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Millesi E, Suchyta M, Wang H, Mardini S. Anatomic Analysis of Masseteric-to-zygomatic Nerve Transfer in Rat and Pig Models. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5344. [PMID: 37859639 PMCID: PMC10584298 DOI: 10.1097/gox.0000000000005344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 10/21/2023]
Abstract
Background Nerve transfer from the masseteric branch of the trigeminal nerve is a widely performed procedure for facial reanimation. Despite achieving powerful muscle force, clinical and aesthetic results leave room for improvement. Preclinical animal models are invaluable to establishing new therapeutic approaches. This anatomical study aimed to establish a masseteric-to-zygomatic nerve transfer model in rats and pigs. Methods The masseteric branch of the trigeminal nerve and the zygomatic branch of the facial nerve were dissected in 30 swine and 40 rat hemifaces. Both nerves were mobilized and approximated to achieve an overlap between the nerve ends. Over the course of dissecting both nerves, their anatomy, length, and branching pattern were documented. At the coaptation point, diameters of both nerves were measured, and samples were taken for neuromorphometric analysis. Results Anatomic details and landmarks were described. Tension-free coaptation was possible in all rat and pig dissections. In rats, the masseteric branch had an average diameter of 0.36 mm (±0.06), and the zygomatic branch average diameter was 0.46 mm (±0.13). In pigs, the masseteric branch measured 0.52 (±0.16) mm and the zygomatic branch, 0.59 (±0.16) mm. No significant differences were found between the diameters and axon counts of both nerves in pigs. In rats, however, their diameters, axon counts, and fascicular areas were significantly different. Conclusion Our study demonstrated the feasibility of direct masseteric-to-zygomatic nerve transfer in rats and pigs and provided general anatomic knowledge of both nerves.
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Affiliation(s)
- Elena Millesi
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
- Division of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marissa Suchyta
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Huan Wang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minn
| | - Samir Mardini
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
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Wong M, Takushima A. Variability in the development of synkinesis in a rabbit facial nerve axotomy model. J Plast Reconstr Aesthet Surg 2020; 74:1455-1463. [PMID: 33303412 DOI: 10.1016/j.bjps.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/31/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Weakness and synkinesis (involuntary cocontraction of different muscle groups) are common sequelae after facial nerve injury. We describe a rabbit model of facial nerve axotomy and repair, which can be used to study such sequelae and propose a grading tool to assess the facial movement outcomes. Using this rabbit model, we assess the effect of delaying facial nerve repair on the quality of the clinical result. METHODS A total of 15 rabbits (30 facial halves) were divided into 4 groups: control, facial nerve main trunk axotomy and immediate repair, axotomy and repair at 2.5 weeks as well as axotomy, and repair at 2 months. Functional recovery was graded according to the observable criteria. We performed retrograde fluorescence labelling of the distal facial nerve branches and assessed the distribution of tracers in the facial nucleus. RESULTS A consistent model of weakness and synkinesis was produced in all rabbits after immediate axotomy and repair. A grading tool was used to clinically grade the quality of the recovery. The somatotopy of the facial nucleus was disrupted, with axons projecting from the facial nucleus to incorrect facial muscle groups. Varying the denervation time before repair affected the quality of the recovery. The worst result was noted when repair was delayed for 2 months. Subtle changes in the pattern and severity of synkinesis was noted among the different treatment groups. CONCLUSION A slight delay in nerve repair by 2.5 weeks as well as contralateral facial paralysis (analogous to botulinum toxin (BTX) injection) appear to improve eye recovery and reduce synkinesis. Because of the large size of the rabbit, such variability in synkinesis severity can be graded.
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Affiliation(s)
- Manzhi Wong
- Department of Plastic, Reconstructive & Aesthetic Surgery, Singapore General Hospital, Singapore.
| | - Akihiko Takushima
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Nemet AY, Vinker S. Considerations and complications after Bells' palsy. J Clin Neurosci 2015; 22:1949-53. [PMID: 26314659 DOI: 10.1016/j.jocn.2015.04.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/22/2015] [Accepted: 04/26/2015] [Indexed: 11/18/2022]
Abstract
We present a retrospective, observational study of all patients diagnosed with Bells' palsy (BP) at the Central District of Clalit Health Services from 2003 through to 2012. BP is associated with several complications. We evaluated clinical characteristics including the number of patient visits to general physicians (GP), otolaryngologists, ophthalmologists and neurologists, medications prescribed in the acute phase of BP (steroids and antiviral agents), and the ophthalmic diagnoses. A total of 4463 patients with the diagnosis of BP were included. The incidence per 100,000/year was 87.0, and it increased with age. Patients had significantly more visits to all specialists at 6 months after the BP event. Steroid treatment was prescribed to 50.4% of the patients and antiviral agents to 65.5%. Both treatments were associated with older patient age and female sex. The rate of post BP lagophthalmos and keratitis was 3.45% and 0.63% at 1-3 months, respectively, and both were more likely to develop in older patients. Steroid and/or antiviral treatments were not associated with a decrease in ophthalmic complications. BP may cause ophthalmic complications at a low rate, which are associated with older age. Steroids and antiviral agents appeared to have no effect on ophthalmic complications.
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Affiliation(s)
- Arie Y Nemet
- Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky Street, Kfar Sava 44281, Israel.
| | - Shlomo Vinker
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Haykal S, Arad E, Bagher S, Lai C, Hohman M, Hadlock T, Zuker RM, Borschel GH. The Role of Botulinum Toxin A in the Establishment of Symmetry in Pediatric Paralysis of the Lower Lip. JAMA FACIAL PLAST SU 2015; 17:174-8. [DOI: 10.1001/jamafacial.2015.10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Siba Haykal
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ehud Arad
- Department of Plastic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaghayegh Bagher
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Lai
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marc Hohman
- Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston
| | - Tessa Hadlock
- Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Boston
| | - Ronald M. Zuker
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gregory H. Borschel
- Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Reanimation of the brow and eye in facial paralysis: Review of the literature and personal algorithmic approach. J Plast Reconstr Aesthet Surg 2015; 68:603-14. [DOI: 10.1016/j.bjps.2014.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/07/2014] [Accepted: 12/13/2014] [Indexed: 11/19/2022]
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Effect of endoscopic brow lift on contractures and synkinesis of the facial muscles in patients with a regenerated postparalytic facial nerve syndrome. Plast Reconstr Surg 2014; 133:121-129. [PMID: 24105091 DOI: 10.1097/01.prs.0000436834.19066.7c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delayed recovery after facial palsy results in aberrant nerve regeneration with symptomatic movement disorders, summarized as the postparalytic facial nerve syndrome. The authors present an alternative surgical approach for improvement of periocular movement disorders in patients with postparalytic facial nerve syndrome. The authors proposed that endoscopic brow lift leads to an improvement of periocular movement disorders by reducing pathologically raised levels of afferent input. METHODS Eleven patients (seven women and four men) with a mean age of 54 years (range, 33 to 85 years) and with postparalytic facial nerve syndrome underwent endoscopic brow lift under general anesthesia. Patients' preoperative condition was compared with their postoperative condition using a retrospective questionnaire. Subjects were also asked to compare the therapeutic effectiveness of endoscopic brow lift and botulinum toxin type A. RESULTS Mean follow-up was 52 months (range, 22 to 83 months). No intraoperative or postoperative complications occurred. During follow-up, patients and physicians observed an improvement of periorbital contractures and oculofacial synkinesis. Scores on quality of life improved significantly after endoscopic brow lift. Best results were obtained when botulinum toxin type A was adjoined after the endoscopic brow lift. Patients described a cumulative therapeutic effect. CONCLUSIONS These findings suggest endoscopic brow lift as a promising additional treatment modality for the treatment of periocular postparalytic facial nerve syndrome-related symptoms, leading to an improved quality of life. Even though further prospective investigation is needed, a combination of endoscopic brow lift and postsurgical botulinum toxin type A administration could become a new therapeutic standard.
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Smile restoration for permanent facial paralysis. Arch Plast Surg 2013; 40:633-8. [PMID: 24086823 PMCID: PMC3785603 DOI: 10.5999/aps.2013.40.5.633] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/14/2013] [Accepted: 03/15/2013] [Indexed: 11/08/2022] Open
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Abstract
BACKGROUND Facial synkinesis comprises unwanted facial muscle contractions in different facial muscle groups following voluntary ones, in cases of incomplete recovery from facial paralysis. Facial expressivity and function are impaired, and the psychological integrity of the patients is seriously affected. METHODS Thirty-one adult patients (older than 18 years) presenting with post-facial paralysis synkinesis were included in this study. The mean patient age was 39.6 years and the mean denervation time was 124 months. RESULTS There were five patient groups. Group A (n = 9) underwent cross-facial nerve grafting and secondary microcoaptations. Group B (n = 8) had cross-facial nerve grafting, secondary microcoaptations, and botulinum toxin type A injections. Group C (n = 6) received cross-facial nerve grafting, secondary microcoaptations, botulinum toxin type A, and selective neurectomies. Group D (n = 2) underwent cross-facial nerve grafting, direct muscle neurotization, and botulinum toxin type A. Group E underwent other means of treating synkinesis (n = 6), such as botulinum injections alone (n = 1), biofeedback alone (n = 2), biofeedback with selective neurectomies and myectomies (n = 2), and biofeedback and botulinum injections (n = 1). Group B had the highest synkinesis improvement (100 percent), followed by groups A and C (66 percent). Functional results were improved, with smile improvement being higher in group C and eye closure being higher in groups A, B, and E. CONCLUSION Meticulous patient selection and evaluation followed by an individualized form of treatment, most frequently including cross-facial nerve grafting and secondary microcoaptations along with botulinum toxin type A and biofeedback including facial muscle retraining, constitute an effective and reliable methodology with which to combat post-facial paralysis synkinesis. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Botulinum Toxin-A–Induced Protective Ptosis in the Treatment of Lagophthalmos Associated With Facial Paralysis. Ophthalmic Plast Reconstr Surg 2012; 28:256-60. [DOI: 10.1097/iop.0b013e31824ee702] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harrison DH, Grobbelaar AO. Pectoralis minor muscle transfer for unilateral facial palsy reanimation: An experience of 35 years and 637 cases. J Plast Reconstr Aesthet Surg 2012; 65:845-50. [DOI: 10.1016/j.bjps.2012.01.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 01/04/2012] [Accepted: 01/29/2012] [Indexed: 11/24/2022]
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Marsk E, Bylund N, Jonsson L, Hammarstedt L, Engström M, Hadziosmanovic N, Berg T, Hultcrantz M. Prediction of nonrecovery in Bell's palsy using Sunnybrook grading. Laryngoscope 2012; 122:901-6. [PMID: 22374870 DOI: 10.1002/lary.23210] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 12/22/2011] [Accepted: 12/29/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a clinical prognostic model to identify Bell's palsy patients with risk for nonrecovery at 12 months. STUDY DESIGN Data from a prospective, randomized, double-blind, placebo-controlled, multicenter study. METHODS There were 829 patients with Bell's palsy randomized in a factorial fashion to treatment with prednisolone or no prednisolone. Facial function was assessed with the Sunnybrook grading scale. Univariate and multivariate logistic regression analyses at different time points were used to identify factors predicting nonrecovery, defined as Sunnybrook <70 at 12 months. Variables studied were age, gender, time to inclusion, prednisolone treatment, side of palsy, pain at inclusion, and Sunnybrook scores. Factors of predictable significance were used to construct prognostic models at baseline, days 11 to 17, and at 1 month. Receiver operating characteristics curves were created to test the predictive capacity of the models. RESULTS At baseline, treatment with prednisolone or no prednisolone (P = .0005), age (P = .04) and the Sunnybrook score (P = .0002) were significant factors for predicting nonrecovery. The receiver operating characteristics area under the curve at baseline for these three variables was 0.74 (sensitivity 0.83, specificity 0.57). At days 11 to 17 and at 1 month, the Sunnybrook score was the only significant predictive variable. The respective areas under the curves for the Sunnybrook score at these time points were 0.83 (sensitivity 0.81, specificity 0.75) and 0.94 (sensitivity 0.91, specificity 0.85). CONCLUSIONS Sunnybrook grading at 1 month most accurately predicts nonrecovery at 12 months in Bell's palsy.
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Affiliation(s)
- Elin Marsk
- Department of Otorhinolaryngology and Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
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Ghali S, MacQuillan A, Grobbelaar AO. Reanimation of the middle and lower face in facial paralysis: review of the literature and personal approach. J Plast Reconstr Aesthet Surg 2010; 64:423-31. [PMID: 20471341 DOI: 10.1016/j.bjps.2010.04.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 04/06/2010] [Accepted: 04/09/2010] [Indexed: 11/29/2022]
Abstract
Facial paralysis refers to a condition in which all or portions of the facial nerve are paralysed. The facial nerve controls the muscles of facial expression, paralysis which results in a lack of facial expression which is not only an aesthetic issue, but has functional consequences as the patient cannot communicate effectively. The treatment of long-standing facial paralysis has challenged plastic surgeons for centuries, and still the ultimate goal of normality of the paralysed hemi-face with symmetry at rest as well as the generation of a spontaneous symmetrical smile with corneal protection has not yet fully been reached. Until the end of the 19th century, the treatment of this condition involved non-surgical means such as ointments, medicines and electrotherapy. With the advent and refinement of microvascular surgical techniques in the latter half of the 20th century, vascularised free muscle transfers coupled with cross-facial nerve grafts were introduced, allowing the possibility of spontaneous emotion being restored to the paralysed face became reality. The aim of this article is to revisit the surgical evolution and current options available as well as outcomes for patients suffering from facial paralysis concentrating on middle and lower face reanimation.
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Affiliation(s)
- Shadi Ghali
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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Majid O. Clinical use of botulinum toxins in oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2010; 39:197-207. [DOI: 10.1016/j.ijom.2009.10.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 06/15/2009] [Accepted: 10/30/2009] [Indexed: 12/12/2022]
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Pacifico MD, Ritz M. Correction of senile drooling using the nasolabial sling. J Plast Reconstr Aesthet Surg 2009; 63:757-62. [PMID: 19477703 DOI: 10.1016/j.bjps.2009.01.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 01/31/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Facial aging, resulting in lower facial ptosis often leads to downward angulation of the oral commissure, which may lead to troublesome angular chelitis. In this paper we present a treatment pathway for management of such patients. METHODS Treatment initially involves a combination of hyaluronic acid injection into the marionette lines and botulinum toxin A to the depressor anguli oris. If this treatment is unsuccessful patients then undergo the creation of a nasolabial sling, using bilateral superiorly-based nasolabial flaps tunnelled through the lower lip with transection of the depressor anguli oris on each side. In addition, two passes of the CO(2) laser are used to resurface the areas of chelitis and to tighten the tissues. Five patients have undergone treatment for their angular chelitis using one or a combination of these methods. RESULTS All cases were successfully treated and no recurrences occurred. Furthermore, all patients were satisfied with their outcome. CONCLUSIONS Little is available in the literature on the management of this disorder. In this paper we detail our surgical technique, discuss the issues encountered and review the current recommended treatment for this difficult problem.
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Affiliation(s)
- Marc D Pacifico
- The Melbourne Institute of Plastic Surgery, 253 Wattletree Road, Malvern, 3144 Victoria, Australia.
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Haltiwanger E, Huber T, Chang JC, Gonzalez-Stuart A, Gonzales-Stuart A. Case study of Bell's palsy applying complementary treatment within an occupational therapy model. Occup Ther Int 2009; 16:71-81. [PMID: 19222052 DOI: 10.1002/oti.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
For 7% of people with Bell's palsy, facial impairment is permanent. The case study patient was a 48-year-old female who had no recovery from paralysis 12 weeks after onset. Goals were to restore facial sensory-motor functions, functional abilities and reduce depression. Facial paralysis was assessed by clinical observations, the Facial Disability Index and Beck Depression Index. Complementary interventions of aromatherapy, reflexology and electro-acupuncture were used with common physical agent modalities in an intensive home activity and exercise programme. The patient had 100% return of function and resolution of depression after 10 days of intervention. The limitation of this study is that it was a retrospective case study and the investigators reconstructed the case from clinical notes. Further research using a prospective approach is recommended to replicate this study.
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Affiliation(s)
- Emily Haltiwanger
- College of Health Sciences, University of Texas at El Paso, El Paso, TX 79902, USA.
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Wong CL, Wong VC. Effect of Acupuncture in a Patient with 7-Year-History of Bell's Palsy. J Altern Complement Med 2008; 14:847-53. [DOI: 10.1089/acm.2007.0780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chau Lai Wong
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Virginia C.N. Wong
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Hong Kong
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Mehta RP, Hadlock TA. Botulinum Toxin and Quality of Life in Patients With Facial Paralysis. ACTA ACUST UNITED AC 2008; 10:84-7. [DOI: 10.1001/archfaci.10.2.84] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ritvik P. Mehta
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Tessa A. Hadlock
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Abstract
Facial nerve palsy affects individuals of all ages, races, and sexes. Psychological and functional implications of the paralysis present a devastating management problem to those afflicted, as well as the carriers. Since Sir Charles Bell's original description of facial palsy in 1821, our understanding and treatment options have expanded. It is essential that a multidisciplinary approach, encompassing ophthalmologists; Ear, Nose, and Throat surgeons; plastic surgeons; and psychologists work closely to optimize patient management in a staged approach. Although the etiology remains unknown, strong histological, cerebral spinal fluid, and radiological evidence suggests a possible association with herpes simplex virus in idiopathic facial nerve palsy (Bell's palsy). The use of steroids has been suggested as a means of limiting facial nerve damage in the acute phase. Unfortunately, no single randomized control trial has achieved an unquestionable benefit with the use of oral steroid therapy and thus remains controversial. In the acute phase, ophthalmologists play a pivotal role in preventing irreversible blindness from corneal exposure. This may be successfully achieved by using intensive lubrication, medical therapy (botulinum toxin), or surgery (upper lid weighting or tarsorraphy). Once the cornea is adequately protected and recovery deemed unlikely, longer term planning for eyelid and facial reanimation may take place in an individualized manner. Onset is sudden and management potentially lengthy. Physician empathy, knowledge, and experience are essential in averting long-term lifestyle and psychological discomfort for patients.
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Affiliation(s)
- Imran Rahman
- Manchester Royal Eye Hospital, Manchester, United Kingdom
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Rogers CR, Schmidt KL, VanSwearingen JM, Cohn JF, Wachtman GS, Manders EK, Deleyiannis FWB. Automated Facial Image Analysis. Ann Plast Surg 2007; 58:39-47. [PMID: 17197940 DOI: 10.1097/01.sap.0000250761.26824.4f] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the ability of Automated Facial Image Analysis (AFA) to detect changes in facial motion after Botox injections in patients with facial nerve disorders accompanied by abnormal muscle activity. Eight subjects received Botox for oral to ocular synkinesis (n = 6), ocular to oral synkinesis (n = 1), and/or depressor anguli oris overactivity (n = 3). Subjects were video-recorded during 2 directed facial action tasks before and after Botox treatment. AFA measurement and Facial Grading System (FGS) scores were used to evaluate the effects of Botox. After Botox, AFA detected a decrease in abnormal movements of the eyelids in all patients with oral to ocular synkinesis, a decrease in oral commissure movement for the patients with ocular to oral synkinesis, and an increase in oral commissure movement in all patients with depressor overactivity. The FGS scores failed to demonstrate any change in facial movement for the case of ocular to oral synkinesis and for 2 cases of depressor overactivity. AFA enables recognition of subtle changes in facial movement that may not be adequately measured by observer based ratings of facial function.
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Affiliation(s)
- Carolyn R Rogers
- Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
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