhalb relativ kurzer Zeit, die durch Verabreichung einer individualisierten homöopathischen Therapie erreicht wurde. Die im vorliegenden Fall beobachteten günstigen Ergebnisse unterstreichen das Potenzial der Homöopathie als vielversprechende Intervention zur Behandlung von RHS. Allerdings sind weitere systematische Untersuchungen unabdingbar, um den Umfang und die Anwendbarkeit der Homöopathie bei der Behandlung von RHS umfassend zu beurteilen.

Guillain-Barrè syndrome is a life threatening postinfectious disease causing acute paralytic neuropathy that rarely presents with asymmetrical limb weakness (1%) and unilateral facial nerve palsy (4.9%).
UNASSIGNED: A 39-year-old male presented with pain and weakness in the right lower limb with right sided facial weakness. The cranial nerve examination revealed lower motor neuron type right facial palsy (Bell \'s palsy). On rest neurological examination, he had decreased power in the right lower limb with an absent knee and ankle reflex on presentation. Later, the weakness was symmetrical in both lower limbs.
UNASSIGNED: Cerebrospinal fluid analysis showed albuminocytologic dissociation with no cells and an elevated protein of 203.2 mg/dl. The nerve conduction study was abnormal in bilateral lower limbs suggesting severe demyelinating motor neuropathy. Intravenous Immunoglobulin was started with the dose of 25 gm (0.4 mg/kg) once daily for 5 days, that is, five doses. The patient started showing signs of recovery with the initial dose of immunoglobulin.
UNASSIGNED: The course of the disease usually recovers spontaneously and completely; however, plasma exchange and immunomodulatory therapy have shown improvement in patient with rapidly deteriorating symptoms.

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BACKGROUND: Bell\'s palsy is an idiopathic facial palsy with an unknown cause, and 75% of patients heal spontaneously. However, the other 25% of patients continue experiencing mild or severe disabilities, resulting in a reduced quality of life. Currently, various treatment methods have been developed to treat this disease. However, there is controversy regarding their effectiveness, and new alternative treatments are needed.
METHODS: The patient suffered from left-sided facial paralysis due to Bell\'s palsy for 7 years. The patient received an uncultured umbilical cord-derived mesenchymal stem cell transplant eight times for treatment. After follow-up for 32 mo, the paralysis was cured, and there was no recurrence.
CONCLUSIONS: Uncultured umbilical cord-derived mesenchymal stem cell transplantation may be a potential treatment for patients with Bell\'s palsy who do not spontaneously recover.