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Facial Nerve Paralysis Causes

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141. Shingles

complications (such as necrotizing fasciitis and sepsis) [ ]. Herpes zoster oticus (Ramsay Hunt syndrome) — occurs when the virus infects the facial nerve (cranial nerve VII). It is characterized by lesions in the ear, facial paralysis, and associated hearing and vestibular symptoms [ ; ; ; ]. Herpes zoster ophthalmicus — occurs when the virus infects the ophthalmic division of the trigeminal nerve. Complications include keratitis, corneal ulceration, conjunctivitis, optic neuritis, retinitis, glaucoma (...) Shingles Shingles - NICE CKS Share Shingles: Summary Shingles (herpes zoster) is a viral infection of an individual nerve and the skin surface that is served by the nerve (dermatome). It is caused by the reactivation of the varicella-zoster virus, the virus which causes chicken pox. The incidence (and severity) of shingles increase with age. Other risk factors include immunocompromise (for example due to long-term corticosteroid use; HIV infection; lymphoproliferative malignancies

2018 NICE Clinical Knowledge Summaries

142. Otitis externa

. The complications of malignant otitis include: Facial nerve paralysis. Meningitis. [ ; ; ] Prognosis What is the prognosis for people with otitis externa? Acute diffuse otitis externa: Symptoms of acute otitis externa usually improve within 48–72 hours of initiation of treatment. Between 65–90% of patients with uncomplicated diffuse otitis externa have clinical resolution within 7 to 10 days, regardless of the topical medicine used. Localized otitis externa: Folliculitis may heal on its own after an initial (...) . Malignant otitis . Neoplasm — if there is a swelling in the ear canal that bleeds easily on contact. Compared with localized otitis externa, there is less pain and the onset is slower. Referred pain — may originate from the sphenoidal sinus, teeth, neck, or throat. Ramsay Hunt syndrome — a form of herpes zoster affecting the facial nerve, associated with facial paralysis and loss of taste, which can also produce pain in the ear and other areas supplied by the nerve. Barotrauma — consider this in people

2018 NICE Clinical Knowledge Summaries

143. Otitis media - acute

those who are subject to passive smoking, attend daycare or nursery, are formula-fed, or have craniofacial abnormalities (such as cleft palate). Complications of AOM include recurrence of infection, hearing loss, tympanic membrane perforation, and rarely, mastoiditis, meningitis, intracranial abscess, sinus thrombosis, and facial nerve paralysis. In older children and adults, AOM usually presents with earache. Younger children may hold or rub their ear, or may have non-specific symptoms (...) , mastoiditis, intracranial abscess, sinus thrombosis, or facial nerve paralysis. Children younger than 3 months of age with a temperature of 38°C or more. Management of persistent AOM involves: Reassessing the person. Considering the need for paediatric or ENT referral or admission, depending on the clinical situation. Considering a first-line antibiotic (if not already prescribed) or a second-line antibiotic if the initial treatment was ineffective. Measures to prevent recurrent AOM include: In children

2018 NICE Clinical Knowledge Summaries

144. Management of Bell palsy: clinical practice guideline

Management of Bell palsy: clinical practice guideline B ell palsy is an idiopathic weakness or paralysis of the face of peripheral nerve origin, with acute onset. It affects 20–30 persons per 100 000 annually, and 1 in 60 indi- viduals will be affected over the course of their lifetime. 1,2 The major cause of Bell palsy is believed to be an infection of the facial nerve by the herpes simplex virus. 3 As a result of this viral infection, the facial nerve swells and is compressed in its canal (...) weakness. (Strong recommendation: very low confidence in estimates.) We identified no randomized or observational studies comparing outcomes for patients with Bell palsy who were and were not referred to a special- ist. Therefore, our confidence in the effect estimates was very low. For patients with no improvement in facial nerve function or progression of facial nerve paralysis, referral to an otolaryngologist may be reasonable to confirm the diagnosis and to exclude other conditions. Referral

2014 CPG Infobase

145. CRACKCast E044 – Neck Trauma

Brown sequard syndrome: Ipsilateral hemiplegia and contralateral sensory changes Direct injury to the spinal cord – more common in GSW’s but still quite rare Direct injury to the recurrent laryngeal nervecausing hoarseness with paralysis of the ipsilateral vocal cord Thoracic Duct/glandular/retropharyngeal injuries Thoracic duct damage presents as a chylothorax Endocrine gland damage – rare This episode was copy-edited and uploaded by Ross Prager (@ross_prager) (Visited 3,683 times, 3 visits (...) with neck trauma → this may lead to massive SC emphysema and possible air embolism 5) Describe techniques for airway management in penetrating neck trauma Airway considerations: Orotracheal RSI Should be considered the first line technique Usually successful even in neck trauma with airway distortion contraindications to oro-RSI: Massive facial trauma Laryngotracheal injury ***consider doing an awake look (+/- inline stabilization if C-spine injury) prior to paralysis Important to have backup plans

2016 CandiEM

146. Management of Nasopharyngeal Carcinoma

-2 The survival rate is higher in rT1 (49.1% to 73%) and rT2 (24.7% to 40%) compared with higher T staging. 42, level II-3; 44, level II-2 Transient complications of nasopharyngectomy such as palatal fistula and submandibular necrosis may resolve spontaneously or require further intervention. 42, level II-3; 44, level II-2 Uncommon complications are: • permanent morbidities due to nerve injury (paralysis causing dysphagia) and severe trismus 42, level II-3; 44, level II-2 • mortality caused (...) , facial numbness, diplopia, ptosis, trismus, dysphagia or hoarseness of voice. The most common cranial nerve involvement is 5 th followed by 6 th , 3 rd , 4 th and others. The images of these symptoms can be viewed in Appendix 3. Majority of NPC patients in Malaysia present with advanced stage (Stages III/IV) at the time of diagnosis (75 - 85%). This is due to lack of awareness of NPC symptoms and signs among patients and doctors. 4, level III; 6, level III; 8, level III 3.2 Referral

2016 Ministry of Health, Malaysia

147. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient

, pyridostigmine, and edrophonium all inhibit acetylcholinesterase; the concentration of acetylcholine increases and competes with an NMBA at the nicotinic receptor, thereby antagonizing NMBA action ( ). The organophosphate pesticides and the chemical nerve agents (e.g., sarin) bind more permanently to and inhibit acetylcholinesterase, producing weakness, fasciculations, and paralysis due to the unopposed actions of acetylcholine on the nicotinic receptor ( ). | Up-Regulation and Down-Regulation (...) ( , , ). The effect on heart rate depends on the patient’s dominant tone, which, at rest, is generally vagal (M 2 muscarinic), thus resulting in tachycardia ( ). | Sympathetic, Ganglionic, or Muscarinic Stimulation. Sympathetic stimulation from pancuronium releases norepinephrine, causing tachycardia ( , ). Vecuronium causes bradycardia via ganglionic or muscarinic stimulation of the vagus nerve ( , ). | INDICATIONS FOR THE USE OF NMBAs Acute ARDS. I. Among adult patients with ARDS, should an NMBA be administered

2016 Society of Critical Care Medicine

148. Assessing Fitness to Drive

physical capability. A range of medical conditions, disabilities and treatments may influence these driving prerequisites. Such impairment may adversely affect driving ability, possibly resulting in a crash causing death or injury. The primary purpose of this publication is to increase road safety in Australia by assisting health professionals to: • assess the fitness to drive of their patients in a consistent and appropriate manner based on current medical evidence • promote the responsible behaviour (...) of a driver licensing authority or industry accreditation body. Health professionals may be requested to undertake a medical examination of a driver for a number of reasons. This may be: - for initial licensing of some vehicle classes (e.g. multiple combination heavy vehicles) - as a requirement for a conditional licence - for assessing a person whose driving the driver licensing authority believes may be unsafe (i.e. for cause examinations) - for licence renewal of an older driver (in certain states

2016 Cardiac Society of Australia and New Zealand

149. CRACKCast E041 – Head Injury

of elevated hydrostatic forces and and increased capillary permeability due to the primary brain injury A systemic inflammatory reaction Key goal is to lower ICP CLOSE ventilator management is essential 7) What are 7 clinical features of basal skull fracture? Basilar skull fracture findings: see box 41-1: Blood in ear canal Hemotympanum Rhinorrhea Otorrhea Battle’s sign (retro auricular hematoma) Raccoon’s sign (periorbital ecchymosis) Cranial nerve deficits: Facial paralysis Decreased auditory acuity (...) to assess seizure activity because of: low GCS, paralysis, Meds: Phenytoin or fosphenytoin No recommendations to suggest long term prophylaxis – this depends on their clinical course TBI is thought to account for 20% of adults with epilepsy – and late seizures may present up to 12 yrs post injury CNS infections Meningitis after basilar skull fractures Fever, AMS, focal findings, Common in people with CSF leaks Fever occurs within 3 days of injury Caused by pneumococcus Trxt: ceftriaxone and vancomycin

2016 CandiEM

150. Isavuconazonium sulfate (BAL8557) (Cresemba)

Patients 45 Table 13: Summary of Demographics and Baseline Characteristics (ITT Population - Study 9766-CL-0104) 51 Table 14: DRC Assessment of Pathogen Causing IFD at Baseline (mITT Population .. 53 Table 15: DRC-assessed location of IFD at baseline for the mITT population, Study 9766-CL-0104 54 Table 16: Study Drug Duration (ITT Population - Study 9766-CL-0104) 54 Table 17: Description of Patients Randomized, but Not Treated in Study 9766-CL-0104 (N=11) 55 Table 18: Primary Reasons (...) for Discontinuation Duringduring Treatment and Follow-up Periods (ITT Population), Study 9766-CL-0104 56 Table 19: Characterization of Analysis Populations, Study 9766-CL-0104 57 Table 20: Patients from ITT Population Excluded from Analysis per PPS Criterion, Study 9766-CL-0104 58 Table 21: All-cause Mortality Through Day 42 Primary Endpoint, Study 9766-CL-0104 59 Table 22: All-cause Mortality through Day 42 by Diagnostic Group, Study 9766-CL-0104 60 Table 23: All-cause Mortality through Day 84, Study 9766-CL

2014 FDA - Drug Approval Package

151. Early Management of Head Injury in Adults

ecchymosis (“Battle’s sign”), cerebrospinal fluid leakage either from the nose [cerebral spinal fluid (CSF) rhinorhoea] or ear (CSF otorhoea), or seventh and eighth cranial nerves deficits causing facial paralysis and hearing loss respectively.5 Early Management of Head Injury in Adults 3. CLASSIFICATION OF SEVERITY The severity of head injury can be classified according the presenting Glasgow Coma Score (GCS): 9 level III • mild head injury (MHI): GCS 13 - 15 • moderate head injury: GCS 9 - 12 • severe (...) ) accounted for 75% of cases with motorcyclists being most commonly injured. The younger age group of 15 - 34 years old (56.6%) is at highest risk of major trauma. A high proportion of those with major trauma (85%) had injuries to the head and neck with Abbreviated Injury Scale (AIS) =3. 1, level III Injury was the fifth (7.86%) commonest cause of hospitalisation in Malaysian public hospitals in 2014 2, level III with RTA being the commonest cause of injury-related hospitalisation. Apart from that, head

2015 Ministry of Health, Malaysia

152. Resources for flooding and poor water sanitation

of symptoms and infection. Onchocerciasis (river blindness) Ivermectin can prevent damage to the front of the eye but its effectiveness in preventing blindness remains uncertain. Onchocerciasis causes severe itching and thickening of the skin, and damages structures at the front and back of the eye. It also affects the nerve that connects the eye with the brain. Onchocerciasis is caused by tiny worms that are transmitted from person to person by a small biting fly. The fly breeds in fast-flowing rivers (...) Collection. The burden caused by natural disasters adds to the existing burden of morbidity and mortality from diarrhoeal diseases. According to the World Health Organization (WHO), diarrhoeal disease is the second leading cause of death in children under five years old and kills 1.5 million children each year.(2) Cochrane systematic reviews can contribute to the use of effective interventions to prevent and treat water-related diseases, and they have also examined interventions to improve sanitation

2014 Evidence Aid

153. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia Full Text available with Trip Pro

or primary causes such as hyperthyroidism or anemia. Atrial tachycardia (AT) • Focal AT An SVT arising from a localized atrial site, characterized by regular, organized atrial activity with discrete P waves and typically an isoelectric segment between P waves. At times, irregularity is seen, especially at onset (“warm-up”) and termination (“warm-down”). Atrial mapping reveals a focal point of origin. • Sinus node reentry tachycardia A specific type of focal AT that is due to microreentry arising from (...) and are discussed only briefly in this document (Section 7). • Manifest accessory pathways A pathway that conducts anterogradely to cause ventricular pre-excitation pattern on the ECG. • Concealed accessory pathway A pathway that conducts only retrogradely and does not affect the ECG pattern during sinus rhythm. • Pre-excitation pattern An ECG pattern reflecting the presence of a manifest accessory pathway connecting the atrium to the ventricle. Pre-excited ventricular activation over the accessory pathway

2015 American Heart Association

154. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

interventions) to low-risk peripheral nerve blocks ( ). The ASRA guidelines may be appropriate for the low- or intermediate-risk category, but the high-risk targets require a more intensive look at the issues specific to patient safety and improved outcomes. For example, SCS lead placement requires the use of large gauge needles with a long bevel and stiff styletted leads to enhance directional control. In many cases, the technique is simple with little tissue stress produced to the region; but in some (...) a multifactorial etiology, certain anatomic features may pose higher risks secondary to the anatomy and vascular supply of that specific spinal location. It is important for interventional pain physicians to apply knowledge of spinal and epidural anatomy during preprocedural planning. Contents of the epidural space include the epidural fat, dural sac, spinal nerves, extensive venous plexuses, lymphatics, and connective tissue (eg, plica mediana dorsalis and scar tissue after previous surgical intervention

2015 American Society of Regional Anesthesia and Pain Medicine

155. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS)

cause, score 3. Double simultaneous stimulation is performed at this point. If there is extinction, the patient receives a 1, and the results are used to answer question 11. 0,Novisualloss;1,partialhemianopia;2,complete hemianopia; 3, bilateral hemianopia (blind including cortical blindness). (Continued) Wojak et al ’ JVIR 1600 ’ Quality Improvement Update: Diagnostic Cervicocerebral AngiographyTable 2. National Institutes of Health Stroke Scale (Continued) Instruction Scale De?nition 4. Facial (...) palsy Ask or use pantomime to encourage the patient to show his or her teeth or smile and close his or her eyes. Score the symmetry of a grimace in response to noxious stimuli in the poorly responsive or noncomprehending patient. If facial trauma/bandages, orotracheal tube, tape, or other physical barrier obscures the face, they should be removed to the extent possible. 0, Normal symmetrical movement; 1, minor paralysis (?attened nasolabial fold, asymmetry onsmiling); 2, partialparalysis(totalor

2015 Society of Interventional Radiology

156. Acute Pain Management: Scientific Evidence

-injection peripheral nerve blocks 211 5.8.2 Periarticular and intra-articular analgesia 216 5.8.3 Wound infiltration including wound catheters 217 5.8.4 Topical application of local anaesthetics 217 5.8.5 Safety 218 5.9 Regional analgesia and concurrent anticoagulant medications 221 5.9.1 Neuraxial block and epidural haematoma 221 5.9.2 Plexus and other peripheral regional block and anticoagulants 223 References 223 6. PATIENT-CONTROLLED ANALGESIA 241 6.1 Efficacy of intravenous PCA 241 6.1.1 Analgesia (...) Cognitive-behavioural interventions 262xvii CONTENTS 7.2 Transcutaneous electrical nerve stimulation 265 7.3 Acupuncture and acupressure 265 7.3.1 Postoperative pain 265 7.3.2 Other acute pain states 267 7.4 Physical therapies 269 7.4.1 Manual and massage therapies 269 7.4.2 Warming and cooling intervention 270 7.4.3 Other therapies 271 References 271 8. SPECIFIC CLINICAL SITUATIONS 279 8.1 Postoperative pain 279 8.1.1 Multimodal postoperative pain management 279 8.1.2 Procedure-specific postoperative

2015 Clinical Practice Guidelines Portal

157. Bell’s palsy: facing up to uncertainty

causes this paralysis of the facial nerve and there are also uncertainties about how best to treat it. Corticosteroids may be prescribed, to reduce inflammation and limit nerve damage. A viral cause has been suggested so antiviral drugs may be used to treat it and there are other options too. Even without treatment, the paralysis is usually temporary, but recovery can take weeks or months and about one in five people are left with some permanent disfigurement or pain. There are several Cochrane (...) moderate and low quality evidence that: adding antivirals to corticosteroids was more effective than corticosteroids alone for treating Bell’s palsy of varying levels of severity and was associated with fewer long-term after-effects of Bell’s palsy for people with severe Bell’s palsy (with complete or almost complete facial paralysis) adding antivirals to corticosteroids was slightly more effective corticosteroids alone were more effective than antivirals alone corticosteroids plus antivirals were more

2015 Evidently Cochrane

158. Endoscope-Assisted Open Reduction And Internal Fixation of Mandibular Subcondylar Fractures Is a Reliable and Comparable Technique to an Extraoral Surgical Approach

, or deviation on opening at the 6-month follow-up. However, one patient treated with the extraoral approach had facial palsy or paralysis at the 6-month follow-up. #3) Haug/2004 13 EAORIF studies (126 patients); 58 extraoral surgical studies (2900 patients) Narrative Review Key results Traditional ORIF and EORIF showed similar results for functional measurements such as maximum interincisal opening, lateral/protrusive excursions, and deviation upon opening at follow-up. Facial nerve palsy was more likely (...) . Comparable functional results were noted in both transoral and extraoral groups without any statistical significant difference; however, an extraoral approach tended to have a greater number of facial nerve injuries. On the other hand, the extraoral approach had an average quicker operation time. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Schmelzeisen/2009 74 patients Randomized Controlled Trial Key

2015 UTHSCSA Dental School CAT Library

159. A case report of the rare fifteen-and-a-half syndrome. Full Text available with Trip Pro

A case report of the rare fifteen-and-a-half syndrome. The dorsal tegmentum of the caudal pons, including the medial longitudinal fasciculus (MLF), the paramedian pontine reticular formation (PPRF), abducens nucleus, and the adjacent facial nerve is the anatomical basis of the the fifteen and a half syndrome (15½) syndrome. No patients of 15½ Syndrome presenting with bilateral peripheral facial paralysis and one-and-a-half simultaneously at the onset have been reported up to now.A 54-year-old (...) , plaque stabilization, free radicals elimination, circulation improvement, nerves nourishment, and other symptomatic treatments.Two months later, her ocular movement recovered, and the bilateral facial paresis showed some improvement.First, our patient with 15½ syndrome maybe one of mutants whose bilateral pontine tegmentum is supplied by unilateral pontine paramedian perforator artery. Second, DWI combined with ADC may be applied in the diagnosis of fifteen-and-half syndrome when the lesions

2019 Medicine

160. Burns and scalds

haemoglobin, which may present with haematuria. See the CKS topic on for more information. Limb loss — high-voltage burns (more than 1000 volts) may cause extensive, deep tissue damage and limb loss. Death — may result from severe, extensive burns or electric shock (currents of more than 70,000 volts may cause cardiac arrhythmias, paralysis of respiratory muscles, and are usually fatal). Later complications Wound infection. See the CKS topic on for more information. Chronic neuropathic pain and itch (...) this may lead to further tissue injury, necrosis, and hypothermia [ ; ]. Elevation of the injury to reduce the risk of oedema is important, as oedema can affect mobilization, cause joint stiffness, and may delay healing [ ]. Cling film is an ideal temporary dressing as it is easily available, pliable, non-adherent, and transparent [ ]. Covering the burn with cling film after cooling helps prevent bacterial colonization, prevents wound desiccation, and may help to relieve pain from exposed nerve endings

2017 NICE Clinical Knowledge Summaries

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