Bilateral facial palsy with paresthesia (FDP) is a rare variant of GBS, characterized by simultaneous bilateral facial palsy and paresthesia of the distal limbs. Mounting evidence indicates that the presence of anti-GT1a IgG has a pathogenic role as an effector molecule in the development of cranial nerve palsies in certain patients with GBS, whereas anti-GT1a antibody is rarely presented positive in FDP. Here, we report the case of a 33-year-old male diagnosed with FDP presented with acute onset of bilateral facial palsy and slight paresthesias at the feet as the only neurological manifestation. An antecedent infection with no identifiable reason for the fever or skin eruptions was noted in the patient. He also exhibited cerebrospinal fluid albuminocytologic dissociation and abnormal nerve conduction studies. Notably, the testing of specific serum anti-gangliosides showed positive anti-GT1a IgG/IgM Ab. The patient responded well to intravenous immunoglobulin therapy. This case brings awareness to a rare variant of GBS, and provides the first indication that anti-GT1a antibodies play a causative role in the development of FDP. The case also suggests that prompt management with IVIG should be implemented if FDP is diagnosed.

We aim to investigate the effect of RVG-Lamp2b-modified exosomes (exos) loaded with neurotrophin-3 (NT-3) on facial nerve injury. Exos were collected from control cells (Ctrl Exo) or bone marrow mesenchymal stem cells co-transfected with RVG-Lamp2b and NT-3 plasmids (RVG-NT-3 Exo) by gradient centrifugation and identified by western blotting, transmission electron microscopy, and nanoparticle tracking analysis. Effect of RVG-NT-3 Exo on oxidative stress damage was determined by analysis of the morphology, viability, and ROS production of neurons. Effect of RVG-NT-3 Exo on facial nerve axotomy (FNA) was determined by detecting ROS production, neuroinflammatory reaction, microglia activation, facial motor neuron (FMN) death, and myelin sheath repair. Loading NT-3 and modifying with RVG-Lamp2b did not alter the properties of the exos. Moreover, RVG-NT-3 Exo could effectively target neurons to deliver NT-3. Treatment with RVG-NT-3 Exo lowered H2O2-induced oxidative stress damage in primary neurons and Nsc-34 cells. RVG-NT-3 Exo treatment significantly decreased ROS production, neuroinflammatory response, FMN death, and elevated microglia activation and myelin sheath repair in FNA rat models. Our findings suggested that RVG-NT-3 Exo-mediated delivery of NT-3 is effective for the treatment of facial nerve injury.

With the continuous progress of technology, the subject of life science plays an increasingly important role, among which the application of artificial intelligence in the medical field has attracted more and more attention. Bell facial palsy, a neurological ailment characterized by facial muscle weakness or paralysis, exerts a profound impact on patients\' facial expressions and masticatory abilities, thereby inflicting considerable distress upon their overall quality of life and mental well-being. In this study, we designed a facial attribute recognition model specifically for individuals with Bell\'s facial palsy. The model utilizes an enhanced SSD network and scientific computing to perform a graded assessment of the patients\' condition. By replacing the VGG network with a more efficient backbone, we improved the model\'s accuracy and significantly reduced its computational burden. The results show that the improved SSD network has an average precision of 87.9% in the classification of light, middle and severe facial palsy, and effectively performs the classification of patients with facial palsy, where scientific calculations also increase the precision of the classification. This is also one of the most significant contributions of this article, which provides intelligent means and objective data for future research on intelligent diagnosis and treatment as well as progressive rehabilitation.

BACKGROUND: Acute bulbar palsy-plus (ABPp) syndrome is an unusual variant of Guillain-Barré syndrome (GBS). Anti-GT1a and anti-GQ1b antibodies have been reported in patients with ABPp, but without reports related to GD3 antibodies.
METHODS: Clinical data of a patient diagnosed as ABPp syndrome were reviewed clinically. And we summarized the GBS patients with ABP and facial paralysis reported in the literature.
RESULTS: We reported a 13-year-old girl presented with asymmetric bifacial weakness, bulbar palsy and transient limb numbness, and had positive serum IgG anti-GD3 antibody. Through reviewing the GBS patients with ABP and facial paralysis reported previously, we found that facial palsy could be unilateral or bilateral. The bilateral facial palsy could present successively or simultaneously, and could be symmetrical or asymmetrical. Other common symptoms included ophthalmoplegia, sensory abnormality and ataxia. IgG anti-GT1a and IgG anti-GQ1b antibodies were the most frequent. Most of the patients had full recovery within two weeks to one year of follow-up.
CONCLUSIONS: We reported a patient with asymmetric bifacial palsy and bulbar palsy, which seemed to fit the diagnosis of ABPp syndrome. This was the first report of ABPp variant of GBS with positive serum ganglioside GD3 IgG antibody.

OBJECTIVE: To observe the clinical effect of repetitive transcranial acupuncture stimulation (rTAS) combined with electroacupuncture (EA) in treatment of acute facial palsy with retroauricular pain.
METHODS: Sixty-eight patients of acute facial palsy with retroauricular pain were randomly divided into an observation group (34 cases, 3 cases dropped out) and a control group (34 cases, 3 cases dropped out). On the basis of conventional therapy, in the control group, Yangbai (GB 14), Cuanzhu (BL 2), Sibai (ST 2), Quanliao (SI 18), Dicang (ST 4), Yifeng (TE 17), Qianzheng (Extra point) and Taiyang (EX-HN 5) on the affected side, and bilateral Hegu (LI 4) were selected. EA was attached to Yangbai (GB 14) and Cuanzhu (BL 2), and Sibai (ST 2) and Dicang (ST 4), respectively, using intermittent wave. In the observation group, on the basis of the regimen as the control group, rTAS was delivered at Baihui (GV 20) and the 1/5 of the lower motor area on the bilateral sides; EA of dense wave was given at the sites of the mastoidⅠand Ⅱ. The intervention of each group was delivered once a day, 6 times a week as one course for 4 courses and taking a day off every course. Before treatment and at the moment after the first treatment completion, the score of visual analogue scale (VAS) was observed in the two groups and the days of retroauricular pain were recorded. Before and after treatment, the score of Sunnybrook facial grading system (SFGS), the grade of House-Brackmann facial nerve function evaluation system (H-B), the latency and amplitude of the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve, were observed in the patients of two groups and the clinical effect was compared between the two groups after treatment.
RESULTS: After treatment, SFGS score was increased (P<0.05), H-B grade was improved (P<0.05), the latency was shortened in the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve (P<0.05) and its amplitude elevated (P<0.05) when compared with those before treatment in the two groups. In the observation group, SFGS score was higher (P<0.05), H-B grade was superior (P<0.05), the latency was shorter in the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve (P<0.05) and its amplitude was higher (P<0.05) when compared with those of the control group after treatment. After the completion of the first treatment, VAS score of either group was reduced in comparison with that before treatment (P<0.05), and the score in the observation group was lower than that of the control group (P<0.05). The duration of retroauricular pain was shortened in the observation group when compared with that of the control group (P<0.05). The total effective rate was 87.1% (27/31) in the observation group, which was higher than 77.4% (24/31) of the control group (P<0.05).
CONCLUSIONS: The rTAS combined with EA is effective for reducing neurologic impairment of acute facial palsy and alleviating retroauricular pain in the patients.
目的：观察经颅重复针刺法结合电针治疗伴耳后疼痛的急性面神经麻痹的疗效。方法：将68例伴耳后疼痛的急性面神经麻痹患者随机分为观察组（34例，脱落3例）和对照组（34例，脱落3例）。两组均给予基础治疗。对照组穴取患侧阳白、攒竹、四白、颧髎、地仓、翳风、牵正、太阳，双侧合谷，阳白和攒竹、四白和地仓分别连接电针，选用断续波；观察组在对照组治疗基础上，于百会、双侧运动区下1/5应用经颅重复针刺法，乳突1穴、乳突2穴连接电针，选用密波。两组治疗均每天1次，每周6次为一疗程，疗程间休息1 d，共治疗4个疗程。观察两组患者治疗前及首次治疗后即刻视觉模拟量表（VAS）评分，并记录耳后疼痛持续天数；观察两组患者治疗前后Sunnybrook面神经评定系统评分、House-Brackmann（H-B）面神经功能分级及患侧面神经从茎乳孔至额肌、口轮匝肌、眼轮匝肌的运动传导的潜伏期、波幅，并于治疗后比较两组临床疗效。结果：与治疗前比较，治疗后两组患者Sunnybrook面神经评定系统评分升高(P<0.05)，H-B面神经功能分级改善（P<0.05），患侧面神经茎乳孔至额肌、口轮匝肌与眼轮匝肌运动传导的潜伏期缩短（P<0.05），波幅升高（P<0.05）；治疗后，观察组患者Sunnybrook面神经评定系统评分高于对照组(P<0.05)，H-B面神经功能分级优于对照组（P<0.05），患侧面神经茎乳孔至额肌、口轮匝肌与眼轮匝肌运动传导的潜伏期短于对照组（P<0.05），波幅高于对照组（P<0.05）。首次治疗后两组患者耳后疼痛VAS评分较治疗前降低（P<0.05），且观察组低于对照组（P<0.05）。观察组耳后疼痛持续时间短于对照组（P<0.05）。观察组总有效率为87.1%（27/31），高于对照组的77.4%（24/31，P<0.05）。结论：经颅重复针刺法结合电针能够改善急性面神经麻痹患者神经功能缺损症状，减轻耳后疼痛。.

Facial palsy can result in a serious complication known as facial synkinesis, causing both physical and psychological harm to the patients. There is growing evidence that patients with facial synkinesis have brain abnormalities, but the brain mechanisms and underlying imaging biomarkers remain unclear. Here, we employed functional magnetic resonance imaging (fMRI) to investigate brain function in 31 unilateral post facial palsy synkinesis patients and 25 healthy controls during different facial expression movements and at rest. Combining surface-based mass-univariate analysis and multivariate pattern analysis, we identified diffused activation and intrinsic connection patterns in the primary motor cortex and the somatosensory cortex on the patient\'s affected side. Further, we classified post facial palsy synkinesis patients from healthy subjects with favorable accuracy using the support vector machine based on both task-related and resting-state functional magnetic resonance imaging data. Together, these findings indicate the potential of the identified functional reorganizations to serve as neuroimaging biomarkers for facial synkinesis diagnosis.

The purpose of this study was to evaluate the facial nerve recovery of patients with traumatic facial nerve transections after tension-free end-to-end nerve epineural anastomosis during the acute phase. A total of 11 patients with traumatic facial nerve transections during the acute phase were surgically treated in the authors\' department from November 2016 to August 2022. The case data and imaging data were collected from the patients, and the House-Brackman evaluation system of the facial nerve was applied to assess the recovery of facial nerve function, and the higher the grade, the worse the facial nerve function. Of the patients, 90.9% recovered to H-B grade II or below, and there were differences in the degree of recovery of the facial nerve function among the branches, and the ones that recovered to H-B grade II or below after surgery were 100% of the zygomatic branch, of which 80% were H-B grade I, 100% of the buccal branch, of which 44.4% were H-B grade I, 88.9% of the marginal mandibular branch, and 66.7% of the temporal branch. The study showed that the recovery rate of young patients was better than that of middle-aged and old people, and the best recovery of each branch of the facial nerve was the zygomatic branch, followed by the buccal branch, the marginal mandibular branch, and the worse was the temporal branch.

Objective:To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Methods:Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023. Results:The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases（38 ears）, and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases（52 ears） , transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases（50 ears） were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases（24 ears） of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved（P<0.05）, and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment（P<0.05）. There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes（P>0.05）. The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse（P<0.05）, but there was no significant difference between the facial nerve function after treatment（P>0.05）. There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group（P>0.05）. Conclusion:Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.
目的：总结外伤性面神经麻痹的临床特点及治疗效果。 方法：对2015年1月至2023年5月间68例（69耳）外伤性面神经麻痹病例进行回顾性分析。 结果：就诊时中位病程33 d；就诊时患者的面神经功能HB-Ⅱ级2例，HB-Ⅲ级4例，HB-Ⅳ级16例，HB-Ⅴ级37例（38耳），HB-Ⅵ级9例；42例为伤后即刻发生，26例为迟发性；纵行骨折51例（52耳），横行骨折6例，混合型骨折4例，7例未发现明确颞骨骨折线；损伤节段49例（50耳）为膝状神经节及邻近，7例为垂直段，7例为水平段，2例为水平段、垂直段，3例无法评估。23耳采用以糖皮质激素为主的保守治疗，46耳采用手术治疗。治疗后6～24个月对患者进行随访，HB-Ⅰ级20例，HB-Ⅱ级19例，HB-Ⅲ级23例（24耳），HB-Ⅳ级4例，HB-Ⅴ级1例；失访1例。治疗前后，患者面神经功能明显改善（P<0.05），保守治疗组和手术治疗组患者在面神经麻痹病程、伤后即刻面瘫比率、治疗前面神经功能、治疗后面神经功能差异有统计学意义（P<0.05）；年龄、性别、听力情况、颞骨骨折情况、面神经损伤节段、面神经功能良好率差异无统计学意义（P>0.05）；对神经变性>90%和≤90%的病例比较显示治疗前神经变性>90%的患者面神经功能明显更差（P<0.05），但两者治疗后的面神经功能差异无统计学意义（P>0.05）；颅中窝入路组和乳突入路组治疗前后面神经功能差异无统计学意义（P>0.05）。 结论：外伤性面神经麻痹病例应进行个体化的评估，面神经麻痹程度轻、神经变性比率低、病程短的患者可先行保守治疗并严密随访，对于面神经麻痹程度重、神经变性率高、病程超过6周的患者可积极考虑手术治疗；正确的评估、治疗可获得良好预后。.

Objective:To investigate the characteristics and prognosis of two anastomosis techniques in repairing facial nerve defects. Methods:A retrospective analysis was conducted on 30 patients who underwent facial nerve anastomosis（direct or rerouting） for facial nerve defects in our department from January 2012 to December 2021. Among them, 21 were male and 9 were female, with an average age of（37.53±11.33） years, all with unilateral onset. Preoperative House-Brackmann（H-B） facial nerve function grades were Ⅳ in 2 cases, Ⅴ in 9 cases, and Ⅵin 19 cases. The duration of facial paralysis before surgery was within 6 months in 21 cases, 6-12 months in 6 cases, and over 1 year in 3 cases. The causes of facial paralysis included 14 cases of cholesteatoma, 6 cases of facial neurioma, 6 cases of trauma, and 4 cases of middle ear surgery injury. Surgical approaches included 9 cases of the middle cranial fossa approach, 8 cases of labyrinthine-otic approach, 7 cases of mastoid-epitympanum approach, and 6 cases of retroauricular lateral neck approach. Results:All patients were followed up for more than 2 years. The direct anastomosis was performed in 10 cases: 6 cases with defects located in the extratemporal segment and 4 cases in the tympanic segment. Rerouting anastomosis was performed in 20 cases: 11 cases with defects located in the labyrinthine-geniculate ganglion, 4 cases from the internal auditory canal to the geniculate ganglion, 3 cases in the internal auditory canal, and 2 cases in the horizontal-pyramid segment. Postoperative H-B facial nerve grades were Ⅱ in 2 cases, Ⅲ in 20 cases, and Ⅳ in 8 cases, with 73.3%（22/30） of patients achieving H-B grade Ⅲ or better. Conclusion:Both direct and rerouting anastomosis techniques can effectively repair facial nerve defects, with no significant difference in efficacy between the two techniques. Most patients can achieve H-B grade Ⅲ or better facial nerve function recovery. Preoperative facial nerve function and duration of facial paralysis are the main prognostic factors affecting the outcome of facial nerve anastomosis.
目的：探讨分析2种吻合术修复面神经缺损的疗效及影响因素。 方法：回顾性分析2012年1月至2021年12月在我科行面神经吻合术（直接或改道）修复面神经缺损的30例患者临床资料，其中男21例，女9例，平均年龄（37.53±11.33）岁，均为单侧发病；术前H-B Ⅳ级2例、Ⅴ级9例、Ⅵ级19例；面瘫患者术前面瘫时间6个月以内21例，6～12个月6例，1年以上3例；面瘫原因包括胆脂瘤14例、面神经肿瘤6例、外伤6例、中耳手术损伤4例。手术入路包括颅中窝入路9例，迷路-耳囊入路8例，乳突-上鼓室入路7例，耳后颈侧入路6例。 结果：随访2年以上。术中采用直接吻合10例：缺损位于颞骨外段6例，水平-锥段4例；改道吻合20例：缺损位于迷路-膝状神经节11例，内听道至膝状神经节及水平段近端4例，内听道3例，水平-锥段2例。术后H-B面神经评分为Ⅱ级2例、Ⅲ级20例、Ⅳ级8例，73.3%（22/30）患者能达到H-B Ⅲ级或更好。 结论：面神经直接吻合术和改道吻合术均可修复面神经缺损，2种术式疗效无明显差异。多数患者能达到H-B Ⅲ级或更好。术前面神经功能评级及术前面瘫时间是影响面神经吻合效果的主要影响因素。.

Objective:To summarize and analyze the effect of facial nerve decompression surgery for the treatment of Bell\'s palsy and Hunt syndrome. Methods:The clinical data of 65 patients with facial nerve palsy who underwent facial nerve decompression in our center from October 2015 to October 2022 were retrospectively analyzed, including 54 patients with Bell\'s palsy and 11 patients with Hunter syndrome. The degree of facial paralysis（HB grade） was evaluated before surgery, and ENoG, pure tone audiometry, temporal bone CT and other examinations were completed. All patients had facial palsy with HB grade V or above after conservative treatment for at least 1 month, and ENoG decreased by more than 90%. All patients underwent facial nerve decompression surgery through the transmastoid approach within 3 months after onset of symptoms. The recovery effect of facial nerve function after surgery in patients with Bell\'s palsy and Hunter syndrome was summarized and analyzed. In addition, 15 cases in group A（operated within 30-60 days after onset） and 50 cases in group B（operated within 61-90 days after onset） were grouped according to the course of the disease（the interval between onset of symptoms and surgery） to explore the effect of surgical timing on postoperative effect. Results:There was no significant difference between the two groups of patients with Chi-square test（P=0.54） in 42 patients（77.8%, 42/54） with Bell\'s palsy and 7 patients（63.6%, 7/11） in patients with Hunter syndrome who recovered to grade Ⅰ-Ⅱ. According to the course of the disease, 10 cases（66.7%, 10/15） in group A recovered to grade Ⅰ-Ⅱ after surgery. In group B, 39 patients（78.0%, 39/50） recovered to grade Ⅰ-Ⅱ after surgery, and there was no statistically significant difference between the two groups by Chi-square test（P=0.58）. Conclusion:Patients with Bell\'s palsy and Hunter syndrome can achieve good results after facial nerve decompression within 3 months of onset, and there is no significant difference in the surgical effect between the two types of patients.
目的：总结分析面神经减压术治疗贝尔面瘫和亨特综合征的效果。 方法：回顾性分析2015年10月至2022年10月接受面神经减压术治疗的65例面神经麻痹患者的临床资料：贝尔面瘫54例，亨特综合征11例；术前评估患者面瘫程度（HB分级）并完成面神经电图（ENoG）、纯音测听、颞骨CT等检查。所有患者接受手术标准均为保守治疗至少1个月效果不佳，HB分级在Ⅳ级以上，ENoG下降超过90%，并且在发病3个月内接受经乳突入路面神经减压术。总结分析贝尔面瘫和亨特综合征两类患者术后面神经功能恢复效果；并且按病程（从发病到手术的间隔时间）分组：A组（发病30～60 d接受手术）15例，B组（发病61～90 d接受手术）50例，探讨手术时机对术后效果的影响。 结果：贝尔面瘫患者术后恢复至Ⅰ～Ⅱ级42例（77.8%，42/54），亨特综合征患者术后恢复至Ⅰ～Ⅱ级7例（63.6%，7/11），经χ²检验（P=0.54）两类患者比较差异无统计学意义。按病程分组，A组术后恢复至Ⅰ～Ⅱ级10例（66.7%，10/15）；B组术后恢复至Ⅰ～Ⅱ级39例（78.0%，39/50），经χ²检验（P=0.58）2组患者比较差异无统计学意义。 结论：贝尔面瘫和亨特综合征患者在发病3个月内接受面神经减压术均可获得良好效果，且两类患者手术效果无显著差异。.