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East and Central African Journal of Surgery, Vol. 13, No. 1, March-April 2008, pp. 101-103 Aetiological Profile of Facial Nerve Palsy in North Central Nigeria O.A. Afolabi1, Alab1 B.S, O.A. Lasisi2 1University of Ilorin/University of Ilorin Teaching
Hospital, Ilorin. Code Number: js08016 Background: Facial nerve
abnormalities represent a broad spectrum of lesions which are commonly seen by
the otolaryngologist. The aim of this paper is to highlight the aetiologic
profile of facial nerve palsy. Introduction Facial nerve paralysis is a common clinical entity to the otolaryngologist. It can affect all age groups but most frequently seen between 20 to 50 years with equal sex distribution1. Incidence is around 30 cases per 100,000 per year, slightly higher in pregnant women (45 per 100,000).2 The patient who suffers with facial paralysis experiences not only functional consequences but also the psychological impact of a change in self-image and impaired communicative ability2 Aetiology include Trauma e.g. fractures of skull base, haematoma after acupuncture3, HIV4 Inactivated Intranasal Influenza Vaccine5 - although this has been disputed6 The aim of this paper is to highlight the aetiologic profile of facial nerve palsy in our environment as there is paucity of data on this. Methods This was a retrospective review of patients with facial nerve palsy seen in the Ear, Nose and Throat clinic over a five year period through 2001to 2005. The hospital chart records of all the patients were retrieved and analyzed for biodata, clinical features, diagnosis and treatment outcome using the SPSS version 11 computer soft ware. Results The study population was comprised of 25 patients, made. Sixteen (64%) males were males and 9 (36%) females (M:F = 1.7:1.0). The age ranged between 6 months and 80 years with a mean of 32.1years (SD=16.38). The peak was in the 30-40 years age group. Table 1 shows the aetiological factors. Bell’s palsy accounted for 13 (52%), road traffic injury for 5 (20%) and chronic suppurative otitis media for 4(12%) of the cases. The majority of patients belonged to social class II 6 (24%) and V 6 (24%). The right side was involved in 13(52%) and left side in 12 (48%) of the patients. Lower motor neuron lesions were seen in 22 (88%) while upper motor neuron lesion accounted for 3 (12%). , A total of 71% of the patients with Bell’s palsy had history of unilateral facial rashes. Recovery was observed in 10 (40%) of the patients Table 1. Aetiology of Facial Nerve palsy
Discussion This study has found Bell’s palsy to be the commonest aetiological factor of facial nerve palsy. In their study, Hassan et al1 found Bell’s palsy to accounted for 28% and peak age of presentation was 40 years1,7. In our study, 71% of the patients with Bell’s palsy had history of unilateral facial rashes which was suggestive of herpes simplex virus type 1 infection1,2,3,4,7. However, we had no laboratory confirmation. Road traffic injury ranked 2nd with a prevalence of 20%. It was the predominant causative factor in the younger age group. Skull base fracture is one of the most frequent causes of injury to the facial nerve1,7-12. A high index of suspicion of facial nerve palsy should be entertained in cases of temporal bone fracture for early detection and prompt management. The others anatomical pathology resulting in facial palsy includes haematoma in the middle ear or traumatic inflammation with oedema compressing the nerve or neuropraxia1,13. Despite the high prevalence of otitis media in our environment, infective cause of facial nerve palsy due to chronic suppurative otitis media was seen in only 3 of our cases.. This could be due to early presentation of the patients once discharge in the ear is noticed as it constitutes a social nuisance irrespective of the sex14. Facial nerve injury affect all social class as in our finding it cut across all the socioeconomic classes compared to chronic suppurative otitis media which is common among the lower socioeconomic class14. Most of our diagnosis was based on history and clinical examinations, although the management could be enhanced by the contemporary radiodiagnostic and electrophysiologic tests which are not readily available in our practice. Similar to other reports15, 16, our studies have found patients across all ages from 6 months to 80 years. The palsy observed in the 6 months old child was found to follow measles infection1. Our study showed male preponderance as against gender equality documented in literature15. Conclusion Bell’s palsy was found to be the commonest cause of facial nerve palsy, followed by trauma. Spontaneous recovery in 40%. This may serve as data base for clinical evaluation of facial palsy in our environment. Reference
© 2008 East and Central African Journal of Surgery |
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