UNASSIGNED: Melkersson-Rosenthal syndrome can cause recurring bilateral facial paralysis. When steroids fail, surgical decompression of facial nerve is recommended, with endoscopic trans-canal decompression as a safe, minimally invasive, and effective option.
UNASSIGNED: Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder, clinically diagnosed by a triad of orofacial swelling, recurrent facial palsy, and fissured tongue. Due to the lack of a comprehensive understanding of MRS, there is no accepted standard of care. In this study we report a 30-year-old female patient, who was referred to the otolaryngology clinic of Rasool Akram Hospital, with classical triad of MRS that was managed by endoscopic trans-canal facial nerve decompression. Bilateral endoscopic trans-canal facial nerve decompression was done when we did not find any improvement with systemic steroids. Endoscopic trans-canal facial nerve decompression could be a safe, reliable minimal invasive treatment of facial paralysis in MRS patients. It needs no external incision or temporal bone drilling which makes this method more convenient for patients with shorter recovery time.

Lyme borreliosis (LB) is a complex tick-borne illness with diverse presentations. We report a case of LB meningitis with herpes simplex virus-1 (HSV-1) co-infection in a 55-year-old woman initially presenting with isolated facial nerve palsy. This case illustrates the multifaceted diagnostic challenges associated with Lyme co-infections. It emphasizes the need for thorough testing to identify all potential pathogens and the importance of differentiating between true co-infection and incidental HSV-1 reactivation. Understanding these complexities is crucial for guiding appropriate treatment decisions.

Background Facial nerve paralysis, leading to the loss of facial expression, poses significant discomfort to patients. While most individuals exhibit a favorable response to treatment, a subset experiences enduring facial deformities without clearly defined etiology. This study aimed to identify prognostic factors influencing outcomes and quality of life in facial nerve palsy patients, contributing to enhanced clinical management. Methods A prospective observational study was conducted in the Otorhinolaryngology Department of Maharaja Krishna Chandra Gajapati Medical College and Hospital, a tertiary care hospital. We included patients presenting with any clinical variety of facial nerve palsy, irrespective of age and gender. Only moribund and noncompliant cases were excluded. Patients underwent clinical assessment using the House-Brackmann (HB) grading at presentation and were subsequently monitored at three weeks, three months, and six months post-onset to assess recovery. Results Out of 66 patients, 18 (27.27%) fully recovered at three weeks, 50 (75.76%) recovered at three months, and 54 (81.82%) at six-month follow-up. Incomplete recovery was observed in 13 (19.69%) patients. Factors associated with favorable outcomes included younger age of onset (p = 0.003), lower baseline HB grade (IV or less) (p = 0.001), Electroneurography Degeneration Index (ENoG DI) of <70% (p < 0.0001), early initiation of treatment (within five days of onset) (p = 0.0003), and absence of comorbid conditions (p = 0.03). Gender and affected side (left or right) did not influence the outcome. Conclusion In summary, age, associated comorbid conditions, baseline HB grade, and extent of facial nerve degeneration are crucial predictors of outcomes in facial nerve palsy. This knowledge can guide clinicians in optimizing treatment strategies for improved patient care.

OBJECTIVE: To establish and validate a clinical prediction model of acupuncture and moxibustion for Bell\'s palsy so as to provide a tool for predicting the effect of acupuncture and moxibustion on Bell\'s palsy.
METHODS: A total of 269 patients with Bell\'s palsy were collected from department of acupuncture, moxibustion and tuina, Shengli Oilfield Central Hospital, neurology department, Shenxian County Central Hospital and department of rehabilitation medicine, Dongying Municipal Hospital of TCM from June 2018 to June 2023. All of these cases were treated with acupuncture and moxibustion. Of them, 182 cases, from department of acupuncture, moxibustion and tuina, Shengli Oilfield Central Hospital and neurology department, Shenxian County Central Hospital, were randomized into a training group (128 cases) and an internal validation group (54 cases); 87 cases from department of rehabilitation medicine, Dongying Municipal Hospital of TCM were assigned to an external validation group. The clinical data of all of the cases were extracted from the electronic medical record information platform. Using SPSS25.0 and R4.2.3, through univariate and multivariate Logistic regression analysis, the independent factors influencing the effects of acupuncture and moxibustion on Bell\'s palsy were identified. By means of internal and external validations, the receiver operating characteristic curve (ROC), the goodness-of-fit curve (GFC) and the decision curve analysis (DCA) were plotted. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the model were calculated; and its comprehensive performance was evaluated.
RESULTS: The results of the multivariate Logistic regression analysis showed that the independent factors for the unsatisfactory effect on Bell\'s palsy were advanced age, severe symptoms before treatment, no use of steroids within 72 h of onset, and lack of acupuncture-moxibustion therapy during the acute phase or single acupuncture-moxibustion protocol (P<0.05, P<0.01). Based on these factors, nomogram model and online columnar plot prediction tool (https://bmuchen.shinyapps.io/dynnomapp/) were established. The area under the ROC curve of the model was 0.921 (95% CI: 0.877, 0.966), 0.876 (95% CI: 0.787, 0.966), and 0.846 (95% CI: 0.766, 0.926) in the training group, the internal validation group, and the external validation group, respectively, indicating good predictive value. The model showed a satisfactory calibration curve alignment. The decision threshold in the range of 0 to 0.8 provided clinical benefits for participants. The model exhibited the sensitivity from 65.9% to 88.0%, the specificity ranging from 77.3% to 90.7%, the accuracy from 77.8% to 85.9%, the positive predictive value from 83.3% to 90.1%, and the negative predictive value from 70.8% to 78.7%. The comprehensive evaluation indicated a satisfactory clinical application value of the model.
CONCLUSIONS: The clinical prediction model of acupuncture and moxibustion for Bell\'s palsy is valuable in its practice and promotion to a certain extent. The predicted results are conductive to clinicians\' judgement of the effect of acupuncture and moxibustion for this disease and making effective and high-quality clinical decisions, as well as formulating the optimal therapeutic regimen.
目的：构建并验证针灸治疗贝尔面瘫的临床预测模型，为针灸治疗贝尔面瘫的疗效预测提供工具。方法：纳入2018年6月至2023年6月于胜利油田中心医院针灸推拿科、莘县中心医院神经内科和东营市中医院康复科就诊，并以针灸为主要治疗方式的贝尔面瘫患者269例，将胜利油田中心医院针灸推拿科、莘县中心医院神经内科182例患者随机分为训练组（128例）和内部验证组（54例），东营市中医院康复科患者作为外部验证组（87例），通过电子病历信息平台提取患者临床资料。采用SPSS25.0和R4.2.3软件，通过单因素和多因素Logistic回归分析，筛选出针灸治疗贝尔面瘫疗效的独立影响因素。并通过内部验证和外部验证的方式，绘制受试者工作特征曲线（ROC）、拟合度曲线和临床决策曲线（DCA），计算模型的灵敏度、特异度、准确度、阳性预测值和阴性预测值，全面评估模型的整体性能。结果：多因素Logistic回归分析结果显示，高龄、治疗前病情重、未在发病72 h内使用激素治疗、急性期未进行针灸和针灸方案单一是针灸治疗贝尔面瘫疗效不佳的独立影响因素（P<0.05，P<0.01）。基于此构建了列线图模型和在线列线图预测工具（https://bmuchen.shinyapps.io/dynnomapp/）。模型在训练组、内部验证组和外部验证组的ROC曲线下面积（AUC）分别是0.921（95%CI：0.877，0.966）、0.876（95%CI：0.787，0.966）和0.846（95%CI：0.766，0.926），具有良好的预测价值。模型与校准曲线贴合较好。决策曲线阈值在0~0.8之间时，可为临床参与者提供临床获益。模型的灵敏度在65.9%~88.0%、特异度在77.3%~90.7%、准确度在77.8%~85.9%、阳性预测值在83.3%~90.1%、阴性预测值在70.8%~78.7%，综合评估该模型的临床应用价值较好。结论：针灸治疗贝尔面瘫的临床预测模型具有一定的实际应用价值和可推广性，预测结果可以辅助临床医师对针灸治疗贝尔面瘫的疗效进行判定，做出有效优质的临床决策，制定最佳的治疗计划。.

OBJECTIVE: Depressor anguli oris (DAO) excision can improve clinician-graded, objective, and patient-reported smile outcomes in patients with nonflaccid facial paralysis (NFFP). However, no prior research has studied changes in perceived emotions after surgery. This study quantifies changes in perceived emotions with smiling after DAO excision in the largest case series presented to date.
METHODS: Prospectively collected data from patients with NFFP who underwent DAO excision at a tertiary care facial nerve center were reviewed. Patient-reported, clinician-graded, and objective smile metrics were compared before and after surgery. Videos of faces at rest and while smiling were analyzed by artificial intelligence-derived facial expression analysis software to quantify perceived emotions.
RESULTS: Sixty-eight patients underwent isolated DAO excision between August 2021 and August 2023. Patients conveyed significantly more perceived happiness with smile and at rest after surgery (p < 0.001 and p = 0.012, respectively). DAO excision improved oral commissure excursion (p < 0.001), dental show (p < 0.001), and smile angle (p < 0.001) symmetry. Patients reported significant improvements in smiling and social function after surgery.
CONCLUSIONS: This study demonstrates DAO excision increases perceived happiness conveyed by patients with NFFP while smiling and at rest. It confirms improved objective, clinician-graded, and patient-reported smile outcomes after surgery.
METHODS: Level 4 Laryngoscope, 2024.

Neurolymphomatosis (NL) is a rare complication of non-Hodgkin\'s lymphoma, characterized by the infiltration of lymphoma cells into the peripheral nerves. A 54-year-old woman initially presented with right facial palsy without any other significant symptoms and was diagnosed with Bell\'s palsy. Despite initial improvement, her condition recurred, prompting further evaluation. Magnetic resonance imaging (MRI) revealed contrast enhancement from the tympanic segment to the surface of the masseter muscle along the right facial nerve and an adjacent mass lesion. Biopsy of the mass revealed a diagnosis of T-cell/histiocyte-rich large B-cell lymphoma. Chemotherapy resulted in complete resolution of facial palsy. Follow-up MRI confirmed the absence of contrast enhancement along the facial nerve. Facial palsy was considered to be caused by NL. This case was classified as that of primary NL because the facial palsy was the first manifestation of a hematologic malignancy. Recurrent facial palsy, which is atypical in Bell\'s palsy, led to further evaluation with MRI, which finally resulted in the diagnosis of malignant lymphoma. In cases of recurrent facial palsy, clinicians should consider various diagnoses, including that of NL, and advocate early imaging tests and biopsy, if possible, for accurate diagnosis and improved outcomes.

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。.

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.
CONCLUSIONS: 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.

OBJECTIVE: Bell\'s palsy, also referred to as clinical manifestations of unilateral facial nerve palsy, encompasses downward angling of the corners of the mouth, the absence of forehead creases, and unilateral incomplete eyelid closure. The incidence of Bell\'s palsy has increased progressively in recent years, but the underlying mechanism of its occurrence remains unknown; therefore, it is essential to investigate both the cause and treatment of Bell\'s palsy. Member 2 of the Subfamily V Transient Receptor Potential Cation Channel is a mechanically and thermally sensitive ion channel that plays a crucial role in neural growth and development. Using a novel modeling technique, we endeavored to develop an animal model of Bell\'s palsy and determine whether TRPV2 expression is altered throughout the course of a facial nerve injury.
METHODS: The rats were categorized into 3 groups, and their facial nerve function was assessed using RT-qPCR, WB, and pathologic testing, respectively, after undergoing unilateral cold air stimulation for 1, 3, and 7 days. TRPV2 expression was identified using these techniques.
RESULTS: In response to cold stimulation, rats exhibited facial nerve paralysis symptoms, demyelinating lesions in the facial nerve, and increased TRPV2 expression.
CONCLUSIONS: Extended cold stimulation of the facial nerve in rats may lead to an imbalance in facial nerve homeostasis and increased TRPV2 expression. These findings will contribute to the understanding of the potential mechanism by which cold stimulation affects the facial nerve. Moreover, this finding implies that TRPV2 could possibly function as an additional diagnostic marker or therapeutic target in the context of Bell\'s palsy.

BACKGROUND: Prior studies have reported a potential relationship between depressive disorder (DD), immune function, and inflammatory response. Some studies have also confirmed the correlation between immune and inflammatory responses and Bell\'s palsy. Considering that the pathophysiology of these two diseases has several similarities, this study investigates if DD raises the risk of developing Bell\'s palsy.
METHODS: This nationwide propensity score-weighting cohort study utilized Taiwan National Health Insurance data. 44,198 patients with DD were identified as the DD cohort and 1,433,650 adult subjects without DD were identified as the comparison cohort. The inverse probability of treatment weighting (IPTW) strategy was used to balance the differences of covariates between two groups. The 5-year incidence of Bell\'s palsy was evaluated using the Cox proportional-hazard model, presenting results in terms of hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS: The average age of DD patients was 48.3 ± 17.3 years, and 61.86% were female. After propensity score-weighting strategy, no significant demographic differences emerged between the DD and comparison cohort. The Cox proportional hazards model revealed a statistically significant adjusted IPTW-HR of 1.315 (95% CI: 1.168-1.481) for Bell\'s palsy in DD patients compared to comparison subjects. Further independent factors for Bell\'s palsy in this model were age (IPTW-HR: 1.012, 95% CI: 1.010-1.013, p < 0.0001), sex (IPTW-HR: 0.909, 95% CI: 0.869-0.952, p < 0.0001), hypertension (IPTW-HR: 1.268, 95% CI: 1.186-1.355, p < 0.0001), hyperlipidemia (IPTW-HR: 1.084, 95% CI: 1.001-1.173, p = 0.047), and diabetes (IPTW-HR: 1.513, 95% CI: 1.398-1.637, p < 0.0001) CONCLUSION: This Study confirmed that individuals with DD face an elevated risk of developing Bell\'s palsy. These findings hold significant implications for both clinicians and researchers, shedding light on the potential interplay between mental health and the risk of certain physical health outcomes.