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Frutos-Reoyo EJ, López-Izquierdo R, Luque-Linero P, Cantalapiedra-Puentes E, Antón-Andrés MJ, Hernández-Gajate JM, Candau-Pérez ED. Analysis of Predictive Factors for the Poor Prognosis of Peripheral Facial Paralysis. Am J Phys Med Rehabil 2024; 103:245-250. [PMID: 37602548 DOI: 10.1097/phm.0000000000002328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
PURPOSE The aim of the study is to evaluate the predictive factors for a poor prognosis in patients with facial paralysis evaluated in the rehabilitation department of a tertiary hospital. METHODS We have conducted a prospective cohort study. Patients who required elective botulinum toxin infiltration, surgical treatment, or follow-up appointments longer than 6 months due to incomplete recovery were considered to have a poor prognosis. Descriptive and analytical analyses of clinical and epidemiological variables were performed. The follow-up period was 6 mos. RESULTS A total of 47 adult patients were analyzed, 54.2% of whom were women. The mean age was 53.2 yrs (SD, 15.5 yrs). Twenty-five percent had an unfavorable prognosis. A statistically significant association with prognosis was observed for neurophysiological results and the scores of the House-Brackmann scale and the Sunnybrook Facial Grading System. CONCLUSIONS Neurophysiological tests are especially useful when evaluating prognosis. Likewise, Sunnybrook Facial Grading System is a useful and accessible tool with prognostic value, especially within a month of initial diagnosis, when a score lower than 65 indicates a poor prognosis with high sensitivity and specificity. These tools can be especially useful to reduce the clinical and psychological impact and to provide patients with early therapeutic management.
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Affiliation(s)
- Emilio Javier Frutos-Reoyo
- From the Servicio de Medicina Física y Rehabilitación, Hospital Universitario Río Hortega, Valladolid, Spain (EJF-R, EC-P, MJA-A, EDC-P); Servicio de Urgencias, Hospital Universitario Río Hortega, Valladolid, Spain (RL-I, JMH-G); Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain (PL-L); Servicio de Medicina Física y Rehabilitación, Hospital Virgen de la Concha, Zamora, Spain (EC-P)
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Machetanz K, Oberle L, Wang SS, Weinbrenner E, Gorbachuk M, Lauer H, Daigeler A, Tatagiba M, Naros G, Schäfer RC. Outpatient care for facial palsy-a survey on patient satisfaction in uni- and interdisciplinary approaches. Front Neurol 2024; 15:1354583. [PMID: 38385047 PMCID: PMC10880734 DOI: 10.3389/fneur.2024.1354583] [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] [Received: 12/12/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
Objective The various causes of facial palsy, diagnostic methods and treatment approaches frequently involve different medical specialities. Nevertheless, there exist only few specialized consultation and therapy services for patients with facial palsy (FP) in Germany. The aim of the present study was to evaluate factors affecting quality of life (QoL) and treatment satisfaction of patients presenting to an interdisciplinary facial nerve outpatient clinic. Methods The study analyzed patients presenting to the interdisciplinary facial palsy outpatient clinic in Tuebingen between February 2019 and December 2022. General satisfaction and QoL was estimated by numerous self-rating questionnaires: ZUF-8, SF-36, FDI, FaCE, PHQ-9. An ANOVA was performed to analyze determinants affecting the ZUF-8. Correlation analyses between cause and regeneration of FP as well as questionnaire scores were performed. Results were compared with a group of patients who were managed in an unidisciplinary setting. Results In total, 66 patients with FP were enrolled. FP patients showed increased levels of depression (PHQ-9: 14.52 ± 3.8) correlating with recovery of the palsy (p = 0.008), FaCE (p < 0.001) and FDI ratings (p < 0.001). There was a high level of satisfaction with the services provided during the uni-and interdisciplinary consultation (ZUF-8: 24.59 ± 6.2), especially among the 12/66 patients who received reconstructive, surgical treatment. However, some patients requested more psychological and ophthalmological support. Conclusion High levels of treatment satisfaction can be achieved in both an uni-and interdisciplinary setting. However, multimodal therapy approaches should be applied, considering physical and psychological aspects. In the absence of recovery, surgical interventions must be considered as treatment options. Further studies should continue to investigate potential differences between uni-and interdisciplinary treatment.
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Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Linda Oberle
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie S. Wang
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Eliane Weinbrenner
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Mykola Gorbachuk
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Henrik Lauer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Ruth C. Schäfer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Tuebingen, Germany
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Zhou W, Wang Z, Xu Q, Liu X, Li J, Yu H, Qiao H, Yang L, Chen L, Zhang Y, Huang Z, Pang Y, Zhang Z, Zhang J, Guan X, Ma S, Ren Y, Shi X, Yuan L, Li D, Huang D, Li Z, Jia W. Wireless facial biosensing system for monitoring facial palsy with flexible microneedle electrode arrays. NPJ Digit Med 2024; 7:13. [PMID: 38225423 PMCID: PMC10789865 DOI: 10.1038/s41746-024-01002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024] Open
Abstract
Facial palsy (FP) profoundly influences interpersonal communication and emotional expression, necessitating precise diagnostic and monitoring tools for optimal care. However, current electromyography (EMG) systems are limited by their bulky nature, complex setups, and dependence on skilled technicians. Here we report an innovative biosensing approach that utilizes a PEDOT:PSS-modified flexible microneedle electrode array (P-FMNEA) to overcome the limitations of existing EMG devices. Supple system-level mechanics ensure excellent conformality to the facial curvilinear regions, enabling the detection of targeted muscular ensemble movements for facial paralysis assessment. Moreover, our apparatus adeptly captures each electrical impulse in response to real-time direct nerve stimulation during neurosurgical procedures. The wireless conveyance of EMG signals to medical facilities via a server augments access to patient follow-up evaluation data, fostering prompt treatment suggestions and enabling the access of multiple facial EMG datasets during typical 6-month follow-ups. Furthermore, the device's soft mechanics alleviate issues of spatial intricacy, diminish pain, and minimize soft tissue hematomas associated with traditional needle electrode positioning. This groundbreaking biosensing strategy has the potential to transform FP management by providing an efficient, user-friendly, and less invasive alternative to the prevailing EMG devices. This pioneering technology enables more informed decision-making in FP-management and therapeutic intervention.
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Affiliation(s)
- Wenjianlong Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Zhongyan Wang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Qin Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Xiangxiang Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
| | - Junshi Li
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Huaiqiang Yu
- Sichuan Institute of Piezoelectric and Acousto-optic Technology, 400060, Chongqing, China
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China
| | - Lirui Yang
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China
| | - Liangpeng Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Yuan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Zhe Huang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Yuxing Pang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Zhitong Zhang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Jiayan Zhang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Xiudong Guan
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Shunchang Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Yingjie Ren
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Xiaoyi Shi
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Linhao Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Deling Li
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), 100070, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China
| | - Dong Huang
- School of Integrated Circuits, Peking University, 100871, Beijing, China.
| | - Zhihong Li
- School of Integrated Circuits, Peking University, 100871, Beijing, China.
- Beijing Advanced Innovation Center for Integrated Circuits, 100871, Beijing, China.
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), 100070, Beijing, China.
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China.
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Li S, Xie S, Li Z, Ding M, Shan X, Zhang L, Yu G, Cai Z. Facial Reanimation After Peripheral Facial Nerve Paralysis: A Single-institution Surgical Experience. J Craniofac Surg 2023; 34:1841-1844. [PMID: 37427918 DOI: 10.1097/scs.0000000000009513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Facial nerve trauma occasionally develops during oral and maxillofacial surgery. This study was aimed at enhancing the available knowledge on facial nerve reanimation correlated to surgery and proposing our surgical algorithm. We retrospectively analyzed medical records of patients who underwent facial reanimation surgery at our hospital. The inclusion criterion was surgery for facial reanimation from January 2004 to June 2021. We included 383 eligible patients who underwent facial reanimation surgery. Trauma or maxillofacial neoplasms were noted in 208 of 383 and 164 of 383 cases, respectively. In 238 of 383 cases, nerve branches were likely more vulnerable. Facial nerve anastomosis was performed in 256 patients. Sixty-eight patients received nerve grafts. In 22 patients, distal facial nerve transfer to the masseteric nerve, sublingual nerve, or contralateral facial nerve was performed. Twenty-five patients received static surgery; in most cases, the temporalis fascia flap (20/25) was used. The nerve function outcomes were HB grade I (n=17), Grade Ⅱ (n=108), Grade Ⅲ (n=118), Grade Ⅳ (n=94), and Grade V (n=46). The mean follow-up time was 4.88 ± 3.93 years. Facial paralysis caused by trauma ( P =0.000), branch injury ( P =0.000), and the primary reconstruction of facial nerve ( P =0.000) were predictive of favorable treatment outcomes. Although facial nerve injury caused by trauma was more likely, cases of interference in facial expression could be limited, and so did the injury to branches. Nerve anastomosis was prioritized if a tension-free suture was possible. Maintaining the integrity of the nerve and shortening the duration of mimetic muscular denervation were crucial.
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Affiliation(s)
- Shijun Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Haidian District, Beijing, China
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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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Multidisciplinary Care of Patients with Facial Palsy: Treatment of 1220 Patients in a German Facial Nerve Center. J Clin Med 2022; 11:jcm11020427. [PMID: 35054119 PMCID: PMC8778429 DOI: 10.3390/jcm11020427] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
To determine treatment and outcome in a tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients referred between 2007 and 2018. Facial grading with the Stennert index, the Facial Clinimetric Evaluation (FaCE) scale, and the Facial Disability Index (FDI) were used for outcome evaluation; 1220 patients (58.4% female, median age: 50 years; chronic palsy: 42.8%) were included. Patients with acute and chronic facial palsy were treated in the center for a median of 3.6 months and 10.8 months, respectively. Dominant treatment in the acute phase was glucocorticoids ± acyclovir (47.2%), followed by a significant improvement of all outcome measures (p < 0.001). Facial EMG biofeedback training (21.3%) and botulinum toxin injections (11%) dominated the treatment in the chronic phase, all leading to highly significant improvements according to facial grading, FDI, and FaCE (p < 0.001). Upper eyelid weight (3.8%) and hypoglossal–facial-nerve jump suture (2.5%) were the leading surgical methods, followed by improvement of facial motor function (p < 0.001) and facial-specific quality of life (FDI, FaCE; p < 0.05). A standardized multidisciplinary team approach in a facial nerve center leads to improved facial and emotional function in patients with acute or chronic facial palsy.
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7
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Çirakli S. Effect of etiological factors on treatment success of pediatric facial paralysis: Success of facial paralysis in children. Medicine (Baltimore) 2021; 100:e28195. [PMID: 34918676 PMCID: PMC8677891 DOI: 10.1097/md.0000000000028195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
Facial paralysis is a clinical condition that causes anxiety in the family and is one of the reasons for urgent admission to the hospital. The purpose of this article is to evaluate to reveal the relationship between etiology and treatment results in childhood facial paralysis.Thirty-three patients who presented with facial paralysis between May 2018 and May 2020, had adequate follow-up were included in the study. Data were reviewed age, gender, side, etiology, features of family, treatment, results, and recurrences.The ages of the cases ranged from 21 months to 17 years, with the mean age was 13.1 years. Ten of the cases were male (30.3%), 23 of them were female (69.7%). It was observed that 15 (45.4%) of the paralysis were on the right half of the face, 17 (51.5%) were on the left side of the face, and 1 (3.1%) had bilateral involvement. However, it was learned from the story that 3 cases had recurrence. Thirty-two (96.9%) of the cases were peripheral and 1 (3.1%) had central facial paralysis. No cause could be found in the etiology of other peripheral paralysis cases and it was considered as Bell Paralysis. According to the House Brackmann Stage at the time of admission of 30 patients who were given steroid treatment, 10 patients were evaluated as stage 6, 15 patients as stage 5, and 5 patients as stage 4. After 6 months of follow-up, 27 patients were evaluated as stage 1 and 2 patients as stage 2. Recurrence was not observed in any of the patients who recovered.It was concluded that etiology determines the success of treatment in facial paralysis.
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Khetpal S, Sasson DC, Lopez J, Steinbacher DM, Gosain AK. The Impact of Social Determinants of Health in Facial and Craniomaxillofacial Reconstruction: Can We Do Better? Cleft Palate Craniofac J 2021; 59:938-945. [PMID: 34514875 DOI: 10.1177/10556656211037510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Social determinants of health (SDOH) are integral to consider when delivering craniomaxillofacial and facial reconstructive care for patients. The American Cleft Palate-Craniofacial Association (ACPA) has instituted a formalized multidisciplinary care team model that recognizes such determinants and has aggregated patient-led organizations to strengthen patients' education and support system. This review discusses the need for all surgeons engaged in facial and craniomaxillofacial reconstruction to consider SDOH in their practice. Additionally, we explore how factors such as race, insurance status, education level, cost, and access to follow-up care, impact surgical care for craniosynostosis, facial trauma, orthognathic surgery, head and neck cancer, and facial paralysis. We propose that the ACPA team model be applied to other societies that care for the broader scope of patients in need of facial and craniomaxillofacial reconstruction to strengthen the communication, collaboration, and standardization of care delivery that is personalized to the needs of each patient.
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Affiliation(s)
| | - Daniel C Sasson
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Joseph Lopez
- 12228Yale School of Medicine, New Haven, CT, USA
| | | | - Arun K Gosain
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
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Combined Sequential Bilateral Hypoglossal-to-facial and Masseter-to-facial Transfers for Bilateral Facial Paralysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3689. [PMID: 34262843 PMCID: PMC8274737 DOI: 10.1097/gox.0000000000003689] [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: 03/12/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
Bilateral facial paralysis is a challenging situation requiring complex management. Surgical treatment can include nerve transfers, mainly masseter-to-facial, or muscle transfers, gracilis free flap, or temporalis transposition. Deciding on the surgical option depends on the duration of the paralysis and the feasibility of facial muscles. We present the case of a 10-year-old child with permanent bilateral facial paralysis after brainstem tumor surgery. The patient was treated with bilateral simultaneous hypoglossal-to-facial transfer followed by bilateral simultaneous masseter-to-facial 12 months later. After 23 months of follow-up and specific physical therapy, she has good and symmetric resting tone, complete eye closure, moderate bilateral smile excursion, mild lip pucker movement, and good oral competence. The combination of these two nerve transfers, when possible, gives the opportunity of restoring movement taking the best of each technique, with acceptable results and no significant clinical deficits in the donor sites.
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10
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van Veen MM, Ten Hoope BWT, Bruins TE, Stewart RE, Werker PMN, Dijkstra PU. Therapists' perceptions and attitudes in facial palsy rehabilitation therapy: A mixed methods study. Physiother Theory Pract 2021; 38:2062-2072. [PMID: 33890851 DOI: 10.1080/09593985.2021.1920074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Facial palsy rehabilitation therapy plays an essential role in treating facial palsy.Purpose: This study aimed to gain insight into therapists' perceptions and attitudes toward facial palsy rehabilitation therapy and to examine whether therapists could be categorized into distinct groups based on these attitudes and perceptions.Methods: Thirteen semi-structured, in-depth interviews were conducted in a purposive sample of therapists. Interviews were analyzed using thematic analysis. Next, a questionnaire containing questions about therapists' characteristics and perceptions and attitudes toward facial palsy rehabilitation therapy was sent to all facial palsy rehabilitation therapists in the Netherlands and Flanders (n = 292). Latent class analysis (LCA) was performed to identify and analyze distinct groups of therapists.Results: Seven themes were derived from the interviews: treatment goals, therapy content, indications, measurement instruments, factors influencing success, emotional support, and cooperation with colleagues. The questionnaire was filled out by 127 therapists. A 2-group structure consisting of a positive class and a negative class was found to fit the questionnaire data best. No distinction could be made regarding therapists' characteristics.Conclusion: Considerable variation in stated treatment practices was present among therapists. Therapists could be classified into 2 groups. This study raises several hypotheses that require further study.
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Affiliation(s)
- Martinus M van Veen
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Britt W T Ten Hoope
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Tessa E Bruins
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands
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Goldbrunner R, Weller M, Regis J, Lund-Johansen M, Stavrinou P, Reuss D, Evans DG, Lefranc F, Sallabanda K, Falini A, Axon P, Sterkers O, Fariselli L, Wick W, Tonn JC. EANO guideline on the diagnosis and treatment of vestibular schwannoma. Neuro Oncol 2021; 22:31-45. [PMID: 31504802 DOI: 10.1093/neuonc/noz153] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The level of evidence to provide treatment recommendations for vestibular schwannoma is low compared with other intracranial neoplasms. Therefore, the vestibular schwannoma task force of the European Association of Neuro-Oncology assessed the data available in the literature and composed a set of recommendations for health care professionals. The radiological diagnosis of vestibular schwannoma is made by magnetic resonance imaging. Histological verification of the diagnosis is not always required. Current treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery. The choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center. In small tumors, observation has to be weighed against radiosurgery, in large tumors surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery. Except for bevacizumab in neurofibromatosis type 2, there is no role for pharmacotherapy.
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Affiliation(s)
- Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jean Regis
- Department of Functional and Stereotactic Neurosurgery and Radiosurgery, Timone University Hospital, Marseille, France
| | - Morten Lund-Johansen
- Department of Neurosurgery, Bergen University Hospital and Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Pantelis Stavrinou
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine and NW Laboratory Genetics Hub, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Florence Lefranc
- Department of Neurosurgery, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - Kita Sallabanda
- Department of Neurosurgery, University Hospital San Carlos, Complutense University of Madrid, Madrid, Spain; University Hospital San Carlos, CyberKnife Centre, Genesiscare Madrid, Madrid, Spain
| | - Andrea Falini
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Patrick Axon
- Cambridge Skull Base Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Olivier Sterkers
- Department of Otolaryngology, Unit of Otology, Auditory implants and Skull Base Surgery, Public Assistance-Paris Hospital, Pitié-Salpêtrière Group Hospital, Paris, France
| | - Laura Fariselli
- Unit of Radiotherapy, Neurological Institute Carlo Best, Milan, Italy
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery Ludwig-Maximilians University and DKTK partner site, University of Munich, Munich, Germany
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Taeger J, Bischoff S, Hagen R, Rak K. Utilization of Smartphone Depth Mapping Cameras for App-Based Grading of Facial Movement Disorders: Development and Feasibility Study. JMIR Mhealth Uhealth 2021; 9:e19346. [PMID: 33496670 PMCID: PMC7872839 DOI: 10.2196/19346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the classification of facial paresis, various systems of description and evaluation in the form of clinician-graded or software-based scoring systems are available. They serve the purpose of scientific and clinical assessment of the spontaneous course of the disease or monitoring therapeutic interventions. Nevertheless, none have been able to achieve universal acceptance in everyday clinical practice. Hence, a quick and precise tool for assessing the functional status of the facial nerve would be desirable. In this context, the possibilities that the TrueDepth camera of recent iPhone models offer have sparked our interest. OBJECTIVE This paper describes the utilization of the iPhone's TrueDepth camera via a specially developed app prototype for quick, objective, and reproducible quantification of facial asymmetries. METHODS After conceptual and user interface design, a native app prototype for iOS was programmed that accesses and processes the data of the TrueDepth camera. Using a special algorithm, a new index for the grading of unilateral facial paresis ranging from 0% to 100% was developed. The algorithm was adapted to the well-established Stennert index by weighting the individual facial regions based on functional and cosmetic aspects. Test measurements with healthy subjects using the app were performed in order to prove the reliability of the system. RESULTS After the development process, the app prototype had no runtime or buildtime errors and also worked under suboptimal conditions such as different measurement angles, so it met our criteria for a safe and reliable app. The newly defined index expresses the result of the measurements as a generally understandable percentage value for each half of the face. The measurements that correctly rated the facial expressions of healthy individuals as symmetrical in all cases were reproducible and showed no statistically significant intertest variability. CONCLUSIONS Based on the experience with the app prototype assessing healthy subjects, the use of the TrueDepth camera should have considerable potential for app-based grading of facial movement disorders. The app and its algorithm, which is based on theoretical considerations, should be evaluated in a prospective clinical study and correlated with common facial scores.
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Affiliation(s)
- Johannes Taeger
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Stefanie Bischoff
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
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Szczepura A, Holliday N, Neville C, Johnson K, Khan AJK, Oxford SW, Nduka C. Raising the Digital Profile of Facial Palsy: National Surveys of Patients' and Clinicians' Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology. J Med Internet Res 2020; 22:e20406. [PMID: 32763890 PMCID: PMC7573702 DOI: 10.2196/20406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Facial nerve palsy leaves people unable to move muscles on the affected side of their face. Challenges exist in patients accessing facial neuromuscular retraining (NMR), a therapy used to strengthen muscle and improve nerve function. Access to therapy could potentially be improved through the use of digital technology. However, there is limited research available on patients' and clinicians' views about the potential benefits of such telerehabilitation based on their lived experiences of treatment pathways. OBJECTIVE This study aims to gather information about facial palsy treatment pathways in the United Kingdom, barriers to accessing NMR, factors influencing patient adherence, measures used to monitor recovery, and the potential value of emerging wearable digital technology. METHODS Separate surveys of patients with facial palsy and facial therapy specialists were conducted. Questionnaires explored treatment pathways and views on telerehabilitation, were co-designed with users, and followed a similar format to enable cross-referencing of responses. A follow-up survey of national specialists investigated methods used to monitor recovery in greater detail. Analysis of quantitative data was conducted allowing for data distribution. Open-text responses were analyzed using thematic content analysis. RESULTS A total of 216 patients with facial palsy and 25 specialist therapists completed the national surveys. Significant variations were observed in individual treatment pathways. Patients reported an average of 3.27 (SD 1.60) different treatments provided by various specialists, but multidisciplinary team reviews were rare. For patients diagnosed most recently, there was evidence of more rapid initial prescribing of corticosteroids (prednisolone) and earlier referral for NMR therapy. Barriers to NMR referral included difficulties accessing funding, shortage of specialist therapists, and limited awareness of NMR among general practitioners. Patients traveled long distances to reach an NMR specialist center; 9% (8/93) of adults reported traveling ≥115 miles. The thematic content analysis demonstrates positive attitudes to the introduction of digital technology, with similar incentives and barriers identified by both patients and clinicians. The follow-up survey of 28 specialists uncovered variations in the measures currently used to monitor recovery and no agreed definitions of a clinically significant change for any of these. The main barriers to NMR adherence identified by patients and therapists could all be addressed by using suitable real-time digital technology. CONCLUSIONS The study findings provide valuable information on facial palsy treatment pathways and views on the future introduction of digital technology. Possible ways in which emerging sensor-based digital technology can improve rehabilitation and provide more rigorous evidence on effectiveness are described. It is suggested that one legacy of the COVID-19 pandemic will be lower organizational barriers to this introduction of digital technology to assist NMR delivery, especially if cost-effectiveness can be demonstrated.
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Affiliation(s)
- Ala Szczepura
- Faculty Health & Life Sciences, Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Nikki Holliday
- Health & Life Sciences, Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
| | - Karen Johnson
- Facial Palsy UK (Charity), Peterborough, United Kingdom
| | - Amir Jahan Khan Khan
- Department of Economics,, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Samuel W Oxford
- Exercise & Life Sciences, Faculty Health & Life Sciences, Centre for Sport, Coventry University, Coventry, United Kingdom
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
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Taeger J, Bischoff S, Hagen R, Rak K. Development of a smartphone app for neuromuscular facial training. HNO 2020; 68:79-85. [PMID: 32638059 DOI: 10.1007/s00106-020-00880-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several studies have demonstrated a significant benefit of neuromuscular facial training in the rehabilitation of patients with facial palsy. However, printed instructions for home training are often not of optimum quality and associated with low adherence to therapy. Professional guidance, e.g., by occupational therapists, is regarded as being of high quality, but is associated with a high cost burden, particularly in chronic forms of disease. OBJECTIVE The idea to develop a smartphone app for facial training arose from the above-described situation. The aim was to provide structured exercises for the mimic muscles in the sense of neuromuscular training with visual feedback via the front camera of the device. MATERIALS AND METHODS A native app architecture in iOS was chosen to implement the graphical and content-related concept. In the Apple Xcode (Apple, Cupertino, CA, US) development environment, the app's code was written in the Swift programming language (Apple) and the graphical user interface was created. RESULTS An app prototype was implemented that provides step-by-step instructions on selected mimic exercises via animated smileys. The duration and speed of the exercise can be varied within a limited range. In the development environment, the correct functionality of both physical and virtual devices was successfully tested. CONCLUSION App-based facial training offers attractive opportunities to motivate patients for improved adherence to treatment, which could hypothetically lead to a better outcome. Evaluation of this question is planned in a clinical trial after completion of the development.
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Affiliation(s)
- J Taeger
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - S Bischoff
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - R Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - K Rak
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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15
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Wu L, Han D, Jiang J, Xie X, Zhao X, Ke T, Zhao W, Liu L, Zhao W. Co-transplantation of bone marrow mesenchymal stem cells and monocytes in the brain stem to repair the facial nerve axotomy. Eur J Histochem 2020; 64. [PMID: 32705858 PMCID: PMC7388641 DOI: 10.4081/ejh.2020.3136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022] Open
Abstract
After the facial nerve axotomy (FNA), the distal end of the axon would gradually decay and disappear. Accumulated evidence shows that transplantation of bone marrow mesenchymal stem cells (BMSCs) reveals potential in the treatment of nervous system diseases or injuries. This study is aimed at investigating the therapeutic effects of co-transplantation of BMSCs and monocytes in FNA. We found that co-culture significantly elevated the CD4+/CD8+ ratio and CD4+ CD25+ T cell proportion compared with monocytes transplantation, and enhanced the differentiation of BMSCs into neurons. After the cell transplantation, the lowest apoptosis in the facial nerve nucleus was found in the co-transplantation group 2 (BMSCs:monocytes= 1:30). Moreover, the lowest expression levels of pro-inflammatory cytokines and the highest expression levels of anti-inflammatory cytokines were observed in the co-transplantation group 2 (BMSCs: monocytes= 1:30). The highest expression levels of protein in the JAK/STAT6 pathway and the SDF-1/CXCR4 axis were found in the co-transplantation group 2. BMSC/monocyte co-transplantation significantly improves the microenvironment in the facial nerve nucleus in FNA rats; therefore these findings suggest that it could promote the anti-/pro-inflammatory balance shift towards the anti-inflammatory microenvironment, alleviating survival conditions for BMSCs, regulating BMSC the chemotaxis homing, differentiation, and the section of BMSCs, and finally reducing the neuronal apoptosis. These findings might provide essential evidence for the in-hospital treatment of FNA with co-transplantation of BMSCs and monocytes.
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Affiliation(s)
- Li Wu
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming.
| | - Dan Han
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming.
| | - Jie Jiang
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming.
| | - Xiaojie Xie
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China.
| | - Xunran Zhao
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming.
| | - Tengfei Ke
- Department of Medical Imaging, Third Affiliated Hospital of Kunming Medical University, Kunming.
| | - Wen Zhao
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming.
| | - Liu Liu
- Department of Plastic Surgery, First Affiliated Hospital of Kunming Medical University, Kunming.
| | - Wei Zhao
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming.
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16
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Taeger J, Bischoff S, Hagen R, Rak K. [Development of a smartphone app for neuromuscular facial training. German Version]. HNO 2020; 68:726-733. [PMID: 32495061 DOI: 10.1007/s00106-020-00879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Several studies have demonstrated a significant benefit of neuromuscular facial training in the rehabilitation of patients with facial palsy. However, printed instructions for home training are often not of optimum quality and associated with low adherence to therapy. Professional guidance, e.g., by occupational therapists, is regarded as being of high quality, but is associated with a high cost burden, particularly in chronic forms of disease. OBJECTIVE The idea to develop a smartphone app for facial training arose from the above-described situation. The aim was to provide structured exercises for the mimic muscles in the sense of neuromuscular training with visual feedback via the front camera of the device. MATERIALS AND METHODS A native app architecture in iOS was chosen to implement the graphical and content-related concept. In the Apple Xcode (Apple, Cupertino, California, US) development environment, the app's code was written in the Swift programming language (Apple) and the graphical user interface was created. RESULTS An app prototype was implemented that provides step-by-step instructions on selected mimic exercises via animated smileys. The duration and speed of the exercise can be varied within a limited range. In the development environment, the correct functionality of both physical and virtual devices was successfully tested. CONCLUSION App-based facial training offers attractive opportunities to motivate patients for improved adherence to treatment, which could hypothetically lead to a better outcome. Evaluation of this question is planned in a clinical trial after completion of the development.
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Affiliation(s)
- J Taeger
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland.
| | - S Bischoff
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - R Hagen
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - K Rak
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
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17
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Mastryukova V, Arnold D, Güllmar D, Guntinas-Lichius O, Volk GF. Can MRI quantify the volume changes of denervated facial muscles? Eur J Transl Myol 2020; 30:8918. [PMID: 32499901 PMCID: PMC7254417 DOI: 10.4081/ejtm.2019.8918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
Could manual segmentation of magnetic resonance images be used to quantify the effects of transcutaneous electrostimulation and reinnervation of denervated facial muscle? Five patients with unilateral facial paralysis were scanned during the study while receiving a daily surface electrostimulation of the paralytic cheek region, but also after reinnervation. Their facial muscles were identified in 3D (coronal, sagittal, and axial) and segmented in magnetic resonance imaging (MRI) data for in total 28 time points over the 12 months of study. A non-significant trend of increasing muscle volume were detected after reinnervation. MRI is a valuable technique in the facial paralysis research.
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Affiliation(s)
- Valeria Mastryukova
- ENT-Department, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Dirk Arnold
- ENT-Department, Jena University Hospital, Jena, Germany.,Institute of Systematic Zoology and Evolutionary Biology with Phyletic Museum, Friedrich-Schiller-University Jena, Jena, Germany
| | - Daniel Güllmar
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- ENT-Department, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- ENT-Department, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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18
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Hayler R, Clark J, Croxson G, Coulson S, Hussain G, Ngo Q, Ch'ng S, Low T(H. Sydney Facial Nerve Clinic: experience of a multidisciplinary team. ANZ J Surg 2020; 90:856-860. [DOI: 10.1111/ans.15782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/15/2020] [Accepted: 02/09/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Raymond Hayler
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
| | - Jonathan Clark
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
| | - Glen Croxson
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
| | - Susan Coulson
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
- School of PhysiotherapyThe University of Sydney Sydney New South Wales Australia
| | - Gazi Hussain
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
- Department of Plastic, Reconstructive, and Hand SurgeryConcord Hospital Sydney New South Wales Australia
| | - Quan Ngo
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
- Department of Plastic SurgeryLiverpool Hospital Sydney New South Wales Australia
| | - Sydney Ch'ng
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
- Institute of Academic SurgeryThe University of Sydney Sydney New South Wales Australia
- Department of Plastic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Tsu‐Hui (Hubert) Low
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Sydney Facial Nerve ClinicChris O'Brien Lifehouse Sydney New South Wales Australia
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Lassaletta L, Morales-Puebla JM, Altuna X, Arbizu Á, Arístegui M, Batuecas Á, Cenjor C, Espinosa-Sánchez JM, García-Iza L, García-Raya P, González-Otero T, Mañós M, Martín C, Moraleda S, Roda JM, Santiago S, Benítez J, Cavallé L, Correia V, Estévez JM, Gómez J, González R, Jiménez J, Lacosta JL, Lavilla MJ, Peñarrocha J, Polo R, García-Purriños F, Ramos F, Tomás M, Uzcanga M, Vallejo LÁ, Gavilán J. Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:99-118. [PMID: 31097197 DOI: 10.1016/j.otorri.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.
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Affiliation(s)
- Luis Lassaletta
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España; Comisión de Otoneurología de la SEORL, Madrid, España; IdiPAZ, Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, España.
| | | | - Xabier Altuna
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Álvaro Arbizu
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
| | - Miguel Arístegui
- Servicio de Otorrinolaringología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Ángel Batuecas
- Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, Salamanca, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Carlos Cenjor
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Juan Manuel Espinosa-Sánchez
- Servicio de Otorrinolaringología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitariaibs, Granada, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Leire García-Iza
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Pilar García-Raya
- Servicio de Neurorradiología, Hospital Universitario La Paz, Madrid, España
| | | | - Manuel Mañós
- Servicio Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Carlos Martín
- Servicio de Otorrinolaringología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Susana Moraleda
- Servicio de Rehabilitación, Hospital Universitario La Paz, Madrid, España
| | - Jose María Roda
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | - Susana Santiago
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, España
| | - Jesús Benítez
- Servicio de Otorrinolaringología, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - Laura Cavallé
- Departamento de Otorrinolaringología, Hospital Universitario La Fe, Valencia, España
| | - Victor Correia
- Servicio de Otorrinolaringología, Hospital de CUF de Porto, Porto, Portugal
| | - Jose Manuel Estévez
- Servicio de Otorrinolaringología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - Justo Gómez
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Rocío González
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Jorge Jiménez
- Servicio de Otorrinolaringología, Complejo Hospitalario de Toledo, Toledo, España
| | - Jose Luis Lacosta
- Servicio de Otorrinolaringología, Hospital San Pedro, Logroño, La Rioja, España
| | - María José Lavilla
- Servicio de Otorrinolaringología, Hospital Lozano Blesa, Zaragoza, España
| | - Julio Peñarrocha
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España
| | - Rubén Polo
- Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Francisco Ramos
- Servicio de Otorrinolaringología, Hospital San Pedro de Alcántara, Cáceres, España
| | - Manuel Tomás
- Servicio de Otorrinolaringología, Hospital Son Espases, Mallorca, Islas Baleares, España
| | - María Uzcanga
- Servicio de Otorrinolaringología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Luis Ángel Vallejo
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España
| | - Javier Gavilán
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España
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Lassaletta L, Morales-Puebla JM, Altuna X, Arbizu Á, Arístegui M, Batuecas Á, Cenjor C, Espinosa-Sánchez JM, García-Iza L, García-Raya P, González-Otero T, Mañós M, Martín C, Moraleda S, Roda JM, Santiago S, Benítez J, Cavallé L, Correia V, Estévez JM, Gómez J, González R, Jiménez J, Lacosta JL, Lavilla MJ, Peñarrocha J, Polo R, García-Purriños F, Ramos F, Tomás M, Uzcanga M, Vallejo LÁ, Gavilán J. Facial Paralysis: Clinical Practice Guideline of the Spanish Society of Otolaryngology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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