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Is There a Cranial Nerve Other Than the 7th Co-Involved in Bell’s Palsy? Answer to the Systematic Review

Review article

Abstrak

Bell’s palsy dicirikan oleh kerosakan neuron motor bahagian bawah sebelah pada saraf muka. Walaupun Bell’s palsy melibatkan palsi saraf muka periferi, saraf kranial lain perlu dikaji kerana ia saling berkaitan secara anatomi dan bukannya terpencil. Matlamat kajian ini adalah untuk mencari bukti saraf kranial lain terlibat dalam Bell’s palsy. Carian menyeluruh telah dijalankan menggunakan lima pangkalan data elektronik, iaitu CINAHL, Academic Search Complete, MEDLINE, SPORTDiscus, dan Scopus, yang semuanya dikemas kini sehingga Mei 2021. Penyelidikan Bell’s Palsy memfokuskan kepada asal-usul dan punca keadaan, tanpa mengira reka bentuk kajian, layak untuk dimasukkan. Penyelidikan haiwan, kajian bukan Bahasa Inggeris, kesusasteraan kabur, kajian tanpa teks penuh tersedia, dan yang diterbitkan dalam jurnal bukan semakan, dikecualikan. Walaupun 3883 kertas ditemui semasa pencarian awal, hanya 13 telah dimasukkan dalam kajian akhir. Manual Institut Joanna Briggs untuk sintesis bukti dan piawaian bukti Sackett digunakan untuk menilai kesahihan kertas yang telah disaring. Jenis yang paling biasa ialah siri kes (n=5), diikuti dengan kawalan kes (n=4), laporan kes (n=3), dan keratan rentas (n=1). Kebanyakan artikel dikategorikan sebagai Tahap-IV (n=8), diikuti oleh Tahap-V (n=3), dengan hanya dua kajian diklasifikasikan sebagai Tahap-III (n=2) oleh kriteria Sackett. Saraf trigeminal dan vestibulocochlear telah ditunjukkan sebagai saraf kranial yang paling terlibat dalam Bell’s palsy. Saraf optik, okulomotor, trigeminal, vestibulocochlear, glossopharyngeal, vagus, dan hypoglossal ialah tujuh saraf kranial yang berpotensi dikaitkan dengan Bell’s palsy.

Abstract

Bell’s palsy is characterised by one-sided lower motor neuron impairment of the facial nerve. Even though Bell’s palsy is a peripheral facial nerve palsy, other cranial nerves should be investigated, because they are anatomically interconnected rather than isolated. The study aimed to look for evidence of other cranial nerves being involved in Bell’s palsy. CINAHL, Academic Search Complete, MEDLINE, SPORTDiscus, and Scopus, all of which were updated until May 2021, were used to conduct a comprehensive search. Bell’s palsy research focused on the origins and cause of the condition, regardless of study design, was eligible for inclusion. Animal research, non-English studies, grey literature, studies with no full text available, and those published in non-peer-reviewed journals, were excluded. While 3883 papers were found during the initial search, only 13 were included in the final study. The Joanna Briggs Institute Manual for Evidence Synthesis and Sackett’s standard of evidence was used to assess the validity of the papers that were screened. The most common type was case series (n=5), followed by case-control (n=4), case report (n=3), and cross-sectional (n=1). Most of the articles were categorised as Level-IV (n=8), followed by Level-V (n=3), with only two studies classified as Level-III (n=2) by Sackett’s criteria. The trigeminal and vestibulocochlear nerves are the most involved cranial nerves in Bell’s palsy. The optic, oculomotor, trigeminal, vestibulocochlear, glossopharyngeal, vagus, and hypoglossal nerves are the seven cranial nerves potentially associated with Bell’s palsy. 

Keywords: Bell’s palsy, clinical anatomy, cranial nerve, facial nerve, neuroanatomy