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Tedeschi R, Donati D, Giorgi F. Beyond the smile: a systematic review of diagnostic tools for peripheral facial paralysis. Acta Neurol Belg 2024:10.1007/s13760-024-02630-w. [PMID: 39198355 DOI: 10.1007/s13760-024-02630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/15/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Effective rehabilitation of peripheral facial paralysis (PFP) requires reliable assessment tools. This systematic review aimed to identify and validate instruments used in PFP rehabilitation, categorizing them according to the ICF framework. METHODS A comprehensive search was conducted across PubMed, Cinahl, Web of Science, and Scopus up to April 2024. Observational analytical studies and one non-randomized controlled trial that validated tools for assessing PFP were included. RESULTS Thirty-three studies were included, covering twenty different tools. Seventeen tools were related to the "Structure and Function" domain, while three addressed "Activity and Participation." The Sunnybrook and House-Brackmann scales were the most extensively studied. The Sunnybrook scale exhibited excellent intra- and inter-rater reproducibility and internal validity, making it suitable for clinical use. The House-Brackmann scale was user-friendly but had limitations in reproducibility and sensitivity to subtle differences, which newer versions like the FNGS 2.0 aimed to address. The FAME scale showed promise by reducing subjective scoring. Computerized tools, such as eFACE and A-FPG, and instruments for lip asymmetry and ocular involvement demonstrated potential but require further validation. The Facial Disability Index and the FaCE Scale were validated for assessing disability and participation restrictions. CONCLUSION This review identified several validated tools for PFP assessment, with the Sunnybrook and House-Brackmann scales being the most reliable. While emerging tools and computerized programs show promise, they need further validation for routine clinical use. Integrating validated tools into clinical practice is essential for comprehensive assessment and effective rehabilitation of PFP.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126, Bologna, Italy.
| | - Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Giorgi
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences of Bologna, Via Altura 3, Bologna, Italy, IRCCS Institute of Neurological Sciences of Bologna, Via Altura 3, Bologna, Italy
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Mazreku M, Feltsan T, El Falougy H, Bevizova K. Chronic Facial Paralysis Treated With Non-absorbable APTOS Barbed Threads: A Case Report With Anatomic Considerations. Cureus 2024; 16:e62539. [PMID: 39022483 PMCID: PMC11254316 DOI: 10.7759/cureus.62539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Chronic paralysis of the facial nerve leads to degenerative facial muscle and surrounding soft tissue alterations on the involved side, making the affected patients seem older than their actual age. Moreover, contralateral facial hypertrophy worsens facial asymmetry. Correction of the drooping or wrinkled face due to aging, trauma, or other pathology has been successfully treated with the thread-lifting technique. Here, we present the case report of a 23-year-old female patient suffering from oncologic post-surgery complications associated with chronic facial nerve paralysis. She also suffered from old and new cerebellar syndromes on the right side and lesions of the oculomotor, trochlear, and abducens nerves. Based on the patient history, the condition was treated under local anesthesia by the use of APTOS minimally invasive threads with barbs made from non-absorbable material. Correction and sculpting of the affected cheek area were performed by insertion of a light lift needle, and lifting of the superficial fat pads was secured by subdermal insertion of the light lift thread method. The jowl area was lifted by the superficial insertion of both types of threads. As a result, we significantly improved facial symmetry at rest, a more symmetric smile, a lifted corner of the mouth, and an anatomically sculpted cheek appearance.
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Affiliation(s)
- Merita Mazreku
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine and Oncologic Institute of St. Elisabeth, Comenius University, Bratislava, SVK
| | - Taras Feltsan
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine and Oncologic Institute of St. Elisabeth, Comenius University, Bratislava, SVK
| | - Hisham El Falougy
- Institute of Anatomy, Faculty of Medicine, Comenius University, Bratislava, SVK
| | - Katarina Bevizova
- Institute of Anatomy, Faculty of Medicine, Comenius University in Bratislava, Bratislava, SVK
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3
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Cao Q, Qi B, Zhai L. Progress in treatment of facial neuritis by acupuncture combined with medicine from the perspective of modern medicine: A review. Medicine (Baltimore) 2023; 102:e36751. [PMID: 38134097 PMCID: PMC10735107 DOI: 10.1097/md.0000000000036751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Facial neuritis is a common clinical disease with high incidence, also known as Bell palsy or idiopathic facial nerve paralysis, which is an acute onset of peripheral facial neuropathy. In modern medicine, there have been obstacles to the effective treatment of facial neuritis. At present, the clinical use of Western medicine treatment is also a summary of clinical experience, the reason is that the cause of facial neuritis is unknown. Facial neuritis belongs to the category of "facial paralysis" in traditional Chinese medicine. For thousands of years, Chinese medicine has accumulated a lot of relevant treatment experience in the process of diagnosis and treatment. At the same time, traditional Chinese medicine, acupuncture and the combination of acupuncture and medicine play an important role in the treatment of facial neuritis. This article discusses the treatment of facial neuritis with acupuncture combined with Chinese medicine, based on the research progress of modern medicine. In this review, we provide an overview of the effectiveness of acupuncture and medication combinations and facial neuritis with current studies investigating acupuncture and medication combinations in the treatment of facial neuritis.
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Affiliation(s)
- Qingxi Cao
- Shiyan People’s Hospital of Baoan District, Shenzhen, China
| | - Biao Qi
- Shiyan People’s Hospital of Baoan District, Shenzhen, China
| | - Lingyan Zhai
- Shiyan People’s Hospital of Baoan District, Shenzhen, China
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Mohd Ridzam MS, Abdullah A. Acute Facial Nerve Palsy in Facial Nerve Schwannoma Following COVID-19 Infection. Cureus 2023; 15:e36764. [PMID: 37123728 PMCID: PMC10132860 DOI: 10.7759/cureus.36764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Lower motor neuron facial nerve palsy (FNP) has many causes. Bell's palsy is by far the commonest cause. Among other causes include infective and neoplastic causes. While FNP caused by facial nerve schwannoma (FNS); a benign neoplastic condition of the facial nerve is slowly progressing, infective causes mainly viral origins present with acute FNP. We present a young female who complained of an acute onset of FNP on day five of her COVID-19 infection. She initially presented with symptoms suggestive of ear infection, and subsequent magnetic resonance imaging (MRI) showed evidence of FNS, which she was subjected to surgery later at our center. This rare acute incidence of FNP in schwannoma might be triggered by the COVID-19 infection and demonstrates the role of imaging in finding the cause of FNP.
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Acute Peripheral Facial Paralysis Masquerading as Bell's Palsy Is the First Presentation of COVID-19 Infection. Case Rep Neurol Med 2023; 2023:4278146. [PMID: 36755987 PMCID: PMC9902140 DOI: 10.1155/2023/4278146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/23/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023] Open
Abstract
Although Bell's palsy is a common diagnosis of acute isolated peripheral facial palsy (PFP), acute isolated PFP can be the first presentation of various illnesses, including COVID-19 disease. A female with a known history of well-controlled diabetes mellitus presented initially with acute isolated PFP mimicking Bell's palsy. A course of oral prednisolone was given to treat acute PFP. Severe fifth cervical radicular pain, which is unusual for Bell's palsy followed 3 days later. The COVID-19 infection was finally diagnosed by a real-time polymerase chain reaction (RT-PCR) test 15 days after facial paralysis when typical pulmonary infection symptoms developed. Oral favipiravir was given for the treatment of COVID-19 infection, to which the symptoms completely responded. The COVID-19 infection as a cause of acute isolated PFP should be added to the differential diagnosis of acute isolated PFP, albeit without typical pulmonary infection symptoms, particularly during the global pandemic of the infection.
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6
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Vaughan A, Copley A, Miles A. Physical rehabilitation of central facial palsy: A survey of current multidisciplinary practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:616-625. [PMID: 34928754 DOI: 10.1080/17549507.2021.2013533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: The role of allied health practitioners providing physical rehabilitation of central facial palsy (CFP) is minimally reported in the literature. This study explores current practice and the roles, attitudes and perceptions of allied health professionals (AHPs) working with people with CFP.Method: An electronic survey was distributed to speech-language pathologists (SLPs), occupational therapists and physiotherapists. Responses (n = 78) were analysed using qualitative and quantitative methods.Result: SLPs often lead management of CFP; however, their role is not clearly defined nor well recognised. Several barriers were identified which prevent AHPs from providing consistent specialist rehabilitation to people with CFP. These included a lack of training, no clear delegation of role, limited evidence and lack of resources.Conclusion: Survey respondents viewed CFP to be within SLP scope of practice; although, ownership of management varies between countries and professions. Most SLPs recognise the negative impact of CFP and feel a sense of responsibility to provide assessment and treatment of this impairment, but many barriers to doing so have been identified. Suggestions to improve access to rehabilitation for people with CFP included increased access to training for SLPs, more evidence, clinical practice guidelines and more clinical resources. Further research is required to ensure people suffering from CFP can access services that provide skilled management of their impairment.
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Affiliation(s)
- Annabelle Vaughan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Anna Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Anna Miles
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Speech Science, The University of Auckland, Auckland, New Zealand
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Hartanto A, Supriyana DS, Simadibrata C. Improved Iatrogenic Facial Nerve Paralysis Based on House-Brackmann Facial Nerve Grading System by Using Acupuncture Therapy: A Case Report. Med Acupunct 2022; 34:337-343. [PMID: 36311887 PMCID: PMC9595611 DOI: 10.1089/acu.2021.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Iatrogenic facial nerve paralysis is often caused by surgical procedures on temporomandibular joint due to temporomandibular disorder. It can affect the quality of life of the patient due to the facial nerve's importance in communication and expressions. Case We hereby report a case of a 22-year-old man with right facial nerve paralysis after he had arthroplasty surgery. He received Mefenamic Acid 3 × 500 mg (if necessary) and Mecobalamin 1 × 500 mg. He was treated with manual acupuncture therapy for 3 times a week with 30 minutes of each session until he has reached the deqi sensation. Acupuncture points used were points on the affected side and several points on both sides. Results The patient underwent acupuncture treatments for 28 sessions in 4.5 months. On the eighth session, the patient had no visible right lagophthalmos. The patients' jaws could open normally after the 12th session, and at the end of the sessions (28th) the patient could raise and lower his right eyebrow perfectly. We found that patient's facial nerve function was improved to normal based on House-Brackmann facial nerve grading system. The nerve conduction velocity and electromyography test results also improved. Conclusions Acupuncture should be considered as one of the therapeutic tools for treating iatrogenic facial nerve paralysis.
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Affiliation(s)
- Andry Hartanto
- Medical Acupuncture, Manyar Medical Centre Hospital Surabaya, Surabaya, Indonesia
| | - Dwi Surya Supriyana
- Medical Acupuncture Division, UNS Teaching Hospital, Faculty of Medicine Universitas Sebelas Maret, Surakarta, Central Java, Indonesia
| | - Christina Simadibrata
- Medical Acupuncture Division, dr. Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Central Jakarta, Indonesia
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8
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Hodkinson J. Sixty seconds on . . . Justin Bieber. BMJ 2022; 377:o1492. [PMID: 35710115 DOI: 10.1136/bmj.o1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pattinson R, Poole HM, Shorthouse O, Sadiq SA, Bundy C. Exploring beliefs and distress in patients with facial palsies. PSYCHOL HEALTH MED 2021; 27:788-802. [PMID: 33486991 DOI: 10.1080/13548506.2021.1876891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence suggests that people with facial palsy may experience higher levels of distress, but the reasons for this are yet to be explored. This study aimed to explore people's illness beliefs, emotions, and behaviours in relation to their facial palsy and understand how distress is experienced by this group. Semi-structured individual interviews were conducted in the UK with adults with facial palsy. Interview questions were theoretically informed by the Common-Sense Self-Regulatory Model (CS-SRM). Thematic Analysis was conducted following a combined inductive and deductive approach. Twenty people with facial palsy participated (70% female; aged 29-84). Patient distress was accounted for by illness beliefs (symptoms, cause, control and treatment, timeline and consequences), and four additional themes (coping behaviours, social support, identity and health service provision). Experiences of anxiety, depression, and anger were widespread, and some participants experienced suicidal ideation. The burden of managing a long-term condition, altered self-perception, and social anxiety and isolation were key drivers of distress. There is a need for more integrated psychological support for patients with facial palsy. Within clinical consultations, patient's beliefs about facial palsy should be identified and systematically addressed. Service development should include appropriate referral to specialist psychological support via an established care pathway.
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Affiliation(s)
- R Pattinson
- School of Healthcare Sciences, College of Biomedical Sciences, Cardiff University, Cardiff, UK
| | - H M Poole
- School of Psychology, Liverpool John Moores University, Liverpool John Moores University, Liverpool, UK
| | - O Shorthouse
- Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - S A Sadiq
- Manchester Royal Eye Hospital, Manchester, UK
| | - C Bundy
- School of Healthcare Sciences, College of Biomedical Sciences, Cardiff University, Cardiff, UK
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10
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Xia W, Zhu J, Wang X, Tang Y, Zhou P, Wei X, Chang B, Zheng X, Zhu W, Hou M, Li S. Overexpression of Foxc1 regenerates crushed rat facial nerves by promoting Schwann cells migration via the Wnt/β-catenin signaling pathway. J Cell Physiol 2020; 235:9609-9622. [PMID: 32391604 PMCID: PMC7586989 DOI: 10.1002/jcp.29772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 12/23/2022]
Abstract
Facial paralysis can result in severe implications for patients. A good prognosis depends on the degree of nerve regeneration. Schwann cells (SCs) play an important role in facial nerve development and regeneration through migration. Forkhead box C1 (Foxc1), a member of the forkhead transcription factor family, is implicated in cell migration. However, the role of Foxc1 in the progression after facial nerve crush remains unknown. Our aim was to evaluate the effect of Foxc1 overexpression on SC migration and recovery of facial nerves after crush injury. The rat facial nerve crush injury model was established through the use of unilateral surgery. The results showed that the expression of Foxc1 was increased in the surgery group compared to that of the control group. SCs were isolated from the sciatic nerves and cultured. Foxc1, delivered by an adeno‐associated virus in vivo, or adenovirus in vitro, both induced overexpression of Foxc1, and increased the expression of CXCL12 and β‐catenin. After the transfection of Foxc1, the migration of SC was increased both in vitro and in vivo, was reduced by the inhibition of CXCL12 or β‐catenin. The facial nerve function and the nerve axon remyelination of the rats transfected with Foxc1 were significantly improved after nerve crush injury. Overall, the results demonstrated that overexpression of Foxc1 promoted SC migration by regulating CXCL12 via the Wnt/β‐catenin pathway, thus contributing to improved facial nerve function after crush injury.
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Affiliation(s)
- Wenzheng Xia
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Jin Zhu
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Xueyi Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Yinda Tang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Zhou
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Xiangyu Wei
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Bowen Chang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Xuan Zheng
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Wanchun Zhu
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Hou
- Department of Radiation Oncology, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shiting Li
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, Center for Diagnosis and Treatment of Cranial Nerve Diseases, Shanghai Jiao Tong University, Shanghai, China
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Ilves M, Lylykangas J, Rantanen V, Mäkelä E, Vehkaoja A, Verho J, Lekkala J, Rautiainen M, Surakka V. Facial muscle activations by functional electrical stimulation. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2018.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kularatne SAM, Fernando R, Selvaratnam S, Narampanawa C, Weerakoon K, Wickramasinghe S, Pathirage M, Weerasinghe V, Bandara A, Rajapakse J. Intra-aural tick bite causing unilateral facial nerve palsy in 29 cases over 16 years in Kandy, Sri Lanka: is rickettsial aetiology possible? BMC Infect Dis 2018; 18:418. [PMID: 30134848 PMCID: PMC6106839 DOI: 10.1186/s12879-018-3338-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022] Open
Abstract
Background Over the last two decades intra-aural tick infestation (otoacariasis) has been a common occurrence in the hilly central region in Sri Lanka. Very occasional detection of isolated unilateral facial nerve palsy associated with otoacariasis attributed to toxin damage of the nerve prompted us to study the clinico-epidemiology and aetio-pathology of the problem. Methods All cases having isolated unilateral facial nerve palsy associated with otoacariasis presented to, Ear Nose and Throat clinic at General Hospital Kandy, Sri Lanka from 2001 to 2016 were included in the study. The facial palsies were assessed with nerve conduction studies and, harvested ticks were identified. Results There were 29 patients with mean age of 46 years (range 22–76 years) with male to female ratio of 1:1.9. First 12 patients without specific treatment took 1–55 months for recovery and 4 had axonal degeneration. Last 5 patients were treated with doxycycline and recovered in 4 weeks. They had strong sero-conversion of immunofluorescence antibodies against spotted fever rickettsioses and the tick harvested from the last patient was PCR positive for rickettsial DNA. Identified ticks belonged to Dermacentor, Amblyomma, Rhipicephalus and Hyalomma species. Conclusions On contrary to popular toxin theory, we were able to demonstrate treatable rickettsial aetio-pathology as the cause of otoacariasis associated lower motor facial palsy in Sri Lanka.
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Affiliation(s)
- Senanayake A M Kularatne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
| | | | | | | | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Sujanthe Wickramasinghe
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Manoji Pathirage
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Vajira Weerasinghe
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Anura Bandara
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Jayanthe Rajapakse
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, 20400, Sri Lanka
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Geoghegan L, Kwasnicki R, Kanabar S, Pethers D, Nduka C. A systematic recurrent theme analysis of the reported limitations of facial electromyography. Ann Med Surg (Lond) 2018; 33:1-6. [PMID: 30094024 PMCID: PMC6072910 DOI: 10.1016/j.amsu.2018.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
Background Advances in digital technology hold promise in expanding the clinical and consumer applications of facial electromyography (EMG) through thedevelopment of wireless pervasive systems capable of operating in a nonclinical environment. This systematic review aims to appraise the most commonly reported limitations of the technology in clinical research and practice. Methods A systematic search for clinical facial EMG literature was performed using MEDLINE, EMBASE, PsychINFO and CINAHL. No language limits were applied. Search results were screened using defined criteria by two authors with disagreements resolved by a third. Practical limitations in the technology, as reported by the authors, were recorded and characterised using recurrent theme analysis. Results A total of 4,983 records were identified. Of those, 1,061 articles met eligibility criteria and were subsequently reviewed. In the medical domain, the most common area of application was in psychosocial studies (28% of medical studies); in the surgical domain monitoring of facial nerve integrity was the most common application of facial electromyography (27% of surgical studies). Collectively, the three most commonly reported limitations were motion artefact (13.7%), inter-subject variability in response and anatomy (13.1%), and muscle crosstalk (12.0%). Conclusions This is the first study to evaluate the limitations of facial EMG using a systematic analysis of author reports. Highlighting technology limitations in this non-biased manner raises awareness to users key issues and reliably informs the development of future systems. The limitations of facial electromyography have been systematically reviewed. The respective limitations of surface and needle facial electromyography have been examined across both medical and surgical domains. Quantification of such limitations informs continued development of future systems.
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Affiliation(s)
- L. Geoghegan
- Imperial College Medical School, Exhibition Road, SW7 2AZ, UK
| | - R.M. Kwasnicki
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, W2 1NY, UK
- Corresponding author. 10th Floor QEQM Building, St. Mary's Hospital, Praed Street, W2 1NY, UK. Tel.: +44 0 20 7589 5111.
| | - S. Kanabar
- Imperial College Medical School, Exhibition Road, SW7 2AZ, UK
| | - D. Pethers
- Imperial College Medical School, Exhibition Road, SW7 2AZ, UK
| | - C. Nduka
- Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK
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Paradoxical Frontalis Activation: An Underrecognized Consequence of Facial Palsy. Plast Reconstr Surg 2018; 141:263e-270e. [PMID: 29369999 DOI: 10.1097/prs.0000000000004057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aberrant reinnervation and synkinesis are common and debilitating after facial palsy. Paradoxical frontalis activation can antagonize eye closure and increase the risk of corneal damage. If recognized, judicious botulinum toxin injection to the affected side may reduce this risk. METHODS One hundred consecutive patients with synkinesis were identified from a prospective database. Routine facial view photographs were converted to a standardized scale using iris diameter. The vertical distance from the midpoint of the midcanthal line to the inferior border of the eyebrow was measured bilaterally. A value of p < 0.05 was considered significant. RESULTS Eighty-two patients were included, with a median age of 44 years (interquartile range, 33 to 59 years); 59 of the patients were women. The commonest cause was idiopathic (n = 55). The median time since onset of palsy was 13 months (interquartile range, 6.5 to 27 months). There was less midpoint of the midcanthal line to the inferior border of the eyebrow excursion on the synkinetic side of the face (p < 0.001). Twenty-two patients (27 percent) displayed paradoxical frontalis movement on the affected side of their face, with increased midpoint of the midcanthal line to the inferior border of the eyebrow distance (eyebrow raise) when attempting eye closure compared with eyebrow raise (n = 19), and tight eye closure compared with gentle eye closure (n = 3). CONCLUSIONS This study highlights the phenomenon of paradoxical frontalis activation during eye closure. This is often underrecognized and may contribute to lagophthalmos. The authors found it to be present in 27 percent of patients with moderate or severe synkinesis. Further dynamic studies are required to understand the relationship among frontalis activity, eye closure, and the effects of its inhibition.
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Abstract
Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications.
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Cooper L, Branagan-Harris M, Tuson R, Nduka C. Lyme disease and Bell's palsy: an epidemiological study of diagnosis and risk in England. Br J Gen Pract 2017; 67:e329-e335. [PMID: 28396367 PMCID: PMC5409434 DOI: 10.3399/bjgp17x690497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/11/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Lyme disease is caused by a tick-borne spirochaete of the Borrelia species. It is associated with facial palsy, is increasingly common in England, and may be misdiagnosed as Bell's palsy. AIM To produce an accurate map of Lyme disease diagnosis in England and to identify patients at risk of developing associated facial nerve palsy, to enable prevention, early diagnosis, and effective treatment. DESIGN AND SETTING Hospital episode statistics (HES) data in England from the Health and Social Care Information Centre were interrogated from April 2011 to March 2015 for International Classification of Diseases 10th revision (ICD-10) codes A69.2 (Lyme disease) and G51.0 (Bell's palsy) in isolation, and as a combination. METHOD Patients' age, sex, postcode, month of diagnosis, and socioeconomic groups as defined according to the English Indices of Deprivation (2004) were also collected. RESULTS Lyme disease hospital diagnosis increased by 42% per year from 2011 to 2015 in England. Higher incidence areas, largely rural, were mapped. A trend towards socioeconomic privilege and the months of July to September was observed. Facial palsy in combination with Lyme disease is also increasing, particularly in younger patients, with a mean age of 41.7 years, compared with 59.6 years for Bell's palsy and 45.9 years for Lyme disease (P = 0.05, analysis of variance [ANOVA]). CONCLUSION Healthcare practitioners should have a high index of suspicion for Lyme disease following travel in the areas shown, particularly in the summer months. The authors suggest that patients presenting with facial palsy should be tested for Lyme disease.
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Affiliation(s)
- Lilli Cooper
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, West Sussex
| | | | - Richard Tuson
- Health analytics and NHS policy expert, Device Access UK Ltd, Michelmersh, Hampshire
| | - Charles Nduka
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, West Sussex
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Abstract
In this article we will explore the mimics and chameleons of Bell's palsy and in addition argue that we should use the term 'Bell's palsy syndrome' to help guide clinical reasoning when thinking about patients with facial weakness. The diagnosis of Bell's palsy can usually be made on clinical grounds without the need for further investigations. This is because the diagnosis is not one of exclusion (despite this being commonly how it is described), a lower motor neurone facial weakness where all alternative causes have been eliminated, but rather a positive recognition of a clinical syndrome, with a number of exclusions, which are described below. This perhaps would be more accurately referred to a 'Bell's palsy syndrome'. Treatment with corticosteroids improves outcome; adding an antiviral probably reduces the rates of long-term complications.
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Affiliation(s)
- Geraint Fuller
- Department of Neurology, Gloucester Royal Hospital, Gloucester, UK
| | - Cathy Morgan
- Department of Neurology, Gloucester Royal Hospital, Gloucester, UK
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