Involvement of the facial nerve(herpes zoster oticus, Ramsay Hunt Syndrome) is a rather common clinical syndrome. It bergins with unilateral ear pain, followed shortly by a peripheral facial palsy. Paresis or paralysis may affect the muscles of
facial
expression, which also close the eyelids. The levator palpebrae which is innervated by the 5th cranial nerve is spared, so the eye may remain open.
The rash is usually confined to the tympanic membrane and the external auditory canal. It may spread to involve the outer surface of the lobe of the ear, anterior pillar or the fauces and mastoid. There also may be a loss of taste in the anterior
two
thirds of tongue At time, the auditory nerve involvement produces tinnitus, deafness and vertigo.
The 5th, 8th ahd 10th nerves and even the upper cervical spinal nerve can be involved presumedly on the base of spread of the infective process along anastomotic connections between the facial nerve. The facial paralysis is dentical to that of
Bell's
palsy. Frequently the recovery of facial nerve function is incomplete. leaving the patient with some residual facial weakness.
We experienced 2 case sof Ramsay Hunt Syndrome. The first patients, 55 year old male, visited our pain clinic on the day when his left facial nerve start to paralyze. We injected 6 ml of 0.25% bupivacaine into his left stellate ganglion 15 times.
tENS
was also applicated simultaneously. His facial paralysis was recovered completely 3 weeks after treatment without any complications.
Another one, 53 year old male, visited us 7 weeks after onset of facial paralysis. He has been treated conventional oriental method (acupuncture, massage warm application, etc.). But the degree of his left facial paralysis didn't improve at all.
He
has
been treating with SGB 50 times and TENS for 2 months. Temporal and zygomatic branch of his left facial nerve recovered nearly completely but buccal and mandibular branch did not recover completely.
We are willing to insist on the early treatment is the best choice in managing of Ramsay Hunt Syndrome.
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