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Pauna HF, Silva VAR, Lavinsky J, Hyppolito MA, Vianna MF, Gouveia MDCL, Monsanto RDC, Polanski JF, Silva MNLD, Soares VYR, Sampaio ALL, Zanini RVR, Abrahão NM, Guimarães GC, Chone CT, Castilho AM. Task force of the Brazilian Society of Otology - evaluation and management of peripheral facial palsy. Braz J Otorhinolaryngol 2024; 90:101374. [PMID: 38377729 PMCID: PMC10884764 DOI: 10.1016/j.bjorl.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.
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Affiliation(s)
- Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | | | | | - José Fernando Polanski
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Maurício Noschang Lopes da Silva
- Hospital de Clínicas de Porto Alegre (UFRGS), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil
| | - Vítor Yamashiro Rocha Soares
- Hospital Flávio Santos and Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Raul Vitor Rossi Zanini
- Hospital Israelita Albert Einstein, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nicolau M Abrahão
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Guilherme Correa Guimarães
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
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Noda M, Koshu R, Dias M, Onaga R, Ito M. Intact Transmastoid Ossicle Swaying Technique to Preserve Hearing in Pediatric Facial Nerve Decompression Surgery: A Case Report. Cureus 2024; 16:e58269. [PMID: 38752103 PMCID: PMC11094520 DOI: 10.7759/cureus.58269] [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: 04/14/2024] [Indexed: 05/18/2024] Open
Abstract
When pharmacological treatments are inadequate, facial nerve paralysis from various etiologies, including Bell's palsy, Hunt syndrome, and trauma, often requires surgical intervention. Facial nerve decompression surgery aims to relieve nerve compression and restore function, with preserving hearing function, especially in pediatric cases, being crucial. Conventional methods, like the transmastoid approach, risk affecting auditory function due to ossicle manipulation. Herein, we describe the case of a 12-year-old boy with left facial palsy diagnosed with zoster sine herpete (ZSH) syndrome. Despite medical treatment, the patient's condition did not improve, prompting facial nerve decompression surgery. Employing the intact transmastoid ossicle (ITO) swaying technique, we minimized ossicular manipulation, preserving auditory function while effectively achieving facial nerve decompression. The patient demonstrated improvement postoperatively in auditory and facial nerve functions. Furthermore, audiometric assessments demonstrated no substantial deterioration in hearing thresholds, and the facial nerve function improved from Grade V to Grade II on the House-Brackmann scale. The ITO technique provides a less invasive alternative compared to conventional approaches, lowering the chance of the ossicular chain and the risk of postoperative hearing loss. This case highlights the significance of customized surgical approaches in pediatric facial nerve decompression surgery, resulting in improved patient outcomes. Further research is required to validate the efficacy and safety of this method across various clinical contexts.
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Affiliation(s)
- Masao Noda
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Ryota Koshu
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Mari Dias
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Ryotaro Onaga
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Makoto Ito
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
- Otolaryngology - Head and Neck Surgery, Jichi Medical University Hospital, Shimotsuke, JPN
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Nam S, Lee YJ, Goo B, Kim J, Lee S, Kim M, Ha I, Lee JY. Cross-cultural adaptation of the Korean Synkinesis Assessment Questionnaire: A validation study. Laryngoscope Investig Otolaryngol 2023; 8:1616-1623. [PMID: 38130256 PMCID: PMC10731483 DOI: 10.1002/lio2.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objective The Synkinesis Assessment Questionnaire (SAQ) is a reliable tool to assess synkinesis symptoms; however, it is yet to be validated in Korea. Thus, this study aimed to translate and validate the Korean SAQ. Methods This validation study was set in a clinic in Seoul, Korea, that provides general integrative medicine services. A total of 100 participants with facial palsy were enrolled. Participants completed the SAQ, House-Brackmann grade (HB grade), Sunnybrook Facial Grading System (SB), and Facial Disability Index (FDI). The forward-backward translation method was followed. Of the 100 participants, 31 underwent a second assessment for test-retest reliability. Internal consistency and test-retest reliability were evaluated using Cronbach's alpha coefficient. The construct validity of the Korean version of the SAQ was tested using Spearman's rank correlation coefficient. Results The internal consistency score for the SAQ was 0.789, and the test-retest reliability score was 0.787. According to Spearman's rank correlation coefficient, the SAQ correlations to the synkinesis subdomain of SB score, total SB score, HB grade, and physical function domain in the FDI score were 0.366 (p < .001), -0.386 (p < .001), 0.315 (p = .001), and -0.269 (p = .007), respectively. All values were statistically significant. Conclusions The Korean SAQ is a valid and reliable tool used to evaluate synkinesis in patients with facial palsy. Level of Evidence Level 3.
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Affiliation(s)
- Sang‐Soo Nam
- Department of Acupuncture & Moxibustion, College of Korean MedicineKyung Hee UniversitySeoulRepublic of Korea
| | - Yoon Jae Lee
- Jaseng Spine & Joint Research InstituteJaseng Medical FoundationSeoulRepublic of Korea
| | - Bonhyuk Goo
- Department of Acupuncture & MoxibustionKyung Hee University Hospital at GangdongSeoulRepublic of Korea
| | - Jung‐Hyun Kim
- Department of Acupuncture & MoxibustionKyung Hee University Hospital at GangdongSeoulRepublic of Korea
| | | | - Me‐Riong Kim
- Jaseng Hospital of Korean MedicineSeoulRepublic of Korea
| | - In‐Hyuk Ha
- Jaseng Spine & Joint Research InstituteJaseng Medical FoundationSeoulRepublic of Korea
| | - Jee Young Lee
- Integrative Cancer Center, Cha Ilsan Medical CenterGoyang‐siRepublic of Korea
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Gracey C, Balladares R. Symptoms of Myasthenia Gravis Obscured by Old Age and Unilateral Presentation. Cureus 2023; 15:e44737. [PMID: 37809196 PMCID: PMC10555472 DOI: 10.7759/cureus.44737] [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: 09/03/2023] [Indexed: 10/10/2023] Open
Abstract
Myasthenia gravis (MG) is a neuromuscular junction disorder involving autoantibodies affecting the postsynaptic muscle membrane. We report an 81-year-old man who presented to the emergency department with three days of left facial droop, who later developed worsening bilateral ptosis, cervical weakness, dysphagia, and dysarthria following an assessment for Bell's palsy. Ultimately, he was diagnosed with MG. This patient's presentation was atypical and challenging. Specifically, the patient had droopy eyelids from a redundancy of skin and an anatomical neck droop, non-specific findings in older adults, which obscured the development of bilateral ptosis and cervical weakness, a classic sign of bulbar disease. The patient also presented with unilateral facial weakness, a rare finding in MG and concerning stroke in the elderly population. Our aim is to discuss the challenges of identifying MG in older populations and to discuss pharmacological challenges in assessing elderly patients with suspected bulbar palsies.
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Affiliation(s)
- Celeste Gracey
- Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA
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Soltanzadi A, Mirmosayyeb O, Momeni Moghaddam A, Ghoshouni H, Ghajarzadeh M. Incidence of Bell's palsy after Coronavirus disease (COVID-19) vaccination: a systematic review and meta-analysis. Neurologia 2023:S2173-5808(23)00038-X. [PMID: 37433426 DOI: 10.1016/j.nrleng.2023.06.002] [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: 04/12/2022] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE To estimate the pooled incidence of Bell's palsy after COVID-19 vaccination. METHODS PubMed, Scopus, EMBASE, Web of Science, and google scholar were searched by two independent researchers. We also searched gray literature including references of the references and conference abstracts. We extracted data regarding the total number of participants, first author, publication year, the country of origin, female/male, type of vaccines, and the number of patients who developed Bell's palsy after COVID-19 vaccination. RESULTS Literature search revealed 370 articles, subsequently deleting duplicates 227 remained. After careful evaluation of the full texts, twenty articles remained for meta-analysis. The most commonly administered vaccines were Pfizer followed by Moderna. In total, 4.54e+07 individuals received vaccines against COVID-19, and 1739 cases developed Bell's palsy. In nine studies, controls (individuals without vaccination) were enrolled. The total number of controls was 1809069, of whom, 203 developed Bell's palsy. The incidence of Bell's palsy after COVID-19 vaccines was ignorable. The odds of developing Bell's palsy after COVID-19 vaccines was 1.02 (95%CI: 0.79-1.32) (I2 = 74.8%, p < 0.001). CONCLUSION The results of this systematic review and meta-analysis show that the incidence of peripheral facial palsy after COVID-19 vaccination is ignorable and vaccination does not increase the risk of developing Bell's palsy. Maybe, Bell's palsy is a presenting symptom of a more severe form of COVID-19, so clinicians must be aware of this.
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Affiliation(s)
- Atena Soltanzadi
- Radiology Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Momeni Moghaddam
- Radiology Department, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Ghoshouni
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Ghajarzadeh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Universal council of epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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Seon C, Lee DH, Kwon BI, Yu JS, Park SK, Woo Y, Kim JH. Neural mechanisms of acupuncture for peripheral facial nerve palsy: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2023; 102:e33642. [PMID: 37145006 PMCID: PMC10158860 DOI: 10.1097/md.0000000000033642] [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: 12/10/2022] [Accepted: 04/07/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Peripheral facial nerve palsy (PFNP) is a cranial neuropathy that occurs when the seventh facial nerve is damaged. PFNP seriously affects patients' quality of life, and approximately 30% of patients suffer from sequelae, such as unrecovered palsy, synkinesis, facial muscle contracture, and facial spasm. Many studies have confirmed the effectiveness of acupuncture for the treatment of PFNP. However, the specific mechanism remains unclear and needs to be further explored. Therefore, the purpose of this systematic review is to investigate the neural mechanisms underlying acupuncture treatment for PFNP using neuroimaging methods. METHODS We will search all published studies from inception to March 2023 using the following databases: MEDLINE, Cochrane Library, EMBASE, CNKI, KMBASE, KISS, ScienceON, and OASIS. All clinical studies evaluating the effectiveness of acupuncture for treating PFNP using functional neuroimaging will be selected without language restrictions. Two reviewers will independently conduct the study selection, data extraction, and risk of bias assessment, according to a predetermined protocol. The outcomes, including the types of functional neuroimaging techniques, brain function alterations, and clinical outcomes, such as the House-Brackmann scale and Sunnybrook Facial Grading System, will also be analyzed. Coordinate-based meta-analysis and subgroup analyses will be performed if possible. RESULTS This study will analyze the effect of acupuncture on brain activity alterations and clinical improvement in patients with PFNP using functional neuroimaging. CONCLUSION This study will provide a comprehensive summary and help elucidate the neural mechanisms of acupuncture treatment for PFNP. PROSPERO REGISTRATION NUMBER CRD42022321827.
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Affiliation(s)
- Changwoo Seon
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Dong Hyuk Lee
- Department of Anatomy, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Bo-In Kwon
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Department of Pathology, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Jun-Sang Yu
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Sang Kyun Park
- Department of Meridian and Acupoints, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Yeonju Woo
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Department of Physiology, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
| | - Joo-Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
- Research Institute of Korean Medicine, Sangji University, Wonju-si, Republic of Korea
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Khan AJ, Szczepura A, Palmer S, Bark C, Neville C, Thomson D, Martin H, Nduka C. Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil 2022; 36:1424-1449. [PMID: 35787015 PMCID: PMC9510940 DOI: 10.1177/02692155221110727] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published between 01 January 2011 and 30 September 2020. METHODS Predetermined inclusion/exclusion criteria were utilised to shortlist abstracts. Two reviewers independently appraised articles, systematically extracted data and assessed the quality of individual studies and reviews (using GRADE and AMSTAR-2, respectively). Thematic analysis used for evidence synthesis; no quantitative meta-analysis conducted. The review was registered with PROSPERO (CRD42017073067). RESULTS Seven new randomised controlled trials, nine observational studies, and three quasi-experimental or pilot studies were identified (n = 854 participants). 75% utilised validated measures to record changes in facial function and/or patient-rated outcomes. High-quality trials (4/7) all reported positive impacts; as did observational studies rated as high/moderate quality (3/9). The benefit of therapy at different time points post-onset and for cases of varying clinical severity is discussed. Differences in study design prevented data pooling to strengthen estimates of therapy effects. Six new review articles identified were all rated critically low quality. CONCLUSION The findings of this targeted review reinforce those of the earlier more general Cochrane review. New research studies strengthen previous conclusions about the benefits of facial exercise therapy early in recovery and add to evidence of the value in chronic cases. Further standardisation of study design/outcome measures and evaluation of cost-effectiveness are recommended.
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Affiliation(s)
- Amir J Khan
- Department of Economics, Institute of Business
Administration, Karachi, Pakistan
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Ala Szczepura
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Shea Palmer
- Centre for Healthcare Research, Coventry University, Coventry, UK
- Centre for Care Excellence, Coventry University & University
Hospital Coventry & Warwickshire, Coventry, UK
| | - Chris Bark
- Lanchester Library, Coventry University, Coventry, UK
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - David Thomson
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - Helen Martin
- St Helens and Knowsley Teaching Hospitals
NHS Trust, Liverpool, UK
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
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Ali L, Alhatou M, Adeli G, Elalamy O, Zada Y, Mohammed I, Sharif M, Noor Illahi M, Naeem M, Iqrar A. Lesion Localization and Prognosis Using Electrodiagnostic Studies in Facial Diplegia: A Rare Variant of Guillain-Barre Syndrome. Cureus 2022; 14:e25047. [PMID: 35719795 PMCID: PMC9200109 DOI: 10.7759/cureus.25047] [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] [Accepted: 05/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background The etiology of facial nerve palsy is diverse and includes herpes zoster virus, Guillain-Barre syndrome (GBS), otitis media, Lyme disease, sarcoidosis, human immunodeficiency virus, etc. The lower motor neuron type facial nerve palsy is usually caused by an ipsilateral facial nerve lesion; however, it may be caused by a central lesion of the facial nerve nucleus and tract in the pons. Facial diplegia is an extremely rare condition that occurs in approximately 0.3% to 2.0% of all facial palsies. Electrodiagnostic studies including direct facial nerve conduction, facial electromyography (EMG), and blink reflex studies are useful for the prognosis and lesion localization in facial nerve palsy. Methodology This retrospective, observational study was conducted at the Neurophysiology Unit, Hamad General Hospital, Doha, Qatar. This study included 11 patients with bilateral facial weakness who visited for electrodiagnostic studies in the neurophysiology laboratory. Results In total, eight (72.7%) patients had facial diplegia, eight (72.7%) had hypo/areflexia, seven (63.6%) had facial numbness, and five (45.5%) had cerebrospinal fluid albuminocytological dissociation. The most frequent cause of facial diplegia in this study was GBS (81.9%). Direct facial nerve conduction stimulation showed that nine (81.8%) patients had bilateral facial nerve low compound muscle action potential amplitudes. The bilateral blink reflex study showed that eight (88.8%) patients had absent bilateral evoked responses. Finally, the EMG study showed that five (55.5%) patients had active denervation in bilateral sample facial muscles. Conclusions Bilateral facial nerve palsy is an extremely rare condition with a varied etiology. Electrodiagnostic studies are useful in detecting the underlying pathophysiologic processes, prognosis, and central or peripheral lesion localization in patients with facial diplegia.
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Comparison of Medical and Surgical Treatment in Severe Bell's Palsy. J Clin Med 2022; 11:jcm11030888. [PMID: 35160337 PMCID: PMC8836601 DOI: 10.3390/jcm11030888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The effectiveness of decompression surgery for Bell’s palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell’s palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with Bell’s palsy who visited the Kyung Hee University Hospital between January 2005 and December 2021. Of these, 45 patients with severe Bell’s palsy were divided into two groups; 30 patients were treated conservatively with steroids and antiviral agents alone, while 15 patients underwent additional decompressive surgery after the conservative treatment. Outcomes were measured using House–Brackmann (H–B) grade for least 6 months after treatment was finished and conducted until full recovery was achieved. (3) Results: There was no significant difference in the rate of favorable recovery (H–B grade 1 or 2) between the surgery group and the conservative treatment group (75% vs. 70.0%, p > 0.05). Although H–B grade improvement occurred in both groups, the degree of improvement was not significantly different between groups. (4) Conclusions: Facial nerve decompression surgery in severe Bell’s palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone. Additional surgical decompression may not be necessary in patients with severe Bell’s palsy if they receive sufficient conservative treatment.
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Clinical analysis of acute peripheral facial palsy in older adults. The Journal of Laryngology & Otology 2022; 136:1113-1117. [DOI: 10.1017/s0022215121004412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
Acute facial palsy is a consequence of various diseases, with the number of patients increasing with advancing age. This study aimed to analyse the clinical characteristics of acute peripheral facial palsy in older adults.
Methods
A total of 30 patients with a mean age of 68.4 ± 9.1 years were included in the study. All patients received a standardised investigation and follow up. The hospital charts of the patients with acute facial palsy were reviewed retrospectively.
Results
The predominant causes of acute facial palsy in older adults were: Bell's palsy, Ramsay Hunt syndrome, trauma, otitis media and malignancy. At baseline, complete and incomplete facial palsies were seen in 26.7 per cent and 73.3 per cent of patients, respectively. The overall rates of good recovery, partial recovery and no recovery were 66.7 per cent, 10 per cent and 23.3 per cent, respectively. Increased age led to a significantly lower level of recovery in older adults.
Conclusion
Bell's palsy and Ramsay Hunt syndrome were the most common aetiologies of acute facial palsy in older adults, and such patients are likely to have incomplete recovery. Active early treatment is necessary for achieving good outcomes in older adults.
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Effectiveness comparisons of antiviral treatments for Bell palsy: a systematic review and network meta-analysis. J Neurol 2021; 269:1353-1367. [PMID: 33674936 DOI: 10.1007/s00415-021-10487-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Antiviral treatments for Bell palsy have been widely used, but there is no definite conclusion of which is the most effective antiviral drug. We conducted a systematic review of randomized controlled trials (RCTs) including network meta-analysis to investigate the comparative effectiveness of antiviral treatments for Bell palsy. DATA RCTs comparing effectiveness between antiviral treatments and placebo were included. Risk of bias within and across studies was assessed with the Cochrane tool and the GRADE approach, respectively. Random-effects pairwise meta-analyses were conducted, followed by network meta-analysis. SOURCES Three electronic databases were searched from inception to May 18, 2020. STUDY SELECTION 11 trials and 3393 patients with four arms and eleven contrasts were included. RESULTS Significant differences were observed between placebo and famciclovir with respect to overall recovery and no statistically significant differences were found from other comparisons. Treatment ranking based on the evidence network indicated that famciclovir shared the best results, followed by valacyclovir, acyclovir, and finally placebo. Adverse events of famciclovir were too rare and slight to be analyzed. Our confidence in pairwise comparisons was moderate to low, due to study limitations, inconsistency, and imprecision; our confidence in ranking was moderate, due to study limitations. Inconsistency is not deemed to exist by a loop-specific approach and node-splitting procedure. Results of exploring publication bias are satisfying. CONCLUSIONS According to pairwise and network comparisons, famciclovir could be better than placebo and the effectiveness of other antiviral treatments are similar. For clinical efficacy, famciclovir obtains the best recovery rate of facial function for Bell palsy. Acyclovir has the lowest rate of synkinesis, though, it is not adequately recommended and more superior trails are needed in the future.
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Zhang CY, Huang Y, Zhang K, Dong F. Evaluation on curative effects of combined acupuncture plus physical therapy for treating idiopathic facial paralysis: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23121. [PMID: 33181683 PMCID: PMC7668508 DOI: 10.1097/md.0000000000023121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The present study primarily aims to evaluate how effective acupuncture combined with physical therapy for the treatment of idiopathic facial paralysis. METHODS The PubMed database was searched (1946 to September 2020), the EMBASE data were also searched (January 1946 to September 2020), moreover, the Cochrane Central Register of Controlled Trials was searched (all years), and finally, the China National Knowledge Infrastructure (CNKI) was also included in the searching of electronic databases. The searching of publications did not include any language constraints. The titles and abstracts were scrutinized by a pair of authors to identify relevant studies. The efficacy of the association in the combination of acupuncture and physical therapy as a method of treatment for idiopathic facial paralysis was evaluated according to the pooled risk ratio (RR), mean differences (MD), or standardized mean difference (SMD) with the corresponding 95% confidence intervals (95% CI). A pair of authors conducted an autonomous risk assessment of the bias that would be introduced when the Cochrane Risk of Bias Tool is used. A pair of authors autonomously extracted data with the aid of a customized data extraction form. The RevMan 5.3 statistical analysis software was utilized for conducting the statistical analysis. RESULTS The final results will be presented in a scientific journal that will be peer-reviewed. CONCLUSION It is expected that the proposed systematic review and meta-analysis of acupuncture combined with physical therapy for treating idiopathic facial paralysis will provide reliable evidence for clinical application. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/RPCSE (https://osf.io/rpcse/).
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Affiliation(s)
- Cui-Yi Zhang
- Department of Neurology, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen
| | - Yan Huang
- Department of neurology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Ke Zhang
- Department of traditional Chinese medicine, Shenzhen Far East Maternity Hospital
| | - Fang Dong
- Medical Records Statistics Division, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, Guangdong, China
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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: 7] [Impact Index Per Article: 1.8] [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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Lee SY, Seong J, Kim YH. Clinical Implication of Facial Nerve Decompression in Complete Bell's Palsy: A Systematic Review and Meta-Analysis. Clin Exp Otorhinolaryngol 2019; 12:348-359. [PMID: 31487771 PMCID: PMC6787481 DOI: 10.21053/ceo.2019.00535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
We compared the therapeutic efficacy of facial nerve decompression (FND) and conservative treatment in patients with Bell’s palsy through a systematic review and meta-analysis. Primary database search was performed in PubMed, Medline, and Embase. After screening, 13 studies were assessed for their eligibility. Among them, seven studies employing either the House-Brackmann grading system (HBGS) or May’s classification (modified HBGS) were selected for quantitative and qualitative analysis. Based on May’s classification, the degree of recovery was classified into complete (HBGS I), fair (HBGS II–III), or failed (HBGS IV–VI) recovery. The outcomes were assessed between 6 and 12 months after surgery. The estimated pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects model. Cohorts were comprised of patients who underwent FND (n=202, 53.0%) and conservative treatments (n=179, 47.0%). In pooled analysis, the rate of complete recovery was significantly higher in the FND group than in the control group (OR, 2.06; 95% CI, 1.22 to 3.48; P=0.007) showing neither heterogeneity nor publication bias. Meanwhile, the rates of fair recovery (OR, 0.71; 95% CI, 0.42 to 1.21; P=0.208) and failed recovery (OR, 0.60; 95% CI, 0.22 to 1.67; P=0.327) in the FND group were similar to that in the control group. In subgroup analyses, there was no significant difference in the OR according to the operation timing and surgical approach. FND can be a possible treatment option for patients with complete Bell’s palsy, especially for complete recovery, which provide insights on decision-making and outcome prediction. However, FND should be determined carefully given the risk of small study effects and possible complications.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeon Seong
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Zhang R, Wu T, Wang R, Wang D, Liu Q. Compare the efficacy of acupuncture with drugs in the treatment of Bell's palsy: A systematic review and meta-analysis of RCTs. Medicine (Baltimore) 2019; 98:e15566. [PMID: 31083225 PMCID: PMC6531040 DOI: 10.1097/md.0000000000015566] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bell's palsy or idiopathic facial paralysis is an acute facial paralysis caused by the inflammation of facial nerve. Several previous studies showed that acupuncture was beneficial in the treatment of facial paralysis. However, its effectiveness is still controversial compared with drug therapy. Therefore, this systematic review and meta-analysis was performed to assess the efficacy of acupuncture for Bell's palsy. METHODS This is a systematic review and meta-analysis of clinical studies among patients with Bell's palsy. We did a systematic literature search in PubMed, Embase, and the Cochrane Register of Controlled Trials to identify studies comparing the efficacy of acupuncture and drug treatment in treating facial paralysis. The search was last updated on July 2018. RESULTS The study included 11 randomized controlled trials with an overall sample of 1258 individuals. Acupuncture treatment was associated with an increased cure rate [relative risk (RR) = 1.77, 95% confidence interval (CI): 1.41-2.21], with significant heterogeneity in the pooled results (I = 67%, P = .0008). There was a significant difference in total effective rate in acupuncture and drug treatment for Bell's palsy (RR = 1.18,95% CI: 1.07-1.31), with substantial heterogeneity (I = 90%, P < .00001). CONCLUSION Although there was not enough evidence to prove its safety, acupuncture seems to be an effective therapy for Bell's palsy. Results of the present meta-analysis showed that acupuncture was associated with increased cure rate and total effective rate of the treatment of Bell's palsy in comparison with drugs. However, the results should be interpreted cautiously, because of the poor quality and heterogeneity of the included studies. In the future, more and more high quality randomized controlled trials (RCT) are needed to prove the safety and effectiveness of acupuncture.
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Affiliation(s)
- Rongchao Zhang
- Acupuncture and Tuina College, Chengdu University of Chinese Medicine, Chengdu, Sichuan
| | - Tao Wu
- Shaanxi University of Chinese Medicine, Xi’an-Xianyang New Economic Zone, Shaanxi, China
| | - Ruihui Wang
- Shaanxi University of Chinese Medicine, Xi’an-Xianyang New Economic Zone, Shaanxi, China
| | - Dong Wang
- Shaanxi University of Chinese Medicine, Xi’an-Xianyang New Economic Zone, Shaanxi, China
| | - Qi Liu
- Shaanxi University of Chinese Medicine, Xi’an-Xianyang New Economic Zone, Shaanxi, China
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Li Q, Jia Y, Feng Q, Tang B, Wei N, Zhang Y, Li Y, Zhang X. Clinical features and outcomes of delayed facial palsy after head trauma. Auris Nasus Larynx 2016; 43:514-7. [PMID: 26837868 DOI: 10.1016/j.anl.2015.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 12/02/2015] [Accepted: 12/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate clinical features and outcomes of delayed facial palsy after head trauma. METHODS The cases who had delayed facial palsy after head trauma treated from March 2008 to March 2013 at our hospital were enrolled in the study, and their clinical features and outcomes were analyzed. RESULTS Thirty-five of 1620 cases developed delayed facial palsy after head trauma. Facial palsy occurred within day 3-7 in 23 cases, during day 8-14 in 8 cases, and 2 weeks later in 4 cases. Thirty-three cases were treated by prednisolone alone, and two cases who showed ≥90% degeneration of nerve fibers underwent surgical exploration and decompression. Among the 33 cases who received conservative treatment, 27 cases (81.8%) recovered completely, 3 cases (9.1%) recovered to Grade II, and only 3 cases (9.1%) recovered to Grade III or IV. The two surgically treated patients recovered to Grade II and III, respectively. CONCLUSION The incidence of delayed facial palsy was 2.2% after head trauma. Delayed facial palsy mainly occurred within 2 weeks after head trauma. And over 90% patients achieved good recovery (HB Grade I or II) of facial nerve after conservative treatment.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, PR China; Second Clinical Medical College of Lanzhou University, Lanzhou 730030, Gansu Province, PR China
| | - Yanfei Jia
- Graduate School of Peking Union Medical College, Beijing 100730, PR China; National Research Institute for Family Planning, Beijing 100081, PR China
| | - Qian Feng
- Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, PR China
| | - Bo Tang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, PR China; Second Clinical Medical College of Lanzhou University, Lanzhou 730030, Gansu Province, PR China
| | - Naili Wei
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, PR China; Second Clinical Medical College of Lanzhou University, Lanzhou 730030, Gansu Province, PR China
| | - Yinian Zhang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, PR China; Second Clinical Medical College of Lanzhou University, Lanzhou 730030, Gansu Province, PR China
| | - Yefeng Li
- Department of Otolaryngology, Peking University Health Science Center, Beijing 100191, PR China
| | - Xuanfen Zhang
- Second Clinical Medical College of Lanzhou University, Lanzhou 730030, Gansu Province, PR China.
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Delayed facial nerve decompression for Bell's palsy. Eur Arch Otorhinolaryngol 2015; 273:1755-60. [PMID: 26319412 DOI: 10.1007/s00405-015-3762-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022]
Abstract
Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.
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Haginomori SI, Ichihara T, Mori A, Kanazawa A, Kawata R, Tang H, Mori Y. Varicella-zoster virus-specific cell-mediated immunity in Ramsay Hunt syndrome. Laryngoscope 2015; 126:E35-9. [DOI: 10.1002/lary.25441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Shin-Ichi Haginomori
- Department of Otolaryngology-Head and Neck Surgery; Osaka Medical College; Takatsuki Japan
| | - Takahiro Ichihara
- Department of Otolaryngology-Head and Neck Surgery; Osaka Medical College; Takatsuki Japan
| | - Atsuko Mori
- Department of Otolaryngology-Head and Neck Surgery; Osaka Medical College; Takatsuki Japan
| | - Atsuko Kanazawa
- Department of Otolaryngology-Head and Neck Surgery; Osaka Medical College; Takatsuki Japan
| | - Ryo Kawata
- Department of Otolaryngology-Head and Neck Surgery; Osaka Medical College; Takatsuki Japan
| | - Huamin Tang
- Division of Clinical Virology; Department of Microbiology and Infectious Disease; Kobe University Graduate School of Medicine; Kobe Japan
| | - Yasuko Mori
- Division of Clinical Virology; Department of Microbiology and Infectious Disease; Kobe University Graduate School of Medicine; Kobe Japan
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Rajabi MT, Shadravan M, Mazloumi M, Tabatabaie SZ, Hosseini SS, Rajabi MB. Bupivacaine Injection for Management of Lagophthalmos Due to Long-Standing Idiopathic Facial Nerve Palsy. Ophthalmic Plast Reconstr Surg 2015; 31:459-62. [PMID: 25675168 DOI: 10.1097/iop.0000000000000387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the results of bupivacaine injection into the orbicularis oculi muscle to treat lagophthalmos in patients with long-standing Bell palsy. METHODS In this prospective interventional case series, bupivacaine, 5 ml of a 0.750% solution, was injected into the preseptal and pretarsal area of the orbicularis oculi in each of 10 patients with idiopathic peripheral facial nerve palsy. The measures of vertical eyelid apertures during open and closed eyes were made before the procedure and 1, 3, and 6 months after injection. RESULTS A total of 10 eyes including 2 men and 8 women with an average age of 43 years (26-64 years) were studied. The mean amount of lagophthalmos before injection and after 6 months of follow up were 3.9 mm and 2.3 mm, respectively (p = 0.01)). The mean amount of corneal exposure before injection and after 6 months of follow up was 1.05 mm and 0.25 mm, respectively (p < 0.01). The mean scleral show in open eyes before injection and after 6 months of follow up were 1.20 mm and 0.75 mm, respectively (p = 0.08). The mean scleral show in closed eyes before injection and after 6 months of follow up were 1.95 mm and 1.15 mm, respectively (p = 0.01). All the patients reported significant decrease in epiphora. CONCLUSION Bupivacaine injection in the paretic orbicularis oculi muscle improves eyelid closure and lagophthalmos and epiphora.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Department of Ophtalmology, Tehran University of Medical Sciences, Tehran, Iran
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SU YIPENG, DONG XIAOMENG, LIU JUAN, HU YAOZHI, CHEN JINBO. Nerve growth factor for Bell’s palsy: A meta-analysis. Exp Ther Med 2015; 9:501-506. [PMID: 25574223 PMCID: PMC4280984 DOI: 10.3892/etm.2014.2100] [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: 01/19/2014] [Accepted: 07/08/2014] [Indexed: 11/06/2022] Open
Abstract
A meta-analysis was performed to evaluate the efficacy and safety of nerve growth factor (NGF) in the treatment of Bell’s palsy. PubMed, the Cochrane Central Register of Controlled Trials, Embase and a number of Chinese databases, including the China National Knowledge Infrastructure, China Biology Medicine disc, VIP Database for Chinese Technical Periodicals and Wan Fang Data, were used to collect randomised controlled trials (RCTs) of NGF for Bell’s palsy. The span of the search covered data from the date of database establishment until December 2013. The included trials were screened comprehensively and rigorously. The efficacies of NGF were pooled via meta-analysis performed using Review Manager 5.2 software. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the fixed-effects model. The meta-analysis of eight RCTs showed favorable effects of NGF on the disease response rate (n=642; OR, 3.87; 95% CI, 2.13–7.03; P<0.01; I2=0%). However, evidence supporting the effectiveness of NGF for the treatment of Bell’s palsy is limited. The number and quality of trials are too low to form solid conclusions. Further meticulous RCTs are required to overcome the limitations identified in the present study.
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Abstract
The aim of this study is to evaluate the types and clinical characteristics of peripheral facial palsy in children. The hospital charts of children diagnosed with peripheral facial palsy were reviewed retrospectively. A total of 81 children (42 female and 39 male) with a mean age of 9.2 ± 4.3 years were included in the study. Causes of facial palsy were 65 (80.2%) idiopathic (Bell palsy) facial palsy, 9 (11.1%) otitis media/mastoiditis, and tumor, trauma, congenital facial palsy, chickenpox, Melkersson-Rosenthal syndrome, enlarged lymph nodes, and familial Mediterranean fever (each 1; 1.2%). Five (6.1%) patients had recurrent attacks. In patients with Bell palsy, female/male and right/left ratios were 36/29 and 35/30, respectively. Of them, 31 (47.7%) had a history of preceding infection. The overall rate of complete recovery was 98.4%. A wide variety of disorders can present with peripheral facial palsy in children. Therefore, careful investigation and differential diagnosis is essential.
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Affiliation(s)
- Unsal Yılmaz
- Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | | | - Tuba Sevim Yılmaz
- Department of Public Health, Dokuz Eylul University Hospital, Izmir, Turkey
| | | | | | - Orkide Güzel
- Dr. Behçet Uz Children's Hospital, Izmir, Turkey
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Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, Deckard NA, Dawson C, Driscoll C, Gillespie MB, Gurgel RK, Halperin J, Khalid AN, Kumar KA, Micco A, Munsell D, Rosenbaum S, Vaughan W. Clinical practice guideline: Bell's Palsy executive summary. Otolaryngol Head Neck Surg 2014; 149:656-63. [PMID: 24190889 DOI: 10.1177/0194599813506835] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.
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Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, Deckard NA, Dawson C, Driscoll C, Gillespie MB, Gurgel RK, Halperin J, Khalid AN, Kumar KA, Micco A, Munsell D, Rosenbaum S, Vaughan W. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg 2014; 149:S1-27. [PMID: 24189771 DOI: 10.1177/0194599813505967] [Citation(s) in RCA: 246] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell's palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell's palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell's palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy. PURPOSE The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell's palsy, to improve the quality of care and outcomes for patients with Bell's palsy, and to decrease harmful variations in the evaluation and management of Bell's palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. The guideline is intended for all clinicians in any setting who are likely to diagnose and manage patients with Bell's palsy. The target population is inclusive of both adults and children presenting with Bell's palsy. ACTION STATEMENTS: The development group made a strong recommendation that (a) clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis, (b) clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell's palsy patients 16 years and older, (c) clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell's palsy, and (d) clinicians should implement eye protection for Bell's palsy patients with impaired eye closure. The panel made recommendations that (a) clinicians should not obtain routine laboratory testing in patients with new-onset Bell's palsy, (b) clinicians should not routinely perform diagnostic imaging for patients with new-onset Bell's palsy, (c) clinicians should not perform electrodiagnostic testing in Bell's palsy patients with incomplete facial paralysis, and (d) clinicians should reassess or refer to a facial nerve specialist those Bell's palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 months after initial symptom onset. The development group provided the following options: (a) clinicians may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset for patients with Bell's palsy, and (b) clinicians may offer electrodiagnostic testing to Bell's palsy patients with complete facial paralysis. The development group offered the following no recommendations: (a) no recommendation can be made regarding surgical decompression for patients with Bell's palsy, (b) no recommendation can be made regarding the effect of acupuncture in patients with Bell's palsy, and (c) no recommendation can be made regarding the effect of physical therapy in patients with Bell's palsy.
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Socolovsky M, Páez MD, Masi GD, Molina G, Fernández E. Bell's palsy and partial hypoglossal to facial nerve transfer: Case presentation and literature review. Surg Neurol Int 2012; 3:46. [PMID: 22574255 PMCID: PMC3347494 DOI: 10.4103/2152-7806.95391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 03/23/2012] [Indexed: 11/15/2022] Open
Abstract
Background: Idiopathic facial nerve palsy (Bell's palsy) is a very common condition that affects active population. Despite its generally benign course, a minority of patients can remain with permanent and severe sequelae, including facial palsy or dyskinesia. Hypoglossal to facial nerve anastomosis is rarely used to reinnervate the mimic muscle in these patients. In this paper, we present a case where a direct partial hypoglossal to facial nerve transfer was used to reinnervate the upper and lower face. We also discuss the indications of this procedure. Case Description: A 53-year-old woman presenting a spontaneous complete (House and Brackmann grade 6) facial palsy on her left side showed no improvement after 13 months of conservative treatment. Electromyography (EMG) showed complete denervation of the mimic muscles. A direct partial hypoglossal to facial nerve anastomosis was performed, including dissection of the facial nerve at the fallopian canal. One year after the procedure, the patient showed House and Brackmann grade 3 function in her affected face. Conclusions: Partial hypoglossal–facial anastomosis with intratemporal drilling of the facial nerve is a viable technique in the rare cases in which severe Bell's palsy does not recover spontaneously. Only carefully selected patients can really benefit from this technique.
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Affiliation(s)
- Mariano Socolovsky
- Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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Murakami S. [Diagnosis and treatment of facial nerve paralysis]. NIHON JIBIINKOKA GAKKAI KAIHO 2012; 115:118-121. [PMID: 22690412 DOI: 10.3950/jibiinkoka.115.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Prognosis of patients with recurrent facial palsy. Eur Arch Otorhinolaryngol 2011; 269:61-6. [DOI: 10.1007/s00405-011-1581-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 03/14/2011] [Indexed: 11/27/2022]
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Toffola ED, Furini F, Redaelli C, Prestifilippo E, Bejor M. Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy. Disabil Rehabil 2010; 32:1414-8. [PMID: 20156046 DOI: 10.3109/09638280903514697] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To assess the effect and efficacy of botulinum toxin type A (BTX-A) in reducing synkinesis in aberrant facial nerve regeneration (following facial paralysis). METHOD A total of 55 sessions of BTX-A (Botox) infiltration were performed on 30 patients (23 female) with synkinesis after facial palsy. Each subject was injected with 2.5 units of BTX-A in each injection site (the sites were chosen on a case-by-case basis). The synkinetic muscles targeted include: orbicularis oculi, zygomaticus major, depressor labii inferioris, platysma, healthy frontalis and healthy corrugator supercilii. The patients were examined using the Sunnybrook Facial Grading System, both before the BTX-A treatment and after an average of 35 days. RESULTS All 30 patients experienced improvement to the synkinesis after treatment. Total scores: median pre-BTX-A: 40; post 53 p = 0.004. Resting symmetry scores: mean pre-BTX-A -7.1; post: -3.5; median pre -5 [interquartile range (IQR) -10 to -5]; post: -5 (IQR -5 to 0); p = 0.0001. Symmetry of voluntary movement median pre-BTX-A: 56 post 60 p = 0.10. Synkinesis scores: median pre-BTX-A: -9 post -3 p < 0.0001. Mean duration of improvement was 4 months. CONCLUSIONS BTX-A injection treatment was effective in reducing facial synkinesis, thus improving facial expression symmetry both at rest and in voluntary movements.
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Affiliation(s)
- Elena Dalla Toffola
- Department of Physical Medicine and Rehabilitation, University of Pavia, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
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Kanaya K, Ushio M, Kondo K, Hagisawa M, Suzukawa K, Yamaguchi T, Tojima H, Suzuki M, Yamasoba T. Recovery of facial movement and facial synkinesis in Bell's palsy patients. Otol Neurotol 2009; 30:640-4. [PMID: 19574944 DOI: 10.1097/mao.0b013e3181ab31af] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined the relationship between the time course of development of facial synkinesis in patients with Bell's palsy and the severity of facial nerve damage. STUDY DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS Thirty-nine consecutive patients with Bell's palsy who developed synkinesis. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES Subjects were divided into groups A (electroneurographic [ENoG] value, <10%; n = 31) and B (ENoG value, > or =10%; n = 8). Development of facial synkinesis was assessed based on the appearance of synkinetic potentials from the orbicularis oris muscle on the blink reflex test. Times to appearance of facial synkinesis in groups A and B were compared. The proportion of patients who developed facial synkinesis after complete recovery of facial movement was also assessed in 14 patients whose facial movement recovered completely. RESULTS The mean time to maximal recovery of facial movement was significantly longer in group A than in group B (p < 0.001), whereas the duration between the appearance of facial synkinesis and the onset of facial paralysis did not differ significantly between the 2 groups (p = 0.72). The proportion of patients who developed facial synkinesis after complete recovery of facial movement was significantly greater in group B than in group A (p = 0.015). CONCLUSION During the course of recovery from Bell's palsy, the patients with an ENoG value of 10% or greater have a higher risk of developing facial synkinesis after complete recovery of facial movement.
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Affiliation(s)
- Kaori Kanaya
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
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Tankéré F, Bernat I. Paralysie faciale a frigore : de l’étiologie virale à la réalité diagnostique. Rev Med Interne 2009; 30:769-75. [DOI: 10.1016/j.revmed.2008.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/22/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
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Komori M, Yanagihara N, Kashiba K. Mouth movement disturbance as a sequela of bilateral Bell's palsy. Otol Neurotol 2009; 30:847-50. [PMID: 19471166 DOI: 10.1097/mao.0b013e3181ab3362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Bell's palsy rarely recurs or arises bilaterally. We describe unique oral motor sequelae that manifest with bilateral facial palsy. PATIENTS Two rare patients with alternating bilateral Bell's palsy experienced compromised mouth movement, affecting eating, speaking, and air exchange, and reduced quality of life. INTERVENTIONS Rehabilitation programs. MAIN OUTCOME MEASURES Electromyography and electroneuronography. RESULTS On electromyography study, little activity of the orbicularis oris muscle was seen in any mouth or eye movement in Case 1. In Case 2, the electromyography activity of the depressor anguli oris and depressor labii inferioris muscles was stronger than that of the orbicularis oris muscle. The 2 cases demonstrated different patterns of recovery after the same subsequent treatment. CONCLUSION Different patterns of reinnervation occur in bilateral Bell's palsy. Mouth movement disturbances after bilateral Bell's palsy are most disabling when incomplete reinnervation (as suggested by electroneuronography) of the orbicularis oris muscle occurs. Misdirection of regenerating nerve fibers produces lesser levels of oral motor impairment.
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Affiliation(s)
- Masahiro Komori
- Department of Otolaryngology, Takanoko Hospital, Matsuyama, Ehime, Japan.
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Abstract
PURPOSE Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. MATERIALS AND METHODS We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. RESULTS The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. CONCLUSION These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different.
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Affiliation(s)
- Chang Il Cha
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang Kee Hong
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Moon Suh Park
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Geun Yeo
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
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On AY, Yaltirik HP, Kirazli Y. Agreement between clinical and electromyographic assessments during the course of peripheric facial paralysis. Clin Rehabil 2007; 21:344-50. [PMID: 17613575 DOI: 10.1177/0269215507073177] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the agreement between clinical and electromyographic assessments during the course of facial paralysis, in order to determine whether electromyography adds more information to the clinical examination in determining voluntary and synkinetic movement. DESIGN Serial clinical and electromyographic assessments were performed. SETTINGS Physical Medicine and Rehabilitation Department of a university hospital. SUBJECTS Thirty patients with acute complete idiopathic facial paralysis were included. MAIN MEASURES Voluntary and synkinetic movements of the orbicularis oculi and orbicularis oris muscles were graded by Facial Grading System and by needle electromyography at three weeks, and two, three and six months after the onset of paralysis. Weighted kappa (kappa) statistics were performed to measure the agreement between clinical and electromyographic assessments. RESULTS Agreement between assessments yielded an overall kappa value of 0.87 for the orbicularis oculi and 0.59 for the orbicularis oris in identifying voluntary movement. electromyography revealed no voluntary movement in the orbicularis oculi, in 65% of the patients in whom slight movement was considered by clinical assessment. In identifying synkinetic movements, an overall kappa value was 0.70 for the orbicularis oculi and 0.85 for the orbicularis oris. Electromyography demonstrated many cases of slight synkinesis that were missed through visual inspection in both muscles. CONCLUSIONS Clinical evaluation provides sufficient information about recovery in voluntary movement in the orbicularis oris, whereas, in the orbicularis oculi, electromyography adds to the clinical evaluation in determining the extent of paralysis.
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Affiliation(s)
- Arzu Yagiz On
- Ege University Medical Faculty, Department of Physical Medicine and Rehabilitation, Izmir, Turkey.
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Ikeda M, Abiko Y, Kukimoto N, Omori H, Nakazato H, Ikeda K. Clinical Factors that Influence the Prognosis of Facial Nerve Paralysis and the Magnitudes of Influence. Laryngoscope 2005; 115:855-60. [PMID: 15867653 DOI: 10.1097/01.mlg.0000157694.57872.82] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To show the significance of various factors when predicting the outcome of facial nerve paralysis. DESIGN Retrospective chart review. SETTING Nihon University Itabashi Hospital in Tokyo. SUBJECTS Four hundred sixty-seven patients with facial paralysis who visited the hospital within 14 days of disease onset. METHODS The failure rate of complete recovery was studied for each of these nine factors: sex, age, varicella-zoster virus (VZV) infection as the cause of paralysis, initial severity of paralysis, number of days from onset of paralysis to the beginning of medical treatment, nerve excitability test (NET), stapedial reflex, lacrimal secretion, and severity of facial paralysis 1 month after onset. These factors were analyzed by logistic regression. RESULTS Logistic regression clarified that age, VZV infection, NET response, loss of stapedial reflex, and the state of paralysis 1 month after the onset had statistical significance for the prognosis of facial paralysis. The poor recovery rate was greater than 50% in the patients who exhibited abnormal responses on NET or failed to attain recovery to grade III or better during the 1-month period after the onset of paralysis. These findings were therefore considered as high risk factors for the prognosis. The poor recovery rate was between 25% and 50% in patients who were 50 years or older or whose initial grading of paralysis was V or worse. These findings were classified as moderate risk factors. Patients with VZV-caused paralysis and loss of stapedial reflex had poor recovery rates of below 25%, and these were classified as low risk factors. CONCLUSION It is possible to predict the prognosis of facial paralysis on the basis of several clinical findings. NET response, severe initial paralysis, age 50 years or older, and, as a second-stage factor, severity of facial paralysis 1 month after the onset were found to be especially important factors for predicting the prognosis of facial paralysis.
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Affiliation(s)
- Minoru Ikeda
- Department of Otolaryngology, Nihon University School of Medicine, Tokyo, Japan.
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Gail Neely J, Hartman JM, Wallace MS. Building the powerful 10-minute office visit, Part I: Introduction to the new section. Laryngoscope 2000; 110:1595-601. [PMID: 11037809 DOI: 10.1097/00005537-200010000-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This is the first of a planned progressive series of articles entitled "Tutorials in Clinical Research" written to assist those who would become more active in the application of scientific methods to their practices and to assist those who would seek to develop and publish new discoveries of their own. On completion of Tutorials, the reader should be able to 1) critically and efficiently read the literature and 2) use his or her personal practice as a laboratory for clinical investigation. STUDY DESIGN Tutorial. METHODS The Journal editor agreed to launch the series "Tutorials in Clinical Research," which was conceived out of a need for an easily understandable and accessible collection of tutorials for the busy practitioner. The Clinical Research Working Group at Washington University, Department of Otolaryngology-Head and Neck Surgery, will write, edit, and solicit additional authors for the completion of this planned 22-article series. The intended audience includes, among other groups, practitioners without research funds who are interested in the application of scientific methods to their practices. RESULTS This first article in the series outlines how to begin and three steps for the initial application of scientific methods to practice, including critical literature review, prospective analysis of practice, and specific project development. CONCLUSIONS The application of scientific methods to practice can be fun, educational, and effective in the enhancement of quality care. The "value added" result is the development of the powerful 10-minute patient office visit for the busy practitioner.
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Affiliation(s)
- J Gail Neely
- Department of Otolaryngology--Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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