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Table of Contents    
NEUROIMAGES
Year : 2016  |  Volume : 64  |  Issue : 2  |  Page : 358-359

Three-dimensional constructive interference in steady-state magnetic resonance imaging diagnosis of isolated unilateral facial nerve hypoplasia


Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar

Date of Web Publication3-Mar-2016

Correspondence Address:
Subramaniyan Ramanathan
Al-Wakra Hospital, Hamad Medical Corporation, P. O. Box: 82228, Doha
Qatar
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.177609

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How to cite this article:
Ramanathan S, Al Heidous M, Kumar D, Palaniappan Y. Three-dimensional constructive interference in steady-state magnetic resonance imaging diagnosis of isolated unilateral facial nerve hypoplasia. Neurol India 2016;64:358-9

How to cite this URL:
Ramanathan S, Al Heidous M, Kumar D, Palaniappan Y. Three-dimensional constructive interference in steady-state magnetic resonance imaging diagnosis of isolated unilateral facial nerve hypoplasia. Neurol India [serial online] 2016 [cited 2019 Aug 22];64:358-9. Available from: http://www.neurologyindia.com/text.asp?2016/64/2/358/177609


An 8-year-old boy presented to the pediatric neurology clinic with mild facial asymmetry and intermittent drooling of saliva from the left angle of mouth. His mother had noticed these changes for the past 2 years. On neurological examination, his face remained symmetric at rest, and muscle weakness of both upper and lower parts of the face was demonstrated. Other examinations including other cranial nerve, otolaryngologic, and ophthalmic examinations were normal. Partial lower motor neuron type of left facial nerve paralysis was diagnosed. A detailed history did not reveal any birth trauma. Magnetic resonance imaging (MRI) of the brain revealed severe hypoplasia of the left facial nerve in its cisternal and canalicular segments, best seen on three-dimensional (3D) constructive interference in steady-state (CISS) sequence [Figure 1] and [Figure 2]. Brain stem and rest of the cranial nerves were normal. Hypoplasia of the left bony facial canal was also demonstrated on limited high-resolution computed tomography (HRCT) of the temporal bones [Figure 3].
Figure 1: (a) Axial three-dimensional constructive interference in steady-state magnetic resonance imaging shows bilateral normal vestibulo-cochlear nerves (arrows); and, (b) axial three-dimensional constructive interference in steady-state magnetic resonance imaging shows the normal right facial nerve (long arrow) and severely hypoplastic left facial nerve (short arrow)

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Figure 2: (a) Sagittal three-dimensional constructive interference in steady-state magnetic resonance imaging shows the normal right facial nerve (long arrow) and the normal vestibulo-cochlear nerves (short arrows); and, (b) sagittal three-dimensional constructive interference in steady-state magnetic resonance imaging shows almost nonvisualization of the left facial nerve (long arrow) and the normal vestibulo-cochlear nerves (short arrows)

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Figure 3: (a) Axial high-resolution computed tomography of the temporal bone shows the normal right bony facial canal (arrow); and, (b) axial high-resolution computed tomography of the temporal bone shows the hypoplastic left bony facial canal (arrow)

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Congenital facial palsy (CFP) is clinically defined as facial palsy of the seventh cranial nerve, which is present at birth or shortly thereafter. CFP is classified as traumatic or developmental, unilateral or bilateral, and complete or incomplete (paresis). Determining the etiology is important because the prognosis and treatment differ, depending on the underlying pathophysiology.[1] An appropriate history and physical examination usually resolves the origin of the facial palsy, but imaging and neuromuscular testing may be necessary for the indeterminate cases and for treatment planning.

Developmental CFP may be related to a number of syndromes such as the Mobius syndrome, velocardiofacial syndrome, Goldenhar's syndrome and Poland's syndrome. Features favoring a developmental etiology include bilateral involvement, other cranial neuropathies, and syndromic features.[2] However, in our index case, it was unilateral and isolated with a late presentation. In such cases, imaging is crucial in establishing the etiology. MRI can exquisitely demonstrate the cisternal course of the cranial nerves in 3D CISS sequences and also the brainstem pathologies.[3] HRCT temporal bone is helpful in looking for fractures as well as in assessing the status of bony facial canal and inner ear malformations.

 
  References Top

1.
Terzis JK, Anesti K. Developmental facial paralysis: A review. J Plast Reconstr Aesthet Surg 2011;64:1318-33.  Back to cited text no. 1
    
2.
Hamizan AW, Yean KT, Abdullah A. Congenital bilateral facial nerve hypoplasia with sensorineural hearing loss: A case report. Int J Pediatr Otorhinolaryngol 2012;76:455-9.  Back to cited text no. 2
    
3.
Sasaki M, Imamura Y, Sato N. Magnetic resonance imaging in congenital facial palsy. Brain Dev 2008;30:206-10.  Back to cited text no. 3
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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