Neuroimaging in facial nerve neuropathy

The timing and volume of neuroimaging for patients with facial nerve neuropathy (FNN) are a cause for discussion.

Aim. To study the current volume of neuroimaging in patients with FNN and to determine the essential diagnostic protocol.

Material and methods. Magnetic resonance imaging (MRI) data analysis of adult patients with FNN (n = 833). Protocols were taken from the Uni fi ed Medical Information and Analytical System of Moscow (EMIAS). The essential diagnostic protocol was created. A prospective study was conducted with new protocol.

Results. According to EMIAS, the timing of MRI was 3 months from the fi rst symptoms to do diagnostics, the longest period from diagnosis to appointment to MRI was 83 days. The list of pulse sequences was given in the protocol in ¾ of cases. The most indicated regimes were T1 WI (80.7%), T2 WI (90.6%), T2 FLAIR (73.2%), less often DWI (54.9%). Studies with contrast amounted to 22.8%. In total, the pathology was detected in 429 (51.5%) patients, including 88 (20.5%) intracranial tumors. In 216 (25.9%) patients, the changes were most likely associated with FNN, of which in 44.5% of cases were in fl ammatory, 21.3% — tumor, 16.2% — demyelinating process, 11.2% — postoperative changes.

According to the new protocol, the cause of FNN was directly identi fi ed in 56.6% of patients, of which in idiopathic — 31,6% of cases, in symptomatic — 70.6% (p = 0.005). Changes that cannot be associated with FNN, but require the participation of a specialist, were detected in a 1/4 of patients. Only in 20.8% of cases, the MRI results were normal.

Conclusion. Recommended volume of neuroimaging for patients with FNN is MRI of the brain and parotid salivary glands with contrast within 1 month from the fi st symptoms. Regimes: T1 WI, T2 WI, FLAIR (with a slice thickness of 1 mm), DWI, 3D TOF, free recession in equilibrium (SSFP, FIESTA-C, CISS, FFE, etc.), sensitive to magnetic fi eld inhomogeneity (T2*, SWI, SWAN, etc.), and also T1 WI after intravenous contrast.

1. Fieux M., Franco-Vidal V., Devic P., Bricaire F., Charpiot A., Darrouzet V. et al. French society of ENT (SFORL) guidelines. Management of acute Bell’s palsy. Eur. Ann. Otorhinolaryngol. Head Neck Dis. 2020;137(6):483–488. https://doi.org/10.1016/j.anorl.2020.06.004

2. Приказ Министерства здравоохранения Российской Федерации от 24.12.2012 N 1497н «Об утверждении стандарта специализированной медицинской помощи при поражениях лицевого нерва». Москва, 2013. [Order of the Ministry of Health of the Russian Federation of December 24, 2012 N 1497n “On approval of the standard of specialized medical care for lesions of the facial nerve”. Moscow, 2013. (In Russ.)].

3. Zhang W., Xu L., Luo T., Wu F., Zhao B., Li X. The etiology of Bell’s palsy: a review. J Neurol. 2020;267:1896–1905.

4. Spencer C.R., Irving R.M. Causes and management of facial nerve palsy. Br J Hosp Med (Lond). 2016;77(12):686–691. DOI:10.12968/hmed.2016.77.12.686

5. Завалий Л.Б., Рамазанов Г.Р., Чехонацкая К.И., Синкин М.В., Селиверстова Е.Г., Семенов Л.Л., и др. Комплексный подход к диагностике, лечению и реабилитации пациентов с невропатией лицевого нерва в разные периоды заболевания. Российский неврологический журнал. 2022;27(1):69–79. [Zavaliy L.B., Ramazanov G.R., Chekhonatskaya K.I., Sinkin M.V., Seliverstova E.G., Semenov L.L., et al. Comprehensive approach to the diagnosis, treatment and rehabilitation of patients with facial nerve neuropathy at diff erent periods of the disease. Russian neurological journal. 2022;27(1):69–79. (In Russ.)]. https://doi.org/10.30629/2658-7947-2022-27-1-69-79

6. Banik R., Miller N.R. Chronic myokymia limited to the eyelid is a benign condition. J Neuroophthalmol. 2004;24(4):290–2.

7. Завалий Л.Б., Рамазанов Г.Р., Калантарова М.В., Рахманина А.А., Синкин М.В., Шамалов Н.А., Петриков С.С. Диагностика невропатии лицевого нерва в клинической практике: результаты опроса российских неврологов. Российский неврологический журнал. 2023;28(2):15–24. [Zavaliy L.B., Ramazanov G.R., Kalantarova M.V., Rakhmanina A.A., Sinkin M.V., Shamalov N.A., Petrikov S.S. Diagnosis of patients with facial neuropathy by practicing neurologists: online survey. Russian neurological journal. 2023;28(2):15–24. (In Russ.)]. https://doi.org/10.30629/2658-7947-2023-28-2-15-24

8. Касаткин Д.С., Синкин М.В., Завалий Л.Б., Гринь А.А., Петриков С.С. Клинико-диагностическое и патофизиологическое обоснование консервативного и раннего хирургического методов лечения паралича Белла в остром периоде. Российский неврологический журнал. 2021;26(2):4–10. [Kasatkin D.S., Sinkin M.V., Zavaliy L.B., Grin A.A., Petrikov S.S. Clinico-diagnostic and pathophysiological grounds of conservative and early surgical treatment methods of Bell palsy in the acute period. Russian neurological journal. 2021;26(2):4–10. (In Russ.)]. https://doi.org/10.30629/2658-7947-2021-26-2-4-10

9. Неробеев А.И., Висаитова З.Ю., Сомова М.М., Салихов К.М. Поражения лицевого нерва: о чем врач должен рассказать пациенту. Вестник эстетической медицины. 2013;12(4):12–20. [Nerobeev A.I., Visaitova Z.Yu., Somova M.M., Salikhov K.M. Facial nerve damage: what should a doctor tell a patient. Aesthetic Medicine Bulletin/Vestnik Esteticheskoy Meditsiny.2013;12(4):12–20. (In Russ.)].

10. Kannan R.Y., Hills A., Shelley M.J., Bisase B., Kapoor K., Norris P., Nduka C. Immediate compared with late repair of extracranial branches of the facial nerve: a comparative study.Br. J. Oral. Maxillofac. Surg. 2020;58(2):163–169. https://doi.org/10.1016/j.bjoms.2019.11.004

11. Farrugia M.E., Bydder G.M., Francis J.M., Robson M.D. Magnetic resonance imaging of facial muscles. Clin Radiol. 2007;62(11):1078–1086. https://doi.org/10.1016/j.crad.2007.05.003

12. Международная классификация болезней 10-го пересмотра (МКБ-10). International Statistical Classifi cation (ISC-10). Доступно: mkb-10.com

13. Завалий Л.Б., Рамазанов Г.Р., Рахманина А.А., Калантарова М.В., Холмогорова А.Б., Петриков С.С. Скрининговая диагностика показателей эмоционального неблагополучия у пациентов с невропатией лицевого нерва. Российский неврологический журнал. 2022;27(3):47–53. [Zavaliy L.B., Ramazanov G.R., Rakhmanina A.A., Kalantarova M.V., Kholmogorova A.B., Petrikov S.S. Screening diagnostics of emotional distress in patients with facial neuropathy. Russian neurological journal. 2022;27(3):47–53. (In Russ.)]. https://doi.org/10.30629/2658-7947-2022-27-3-47-53

14. Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of diff erent etiologies. Acta Otolaryngol Suppl. 2002;(549):4–30. PMID: 12482166

15. Нуров Р.Р., Маматова М.Ш., Курбанкулов У.М. Эпидемиология опухолей слюнных желез (обзор). European research. 2017;8(31). [Nurov R.R., Mamatova M.Sh., Kurbankulov U.M. Epidemiology of salivary gland tumors (review). European research. 2017;8(31). (In Russ.)].