Facial synkinesis refers to pathologic cocontraction and baseline hypertonicity of muscles innervated by the facial nerve, commonly attributed to the aberrant regeneration of nerve fibers following injury. The pathomechanism and optimal treatment of facial synkinesis remain unclear. The goal of this review is to highlight current understanding of the epidemiology, pathophysiology, clinical presentation, assessment, and treatment of facial synkinesis.
BACKGROUND: There is a lack of studies exploring factors influencing synkinesis severity. This study aims to identify factors that may contribute to variations in severity of facial synkinesis. METHODS: Patients with a diagnosis of facial synkinesis presenting between 2009 and 2024 were reviewed. The synkinesis score of the eFACE Facial Nerve Clinician-Graded Scale was analyzed for associations with patient characteristics and facial palsy history using univariable and multivariable analysis. RESULTS: Two-hundred-forty-nine synkinesis patients were included in the study. The etiology of facial palsy was infectious or idiopathic in 185 patients (74%), tumor resection in 40 patients (16%), trauma in 17 patients (7%), and compression of the facial nerve by a benign tumor in seven patients (3%). Factors independently associated with more severe synkinesis scores included age of facial palsy onset over 50 years (-7.4, 95% CI, [-10.9, -3.9]; p < 0.001), diabetes (-8.6, 95% CI, [-14.9, -2.3]; p = 0.007), smoking (-4.9; 95% CI, [-8.0, -1.8]; p = 0.003), and intratemporal facial nerve injury (-19.4; 95% CI, [-27.8, -10.8]; p < 0.001). Other variables including sex, race, hypertension, and etiology were not found to be independently associated with synkinesis severity. CONCLUSIONS: Older age at facial palsy onset, diabetes, smoking, and intratemporal facial nerve injury were found to be independently associated with more severe synkinesis. These findings are novel and may aid in prognostication and treatment selection.
Background: Many patients with spinal juvenile pilocytic astrocytoma can experience prolonged remission after resection. However, some reports suggest that pregnancy may be associated with progression. Case Description: The authors provide an image report highlighting a case of rapid and aggressive transformation of an intramedullary astrocytoma of the cervical spine in a pregnant patient. Over the course of 1 year, the lesion progressed from a juvenile pilocytic astrocytoma to an anaplastic astrocytoma. Genetic testing revealed mutations associated with aggressive behavior. Conclusion: The case and associated imaging demonstrate the importance of close neurologic monitoring and counseling regarding risk of progression in pregnant patients with spinal gliomas.
Kafka, Benjamin MD*; Rail, Benjamin BS*; Ban, Vin Shen MD*; El Ahmadieh, Tarek Y. MD*; Vira, Shaleen MD‡; Caldwell, Christie PA-C*; Al Tamimi, Mazin MD*; Bagley, Carlos A. MD*,‡; Abdullah, Kalil MD*; Aoun, Salah G. MD* Author Information
Background: The effective management of facial palsy resulting from malignancy necessitates technical proficiency and careful clinical considerations. Patients are typically offered dynamic reanimation along with static procedures for eye protection, volume restoration, and facial balance. The purpose of this study was to examine the subset of patients who received static interventions alone. Methods: A retrospective review was performed on all adult patients with cancer-related facial palsy over a 13-year period who presented to our facial palsy unit. Detailed information on demographics, medical history, cancer treatment, reanimation procedures, and outcomes was collected. Descriptive statistics were performed. Independent Student t-tests were used for numerical measurements and Chi-square contingency table analyses or Fisher exact tests when Chi-Square was not valid were used to compare patients who received dynamic reanimation versus static reanimation alone. Results: Of the 61 patients with cancer-related facial palsy, a total of 26 patients underwent surgery that included dynamic reanimation (DR), while 17 patients received static reanimation only (SR). Preoperative Karnofsky Performance Status was 84 in the DR group and 67 in the SR group (p = < 0.001). Preoperative Sunnybrook composite scores were similar between groups. In the DR group, 6 patients (23%) have died, compared to 11 patients (65%) in the SR group (p = 0.014). The mean time to death after DR was 57 months, and 29 months after SR (p = 0.182). Within the first-year post-surgery, mortality rates were 8% for DR and 35% for SR (p = 0.042). All patients completed at least one year of follow-up. Conclusion: Patients who underwent static procedures only had a lower preoperative Karnofsky Performance Status and decreased survival after surgery. All patients with facial palsy secondary to malignancy should be offered both dynamic and static reanimation concurrently. Dynamic reanimation should rarely be withheld, but the benefits can take months to be realized. The patient's functional status and wishes in the context of limited life expectancy may favor the use of static procedures only.
Despite numerous operative and non-operative treatment modalities, patients with glioblastoma (GBM) have a dismal prognosis. Identifying predictors of survival and recurrence is an essential strategy for guiding treatment decisions, and existing literature demonstrates associations between hematologic data and clinical outcomes in cancer patients. As such, we provide a novel analysis that examines associations between preoperative hematologic data and postoperative outcomes following GBM resection. We performed a retrospective analysis of patients who underwent GBM resection from January 2016 to December 2020. Standard demographic and clinical variables were collected, including pre-operative complete blood count (CBC), and inferential analyses were performed to analyze associations between CBC parameters and postoperative outcomes. One hundred and eighty nine (189) patients met inclusion criteria, with a mean age of 60.7 years. On multivariate regression analysis, controlling for age, gender, and performance status, we observed trends suggesting anemic patients may have longer lengths of stay (t statistic = 3.23, p = 0.0015) and higher rates of discharge to inpatient facilities [OR 3.01 (1.09-8.13), p = 0.029], though these associations did not reach statistical significance after correction for multiple comparisons (Bonferroni-corrected significance threshold p < 0.01). Preoperative anemia may be a useful pre-operative predictor of postsurgical GBM outcomes. Further study is required to determine whether pre-operative hemoglobin optimization can improve postoperative clinical outcomes, and whether other hematologic and inflammatory markers are predictive of postoperative recovery and functional status.
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