Facial diplegia (FD) rarely occurs as a regional Guillain-Barré syndrome (GBS) variant. A 70-yearold male presented with bifacial weakness that had started on the left side and extended to the right after several days. He was then treated using steroids and gradually improved. Serum antiganglioside antibody testing revealed positivity for anti-GM1 IgG antibodies. FD can be idiopathic, but it is an uncommon GBS variant. The ganglioside antibody test may increase the possibility of diagnosing isolated FD.

Peripheral facial palsy is often reported after surgery for head or neck tumors and otolaryngologic surgery, but the occurrence of facial nerve palsy after dental procedures is very rare. A 29-year-old man visited our clinic with right-side facial asymmetry and right facial weakness 7 days before. The patient underwent dental treatment 8 days ago. He exhibited weakness of the right side of his face and was unable to close his right eye. He was diagnosed with right-sided peripheral type facial nerve paralysis and treated with an antiviral agent and prednisolone, and the symptoms gradually improved. Facial nerve palsies after dental procedures have been reported in foreign countries, but these cases have been very rarely reported in Korea. We also reported on the efficacy of the conventional treatment of facial nerve palsy after a dental procedure.

Bell’s palsy is an acute peripheral facial paralysis with no detectable cause. Although the prognosis of Bell’s palsy is generally good, some patients experience poor recoveries and there is no established treatment for those that do not recover even after receiving the conventional treatment. Here we present two cases of refractory Bell’s palsy with facial nerve enhancement in magnetic resonance imaging who showed symptomatic improvement after the late administration of high-dose intravenous methylprednisolone.

Citations

• Development of the Korean Medicine Core Outcome Set for Facial Palsy: herbal medicine treatment of patients with facial palsy in primary clinics
  Soo-Dam Kim, Sungha Kim, Mi Ju Son, Jiyun Cha, Pyung-Wha Kim, Mi Mi Ko, Soobin Jang, Changsop Yang, Myeong Soo Lee
  Frontiers in Medicine.2024;[Epub]     CrossRef

A 64-year-old man presented with facial diplegia occurring 2 weeks after scrub typhus diagnosis. The serum scrub typhus antibody titer was elevated to 1:5120. Brain magnetic resonance imaging revealed contrast-enhancement of the signal for both facial nerves. He was administered prednisolone. After two weeks, the symptoms improved, and after one month, he completely recovered from facial diplegia. This is the first case in the literature in which the patient exhibited facial diplegia, a delayed complication, in scrub typhus. Facial diplegia should be considered a type of cranial nerve palsy that may occur as a delayed complication of scrub typhus.

Citations

• Progressive Bulbar Palsy with Facial Diplegia and Proximal Weakness Diagnosed as Juvenile-Onset Myasthenia Gravis
  Rajesh Verma, Rajarshi Chakraborty, Pooja Tripathi
  Annals of Indian Academy of Neurology.2023; 26(4): 589.     CrossRef

A 69 year-old woman was admitted with sudden left facial weakness. She had no other neurologic deficit, except for left peripheral type facial palsy. She had a presumptive diagnosis of Bell

Since the majority of cases with unilateral peripheral facial palsy are idiopathic, radiological studies such as CT or MRI are not usually recommended for further evaluation. We report a patient with peripheral facial palsy caused by minor salivary gland tumor which was demonstrated by appropriate imaging study.

Background
Miller-Fisher syndrome (MFS) is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia,and is considered a variant form of Guillain-Barre syndrome. Although some cases of delayed-onset facial palsy in MFShave been reported, the characteristics of this facial palsy are poorly described in the literature. Methods: Between 2007and 2010, six patients with MFS were seen at our hospital. Delayed facial palsy, defined as a facial palsy that developedwhile the other symptoms of MFS began to improve following intravenous immunoglobulin treatment, was confirmed in fourpatients. The clinical and electrophysiological characteristics of delayed facial palsy in MFS, as observed in these patients,are described here. Results: Four patients with delayed-onset facial palsy were included. Delayed facial palsy developed 8-16days after initial symptom onset (5-9 days after treatment). Unilateral facial palsy occurred in three patients and asymmetricfacial diplegia in one patient. The House-Brackmann score of facial palsy was grade III in one patient, IV in two patients,and V in one patient. None of the patients complained of posterior auricular pain. Facial nerve conduction studies revealednormal amplitude in all four patients. The blink reflex showed abnormal prolongation in two patients and the absence ofaction potential formation in two patients. Facial palsy resolved completely in all four patients within 3 months. Conclusions:Delayed facial palsy is a frequent symptom in MFS and resolves completely without additional treatment. Thus, standardtreatment and patient reassurance are sufficient in most cases.