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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1 |Name of the candidate and |DR.ARUN INGALE |

| |address |P.G. IN OTO-RHINO-LARYNGOLOGY, |

| | |DEPARTMENT OF ENT, |

| | |VIMS, BELLARY. |

|2 |Name of the Institution |VIJAYANAGAR INSTITUTE OF |

| | |MEDICAL SCIENCES, BELLARY. |

|3 |Course of the study and subject |MS IN ENT |

|4 |Date of admission to the course |18-05-2012 |

|5 |Title of the topic |A CLINICAL STUDY OF ETIOLOGY AND MANAGEMENT OF LOWER MOTOR NEURON TYPE |

| | |PALSY OF FACIAL NERVE |

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| |BRIEF RESUME OF INTENDED WORK |

| |6.1. Need for study; |

|6 |Like most cranial nerves, the facial nerve contain motor, sensory and parasympathetic fibers Among its functions the vital |

| |are control of facial expression, taste to the anterior two third of tongue and salivary and lacrimal gland secretion. |

| |More than 40 different causes of facial paralysis are known, classified as idiopathic, traumatic, infection, neoplastic and |

| |metabolic. Of the various causes, 75% are usually due to Bell’s palsy or secondary to trauma1.Of all the cranial nerves; the |

| |facial nerve is most susceptible to injury because the nerve has complex course through the temporal bone in proximity to |

| |various structures which are frequent sites of disease. |

| |A patient who suffers from facial paralysis experiences not only functional consequences but also the psychological impact of|

| |change of self-image and impaired communication ability2. |

| |In facial paralysis, history and physical examination provide the more information than do the lab tests. Diagnostic tests |

| |add information to what is already known and influences the choice of the therapy which can improve the clinical out |

| |come3.Successfull management of disease process that causes facial nerve dysfunction requires thorough knowledge of |

| |pathophysiology of disease process. Management of facial nerve dysfunction is individualized and may include observation, |

| |administration of pharmacological agents, surgical interventions, physical therapy and psychological counselling4. Degree of |

| |recovery also varies as per modality of treatment used. |

| |Keeping this in mind, this study aims at understanding different causes of facial nerve paralysis seen and to assess the |

| |outcome of treatment on the disease. |

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| |6.2 Review of Literature; |

| |Sir Charles Bell, the British physician, in 1824 described onset, physical finding and course of idiopathic facial palsy5. |

| |Bell’s palsy is a self-limiting, non- progressive, non-life threatening and spontaneously remitting condition. Incidence |

| |varies between 15&40 per 100,000population. |

| |Bell’s palsy accounts for 60% to 80% of all causes of Facial palsy. Male to female ratio is equal except for predominance for|

| |men over 40yrs of age. At presentation 30% have incomplete paralysis, bilateral paralysis occurs in 0.3% of patients, 8% have|

| |family history,9% patients give previous history of paralysis.6,7 |

| |Paterson (1982)studied natural history of 1000patients with Bell’s palsy over |

| |Period of 15yrs and found that in 84% cases recovery was satisfactory. 85% patients begin recovery by 3weeks and fully |

| |recovered by 6months.The earlier recovery better prognosis8. |

| |Otogenic Facial palsy may be due to AOM, COM, acute mastoiditis, chronic mastoiditis. |

| |James Ramsay Hunt (1872-1937) an American neurologist described the clinical Syndrome of Herpes Zoster oticus that bears his |

| |name9. Herpes Zoster oticus is characterized by viral prodrome with severe pain in and around ear with vesicle involving |

| |pinna. Viral eruption distribution defends on which sensory afferent fibre involved, that communicates with Facial |

| |nerve.10,11 |

| |J.Douglas Green, et all (1994)12 reviewed 22 patients with iatrogenic Facial palsy. Injury during |

| |mastoidectomy(55%),tympanoplasty(14%),removal of exostoses(14%). Common area involved was lower tympanic segment in 55% and |

| |descending mastoid segment in 32% of patients. |

| |Facial paralysis is not an infrequent complication of basal skull fracture. 90% of fractures are longitudinal, of which only |

| |20% had Facial paralysis and 10% tansverse fractures, of which 50% had Facial paralysis.13 |

| |Approximately 5% Facial nerve dysfunction is by tumour.14vestibular schwannoma is common tumor of internal auditory canal. |

| |Intrinsic Facial nerve tumors like facial schwannoma, meningioma and haemangioma are very rare(Thomas R.Kertesz et all 2001 |

| |).15 |

| |Most common malignant tumour involving Facial nerve is squamous cell carcinoma of head and neck. Rare malignancy like |

| |rhabdomyosarcoma of middle ear and mastoid (R.K Mundra and Goyal Amit, 2002).16 Metastatic tumor like small cell carcinoma of|

| |lung to temporal bone.17 |

| |Management is directed to protect nerve or help to regenerate damaged nerves. Patient must be informed about Facial deformity|

| |if recovery is not expected and supported sympathetically, pharmacotherapy using prednisolone in large doses has recently |

| |found effective for Bell’s palsy(Taverner,1970)18 and also use of antiviral agents improve the recovery of Facial palsy.19 |

| |Even though no Facial movements noted in intact nerve fibers, will be activated and exercise will help to maintain muscle |

| |tone.16 Physical pain can be controlled with non-steroidal anti-inflammatory drugs. Surgery to reanimate paralyzed eyelids |

| |should be considered if medical treatment is ineffective for eye care20. |

| |Surgical decompression is considered if ENOG degeneration more than 90% of unaffected side, age is ................
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