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INTRODUCTION:
In
1907, Dr James Ramsay Hunt, an American neurologist, described in the syndrome
of herpes zoster associated with facial palsy as Ramsay Hunt syndrome II. A
great part of the illness is Bell's palsy which itself has many causal factors
and is the most common form of facial paralysis worldwide.
Ramsay Hunt syndrome is a herpes zoster virus infection
of the geniculate ganglion of the facial nerve which
results in paralysis of the facial muscles on the same side of the face as the
infection. It is also termed Hunt's Syndrome and herpes zoster oticus.
·
It is caused by
reactivation of herpes zoster virus that has previously caused chickenpox in
the patient.
·
So, the virus
infects the facial nerve that normally innervates controls the muscles of the
face.
·
Ramsay Hunt
syndrome is typically associated with a red rash and blisters (inflamed
vesicles or tiny water-filled sacks in the skin) in or around the ear and
eardrum and sometimes on the roof of the mouth or tongue.
·
The classic
symptoms of Ramsay Hunt syndrome are:
A red
painful rash associated with blisters in or around the ears, eardrum, mouth or
tongue.
§ Facial paralysis on one side of the face.
Other symptoms such as:
Ear pain,
Hearing loss,
Dizziness (or vertigo),
Dry eye and
The syndrome is not contagious; however, the herpes
zoster virus that can be found in the blisters of Ramsay Hunt syndrome can be
transmitted to other people and cause chickenpox in those that are unvaccinated
against chickenpox. Individuals with Ramsay Hunt syndrome should avoid contact
with newborns, pregnant women, immunodepressed
individuals, and people with no history of chickenpox, at least until all the
blisters change to scabs.
·
Diagnosis of the
syndrome is most often made by observing the symptoms described above (red
painful rash with ear and or mouth blisters and one-sided facial paralysis).
·
PCR test
(Polymerase Chain Reaction) can be performed on the fluid from the blisters to
demonstrate the viral genetic material, but this test is not done routinely.
Treatment
consists of:
·
Antiviral agents
(for example, acyclovir, valacyclovir or famciclovir) for about one week,
·
Steroids
(prednisone),
·
Pain medications,
and
·
For children, the varicella vaccine can reduce the chance of
getting chickenpox from which the syndrome comes (reactivation of the virus).
However, once a person gets chickenpox, the person is susceptible to
reactivation of the virus and thus can develop Ramsay Hunt syndrome.
Fortunately, there is another vaccine, Zostavax, which is helpful in preventing viral reactivation.
Consequently, Ramsay Hunt syndrome can be either
prevented or their symptoms reduced if the vaccine is administered. Usually,
this vaccine is given to individuals that have had chickenpox as children and
are now age 60 or older.
Best results are reported when treatment protocols are
started within about three days after symptoms appear. Early treatment usually
results in a better prognosis.
Facial
Exercises:
1.
The only kind of
therapy we should try immediately after the onset of Ramsay Hunt Syndrome is
warmth and very gentle circulatory massage.
2.
After the
inflammation has subsided, portions of the myelin coating on the affected
cranial nerves may be damaged and need time to regenerate. During this time of
regeneration, do not advise performing any facial exercises or stimulation of
the facial muscles, since forcing movement of the muscles is believed by many
neurologists to encourage synkinesis.
3.
After the natural
healing process has completed, which usually takes around two years, the
patient may wish to undertake some kind of facial therapy. Facial exercises
should be performed only after consulting the doctor and/or under the
supervision of a professional therapist.
For
those with facial paralysis resulting from Ramsay Hunt Syndrome, recommend not
forcing any movement of the facial muscles for two years post onset.
To
begin with, the patient should always perform the exercises in front of a mirror
so he/she can react off the feedback and control the movements to aid a
balanced recovery. Any facial movement should always be performed gently and
never forced. Perform each exercise slowly 10 times and repeat a two or three
times a day:
·
Raise your
eyebrows and form horizontal wrinkles on your forehead (Surprise)
·
Draw your eyebrows
together and downwards forming vertical wrinkles between the eyebrows
(Frowning)
·
Lift the outside
borders of your nostrils forming diagonal wrinkles along the bridge of your
nose (Distaste)
·
Draw your lips
together and make a kissing motion
·
Protrude your
upper lip
·
Smile without
showing your teeth
·
Smile and show
your teeth
·
Pull your lips
tight and wide (Grimace)
·
Purse your lips as
if blowing through a straw
·
Attempt to whistle
·
Protrude your
lower lip like a spoilt child
·
Puff out your
cheeks and hold the air. Try to transfer the air from one side of mouth the
other
·
Close eyes
together tightly
·
Open your eyes
wide
·
Wink each eye
alternately
Don't
rush or force any movements or exercises and don't be under the assumption that
constant exercising will speed recovery. In fact a number of sufferers have
never performed any kind of extra facial stimulation and have made a full
recovery.
For
people who have long term facial paralysis it may be necessary to seek
professional attention and perform other methods of recuperation under
specialist supervision.
·
Synkinesis (inappropriate nerve responses such as blinking or
tear formation while trying to talk),
·
Eye damage, viral
spread to other nerves causing many other problems (for example, pain,
confusion, weakness).
·
Postherpetic Neuralgia (pain due to nerve fiber damage by the
virus) may also develop and persist for months to years.
REFERENCE:
1.
Gwinyai Masukume; Sheenah Chibwowa; Mbongeni Ndlovu, A case report of
pediatric Ramsay Hunt Syndrome. J Med Case Reports. 2011; 5(376).
Received on 02.12.2011 Modified on 12.12.2011
Accepted on 24.12.2011 © A&V Publication all right reserved