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Daloiso A, Franz L, Mondello T, Pavone C, Spinato G, Emanuelli E, Cazzador D, de Filippis C, Zanoletti E, Marioni G. Post-traumatic Delayed Facial Nerve Palsy: Report of 2 Cases and Systematic Review. Otolaryngol Head Neck Surg 2024; 171:990-999. [PMID: 38769871 DOI: 10.1002/ohn.829] [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: 10/09/2023] [Revised: 04/13/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Delayed facial nerve palsy (dFNP) secondary to head injury is definitely uncommon. Although the mechanism of immediate facial nerve paralysis is well-studied, its delayed presentation remains debated. Given the dearth of available information, we reported herein our experience with 2 cases of posttraumatic dFNP. This systematic review aimed to evaluate all available information on dFNP and to assess treatment outcome also comparing conservatively and surgically approaches. DATA SOURCES Pubmed, Scopus, and Web of Science databases were systematically screened. REVIEW METHODS The protocol of this investigation was registered on PROSPERO in April 2023 and the systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. RESULTS Both patients in the case studies showed a complete recovery within 2 to 3 months after the head trauma. One of them still reported a subjective taste alteration at last control. After the application of the inclusion-exclusion criteria, 9 manuscripts with adequate relevance to this topic were included in the systematic review. The study population consisted of 1971 patients with a diagnosis of posttraumatic facial nerve palsy, of which 128 with a dFNP. CONCLUSIONS dFNP due to head trauma is a rarely encountered clinical entity, and optimal treatment still remains to be elucidated. Based on the reported data, it seems rational to propose a conservative approach for dFNP with steroid administration as a first line in most cases, indicating surgery in severe and/or refractory cases.
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Affiliation(s)
- Antonio Daloiso
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
| | - Tiziana Mondello
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Chiara Pavone
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Giacomo Spinato
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Enzo Emanuelli
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Diego Cazzador
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
| | - Elisabetta Zanoletti
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Gino Marioni
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
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Boillat M, Bonnet AS, Groubatch F, Falanga A, Gillet R, Parietti-Winkler C. Analysis of the milling response of an artificial temporal bone developed for otologic surgery in comparison with human cadaveric samples. Med Eng Phys 2024; 131:104220. [PMID: 39284647 DOI: 10.1016/j.medengphy.2024.104220] [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: 08/24/2023] [Revised: 07/18/2024] [Accepted: 07/31/2024] [Indexed: 09/19/2024]
Abstract
Temporal-bone milling is a delicate process commonly performed during otologic surgery to gain access to the middle and inner ear structures. Because of the numerous at-risk structures of this anatomic area, extensive surgeon training is required. Artificial temporal bones offer an interesting alternative to cadaveric training. However, the evaluation of such simulators has not been systematic, with an absence of objective validation of their milling response, especially in a surgical context. By measuring the milling forces obtained during the classical steps of otologic surgery on six 3D-printed and three cadaveric temporal bones, this work aims at evaluating the ability of the OTOtwin® synthetic temporal bone to reproduce human bone behavior. A better repeatability was obtained for artificial bones than for cadaveric ones. However, the level of forces recorded during artificial bone milling was close to the one measured with cadaveric samples. The effects of both surgical phase and irrigation on milling force levels were also quantified. The experiments conducted in this study confirmed the suitability of OTOtwin® temporal bone model for both otologic surgery training and research purposes. Valuable insights were also gained from this study regarding the understanding of the otologic milling process.
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Affiliation(s)
- Martin Boillat
- Université de Lorraine, CNRS, Arts et Métiers ParisTech, LEM3 F-57000 Metz, France
| | - Anne-Sophie Bonnet
- Université de Lorraine, CNRS, Arts et Métiers ParisTech, LEM3 F-57000 Metz, France.
| | - Frédérique Groubatch
- Université de Lorraine, Faculté de Médecine, 9 avenue de la Forêt de Haye 54500 Vandoeuvre-les-Nancy, France
| | - Aude Falanga
- Université de Lorraine, Faculté de Médecine, 9 avenue de la Forêt de Haye 54500 Vandoeuvre-les-Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny F-54000 Nancy, France; Université de Lorraine, CHRU Nancy, INSERM, IADI F-54000 Nancy, France
| | - Cécile Parietti-Winkler
- Département d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, CHRU Nancy, France; Université de Lorraine, Ecole de Chirurgie Nancy-Lorraine, Faculté de Médecine de Nancy 54500 Vandœuvre-lès-Nancy, France
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Rostami S, Min S, McCann A, Sayers C, Samy R, Collar R, Hsieh TY. The Effectiveness of Facial Neuromuscular Retraining on Patients with Facial Nerve Dysfunction: A Mental Health and Quality of Life Analysis. Facial Plast Surg Aesthet Med 2024; 26:551-557. [PMID: 38635958 DOI: 10.1089/fpsam.2023.0119] [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: 04/20/2024] Open
Abstract
Background: Facial muscle dysfunction can have drastic psychosocial effects. Objectives: To evaluate the impacts of customized neuromuscular retraining on mental health, quality of life (QoL), facial muscle function, and synkinesis. Methods: Thirty patients with facial nerve dysfunction completed a course of neuromuscular retraining. Patients' mental health, QoL, facial muscle function, and synkinesis were evaluated using Patient Health Questionnaire (PHQ-9), Facial Clinimetric Evaluation (FaCE) scale, electronic, clinician-graded facial function scale (eFACE), and Synkinesis Assessment Questionnaire (SAQ) at the initial and final visits. Scores were compared before and after treatment. Results: Patients (n = 30) included had a mean age of 59.4 ± 13.4 years (range 32.3-82.8) and were mostly female (22/30, 73.3%). The most common etiology was Iatrogenic facial nerve paralysis (11/20, 36.7%). Most patients had postfacial paralysis synkinesis (15/30, 50%), while 10 had complete flaccid paralysis. The median house-Brackmann score was 2 (range 1-6). The mean duration of facial palsy was 39.5 ± 106.9 (range 1-576 months). The duration of follow-up after the initial treatment session was 5.5 months, including 10 sessions. After neuromuscular retraining median PHQ-9 scores improved from 5 (range 0-25) to 3 (range 0-20) (p = 0.002). Mean FaCE PROM scores increased from 47.7 ± 11.5 to 56.5 ± 8.8 (p = 0.001). The mean eFACE score increased from 55.8 ± 15.1 to 71.7 ± 13.6 (p < 0.001). Median SAQ score was lower at the final visit (34.6 ± 13.4) compared to the initial visit (47.7 ± 17.8; p < 0.001). Conclusion: Customized neuromuscular retraining may improve patient-reported mental health, QoL, and facial muscle function and reduce synkinesis in facial nerve dysfunction.
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Affiliation(s)
- Sara Rostami
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susie Min
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Adam McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Colton Sayers
- Outpatient Rehabilitative Services Department, UCHealth, Cincinnati, Ohio, USA
| | - Ravi Samy
- Division of Otolaryngology/Head and Neck Surgery, Institute for Surgical Excellence, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Ryan Collar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tsung-Yen Hsieh
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Varelas AN, Bhatt N, Varelas EA, Franco A, Lee JW, Eytan DF. Reanimation of the Lower Lip with the Anterior Belly of Digastric Transfer: A Systematic Review. Facial Plast Surg Aesthet Med 2024; 26:538-543. [PMID: 38350142 DOI: 10.1089/fpsam.2023.0142] [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: 02/15/2024] Open
Abstract
Background: Dynamic reanimation of the lower lip is a challenging issue for patients, with depressor asymmetry commonly addressed with chemodenervation, selective neurectomy, or myectomy. Objective: To determine whether the anterior belly of digastric transfer is an effective method of lower-lip reanimation for patients with either isolated marginal mandibular branch weakness or inadequate depressor function after hemifacial reanimation, as measured by patient satisfaction and objective symmetry evaluation. Method: Systematic review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Abstracts and full texts were reviewed. A Risk of Bias assessment was performed. Results: Nine studies with 164 patients were included. Anterior belly of digastric transfer was successfully performed in 162 patients. Most patients (52%) underwent one-staged reanimation innervated by the native nerve to the mylohyoid. A two-staged approach after placement of a cross face nerve graft was performed in 46%. Patient satisfaction was excellent (90.6%), with minimal complications including revision (4/162), infection (4/162), and lipofilling (8/162). Conclusion: In patients seeking a permanent outcome, use of an anterior belly of digastric transfer in either a one-stage or two-stage approach appears to be a safe and effective method to restore symmetry and dynamic function.
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Affiliation(s)
- Antonios N Varelas
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Nupur Bhatt
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Eleni A Varelas
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Alexa Franco
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Judy W Lee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Danielle F Eytan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, USA
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Tedeschi R, Donati D, Giorgi F. Beyond the smile: a systematic review of diagnostic tools for peripheral facial paralysis. Acta Neurol Belg 2024:10.1007/s13760-024-02630-w. [PMID: 39198355 DOI: 10.1007/s13760-024-02630-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/15/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Effective rehabilitation of peripheral facial paralysis (PFP) requires reliable assessment tools. This systematic review aimed to identify and validate instruments used in PFP rehabilitation, categorizing them according to the ICF framework. METHODS A comprehensive search was conducted across PubMed, Cinahl, Web of Science, and Scopus up to April 2024. Observational analytical studies and one non-randomized controlled trial that validated tools for assessing PFP were included. RESULTS Thirty-three studies were included, covering twenty different tools. Seventeen tools were related to the "Structure and Function" domain, while three addressed "Activity and Participation." The Sunnybrook and House-Brackmann scales were the most extensively studied. The Sunnybrook scale exhibited excellent intra- and inter-rater reproducibility and internal validity, making it suitable for clinical use. The House-Brackmann scale was user-friendly but had limitations in reproducibility and sensitivity to subtle differences, which newer versions like the FNGS 2.0 aimed to address. The FAME scale showed promise by reducing subjective scoring. Computerized tools, such as eFACE and A-FPG, and instruments for lip asymmetry and ocular involvement demonstrated potential but require further validation. The Facial Disability Index and the FaCE Scale were validated for assessing disability and participation restrictions. CONCLUSION This review identified several validated tools for PFP assessment, with the Sunnybrook and House-Brackmann scales being the most reliable. While emerging tools and computerized programs show promise, they need further validation for routine clinical use. Integrating validated tools into clinical practice is essential for comprehensive assessment and effective rehabilitation of PFP.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126, Bologna, Italy.
| | - Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Giorgi
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences of Bologna, Via Altura 3, Bologna, Italy, IRCCS Institute of Neurological Sciences of Bologna, Via Altura 3, Bologna, Italy
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Yu LQ, Ma H, Cao LY, Zhou YL. Noninvasive Evaluation of Acupuncture-Induced Cortical Plasticity in Advanced Rehabilitation of Facial Paralysis. J Craniofac Surg 2024:00001665-990000000-01837. [PMID: 39178417 DOI: 10.1097/scs.0000000000010544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/13/2024] [Indexed: 08/25/2024] Open
Abstract
OBJECTIVE Facial paralysis (FP), which resulted from head and neck cancer resection, significantly impacts patients' quality of life. Traditional assessments rely on subjective evaluations and electromyography, whereas functional magnetic resonance imaging offers a noninvasive alternative for enhanced rehabilitation. Acupuncture has shown promise in promoting cerebral cortex reorganization, yet the precise relationship between acupuncture-induced structural and functional changes remains unclear, necessitating further investigation into therapeutic mechanisms. METHODS Fifty-five patients afflicted with FP underwent evaluations using voxel-mirrored homotopic connectivity (VMHC) and tract-based spatial statistics and were divided into the acupuncture intervention group (n = 35) and pseudo intervention group (n = 20). Comparative analyses of metrics pre and postintervention were conducted to delineate therapy-induced modifications in acupuncture intervention. The postacupuncture effect between groups to verify the necessity of accurate positioning for the rehabilitation of FP. RESULTS Patients with FP showed deficits in VMHC in regions of the postcentral, precentral, and parietal areas. Corpus callosum and internal capsule showed significantly increased fractional anisotropy of the white matter skeleton in tract-based spatial statistics after treatment. Comparison postintervention results between groups exhibited deficits in VMHC and increased fractional anisotropy in regions of the corpus callosum in the acupuncture intervention group. CONCLUSIONS Early acupuncture intervention may suppress cortical hyperactivation and restore interhemispheric inhibition across the corpus callosum to inhibit maladaptive structural plasticity. Precise acupoint localization is crucial for effective therapy, highlighting the potential of postacupuncture cortical space data for refining therapeutic strategies.
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Affiliation(s)
- Li-Qing Yu
- Department of Acupuncture, Shanghai Changning Tianshan Traditional Chinese Medicine Hospital
| | - Hao Ma
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lian-Ying Cao
- Department of Acupuncture, Shanghai Changning Tianshan Traditional Chinese Medicine Hospital
| | - Yu-Lu Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Doty S, Goslawski A, Cabrera CI, Tranchito E, Fowler N, Li S, Thuener JE, Teknos TN, Rezaee RP, Rabbani CC, Tamaki A. Examining timing of periorbital interventions in patients with upper division facial paralysis. Head Neck 2024. [PMID: 39143866 DOI: 10.1002/hed.27893] [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: 03/07/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Facial paralysis is a life-altering condition that may arise from various etiologies, ranging from trauma to malignancy. Permanent facial paralysis may occur secondary to facial nerve sacrifice or irreversible damage to the nerve. In these particularly devastating cases, protection and maintaining function of the eye is paramount. There are many effective lagophthalmos corrective surgical procedures available for these patients. While placement of eyelid weights and lid tightening surgeries are the cornerstone of eyelid rehabilitation, limited information exists on whether the timing of eyelid interventions in the setting of permanent facial paralysis impact outcomes, including need for revision surgery. METHODS A single-center retrospective chart review was performed for patients with irreversible facial paralysis treated with an upper eyelid weight between 2013 to 2022. Electronic health records were acquired to obtain facial paralysis etiology, associated clinical characteristics, the type of intervention, and the timing of intervention. Patients were classified as immediate if the eyelid weight operation occurred within 29 days of the initial facial paralysis and delayed if the surgery occurred 30 days or more after initial presentation. Outcomes were assessed in terms of revision procedures and surgical complications. RESULTS There were 70 patients in total, with 35 patients in the immediate category and 35 patients in the delayed category. The most common etiology related to parotid gland pathology, and 58.6% of patients had facial paralysis from cancer-related surgeries. There were no significant differences in revision rates (p < 0.208) or in the types of procedures (p = 0.077) between the two groups. The complication rates also did not differ significantly between groups; however, there were only complications in the delayed intervention group. CONCLUSIONS These findings suggest there is no difference in postoperative complications between groups, including the need for revision surgeries when comparing groups with immediate or delayed intervention. Thus, treatment plans should be customized based on patient and provider preferences.
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Affiliation(s)
- Samuel Doty
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Amanda Goslawski
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Claudia I Cabrera
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Eve Tranchito
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nicole Fowler
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shawn Li
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jason E Thuener
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Theodoros N Teknos
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Rod P Rezaee
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Cyrus C Rabbani
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Akina Tamaki
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology - Head and Neck Surgery, Fox Chase Cancer Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Lauda L, Sykopetrites V, Caruso A, Maddalone E, Di Rubbo V, Copelli C, Sanna M. Masseteric-facial anastomosis and hypoglossal-facial anastomosis after lateral skull base and middle ear surgery. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08866-9. [PMID: 39095536 DOI: 10.1007/s00405-024-08866-9] [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: 02/02/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION Lateral skull base (LSB) and middle ear pathologies often involve the facial nerve (FN), and their treatment may require FN sacrifice. Cases with unidentifiable proximal stump or intact FN with complete FN palsy, necessitate FN anastomosis with another motor nerve in order to restore innervation to the mimicking musculature. The results of hypoglossal-to-facial nerve anastomosis (HFA) and masseteric-facial nerve anastomosis in patients with facial paralysis after middle ear and LSB surgeries, are presented and compared. METHODS Adult patients with total definitive facial paralysis after middle ear or LSB surgery undergoing facial nerve reanimation through hypoglossal or masseteric transfer anastomosis were enrolled. The facial nerve function was graded according to the House Brackmann grading system (HB). The facial function results at 3 months, 6 months, 12 months, 18 months and at the last follow up (more than 18 months) are compared. RESULTS 153 cases of LSB and middle ear surgery presented postoperative facial palsy and underwent facial nerve reanimation surgery with HF in 85 patients (55.5%) and MF in 68 patients (44.5%). The duration of the FN palsy before reconstructive surgery was inversely associated to better FN results, in particular with having a grade III HB (p = 0.003). Both techniques had significantly lower HB scores when an interval between palsy onset and reanimation surgery was 6 months or less (MF p = 0.0401; HF p = 0.0022). Patients who underwent a MF presented significant improvement of the FN function at 3 months from surgery (p = 0.0078). At the last follow-up, 63.6% recovered to a grade III HB and 22.7% to a grade IV. On the other hand, the first significant results obtained in the HF group were at 6 months from surgery (p < 0.0001). 67.8% of patients had a grade III HB after a HF at the last follow-up, 28.8% a grade IV. FN grading at 6 months from surgery was significantly lower in the MF group compared to the HF (p = 0.0351). The two techniques had statistically similar results at later follow-up evaluations. DISCUSSION/CONCLUTION MF was associated to initial superior results, presenting significant facial recovery at 3 months, and significantly better functional outcomes at 6 months from surgery compared to HF. Although later results were not significantly different in this study, earlier results have an important role in order to limit the duration of risk of corneal exposure.
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Affiliation(s)
- Lorenzo Lauda
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Casa Di Cura "Piacenza" S.P.A, Piacenza-Rome, Italy
| | - Vittoria Sykopetrites
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Casa Di Cura "Piacenza" S.P.A, Piacenza-Rome, Italy
- Mario Sanna Foundation, Piacenza, Italy
| | - Antonio Caruso
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Casa Di Cura "Piacenza" S.P.A, Piacenza-Rome, Italy
| | - Enrico Maddalone
- Head and Neck Department, ASST Sette-Laghi Ospedale Di Circolo, Varese, Italy.
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Casa Di Cura "Piacenza" S.P.A, Via Antonio Emmanueli, 42, 29121, Piacenza, Italy.
| | - Vittoria Di Rubbo
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Casa Di Cura "Piacenza" S.P.A, Piacenza-Rome, Italy
| | - Chiara Copelli
- Head and Neck Department, IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Casa Di Cura "Piacenza" S.P.A, Piacenza-Rome, Italy
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Greiner RC, Kohlberg GD, Lu GN. Management of facial nerve trauma. Curr Opin Otolaryngol Head Neck Surg 2024; 32:234-238. [PMID: 38695542 DOI: 10.1097/moo.0000000000000976] [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: 05/06/2024]
Abstract
PURPOSE OF REVIEW To present the current literature on management of facial nerve disorder secondary to trauma, with a focus on the utility of electrodiagnostic testing in this setting. RECENT FINDINGS Patients with facial palsy related to temporal bone fractures should be started on high-dose corticosteroids as early as possible. Recent literature on the benefit of surgical intervention in the setting of temporal bone fracture is mixed. Some studies support early surgical decompression whereas others have found no benefit compared with conservative treatment. SUMMARY The management of facial nerve trauma is based on location and extent of injury. Extratemporal trauma and transected nerve should be treated with surgical exploration and tension-free coaptation ideally within 72 h. There are no guidelines for intratemporal facial nerve trauma. Surgical decompression compared with medical management is debated in the literature without consensus and more large studies are needed.
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Affiliation(s)
| | - Gavriel D Kohlberg
- University of Washington Department of Otolaryngology - Head and Neck Surgery, Seattle, Washington, USA
| | - G Nina Lu
- University of Washington Department of Otolaryngology - Head and Neck Surgery, Seattle, Washington, USA
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10
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Winter JM, Dimovska EOF, Tzou CHJ, Rodriguez-Lorenzo A. Rethinking Oncologic Facial Nerve Reconstruction in the Acute Phase Through Classification of the Level of Injury. Facial Plast Surg 2024; 40:450-458. [PMID: 38701854 DOI: 10.1055/a-2318-6989] [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: 05/05/2024] Open
Abstract
Early facial nerve reconstruction should be offered in every patient with oncological resections of the facial nerve due to the debilitating functional and psychosocial consequences of facial nerve palsy. Oncologic pathology or oncologic resection accounts for the second most common cause of facial nerve palsy. In the case of these acute injuries, selecting an adequate method for reconstruction to optimize functional and psychosocial well-being is paramount. Authors advocate consideration of the level of injury as a framework for approaching the viable options of reconstruction systematically. Authors breakdown oncologic injuries to the facial nerve in three levels in relation to their nerve reconstruction methods and strategies: Level I (intracranial to intratemporal), Level II (intratemporal to extratemporal and intraparotid), and Level III (extratemporal and extraparotid). Clinical features, common clinical scenarios, donor nerves available, recipient nerve, and reconstruction priorities will be present at each level. Additionally, examples of clinical cases will be shared to illustrate the utility of framing acute facial nerve injuries within injury levels. Selecting donor nerves is critical in successful facial nerve reconstruction in oncological patients. Usually, a combination of facial and nonfacial donor nerves (hybrid) is necessary to achieve maximal reinnervation of the mimetic muscles. Our proposed classification of three levels of facial nerve injuries provides a selection guide, which prioritizes methods for function nerve reconstruction in relation of the injury level in oncologic patients while prioritizing functional outcomes.
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Affiliation(s)
- Jessica M Winter
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Eleonora O F Dimovska
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Chieh-Han John Tzou
- Plastic and Reconstructive Surgery, Hospital of Divine Savior and Sigmund Freud University, Vienna, Austria
- Faculty of Medicine, Sigmund Freud University of Vienna, Vienna, Austria
- Facial Palsy Center, TZOU MEDICAL, Vienna, Austria
| | - Andres Rodriguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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11
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Hohman MH, Krivda JS, Herr MW, Anderson KG, Bevans SE, Montgomery EA, Robitschek JM, Vincent AG. Composite Sterno-Omohyoid Functional Muscle Transfer for Dual-Vector Smile Reanimation: A Case Series. Facial Plast Surg Aesthet Med 2024; 26:418-423. [PMID: 37948552 DOI: 10.1089/fpsam.2023.0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: Facial reanimation flaps often add bulk and produce single-vector smiles, and multivector flaps frequently require challenging intramuscular dissection. Objective: To evaluate the effectiveness of sterno-omohyoid flap (SOHF) transfer for dual-vector smile reanimation by measuring upper dental show and oral commissure movement. Methods: SOHF transfers from 2017 to 2020 were retrospectively evaluated using eFACE and Emotrics software. Results: Four patients with flaccid and one with nonflaccid facial paralysis were identified (four females and one male, median age: 39 years (range: 38-65); two acoustic neuromas, two congenital, one temporal bone fracture). Median follow-up was 20 months (range: 14-26). All flaps received masseteric nerves and two had additional cross-face grafts. Four developed contraction [median time to contraction: 5.5 months (range: 3-10)]. Mean oral commissure excursion and dental exposure improvements were 7.6 ± 4.0 mm (p = 0.03) and 2.9 ± 1.8 mm (p = 0.05), respectively. Dynamic, smile, and midface-smile eFACE improvements were 20.3 ± 6.8 (p = 0.007), 25.5 ± 14.5 (p = 0.03), and 50.5 ± 12.0 mm (p = 0.004) points, respectively. Mean SOHF mass was 14 ± 1.7 g. Conclusion: The SOHF is a small flap that provides dual-vector smile reanimation in flaccid and nonflaccid facial paralysis.
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Affiliation(s)
- Marc H Hohman
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Joseph S Krivda
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Marc W Herr
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Kelly G Anderson
- Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Scott E Bevans
- Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Emily A Montgomery
- Otolaryngology-Head & Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jon M Robitschek
- Otolaryngology-Head & Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Aurora G Vincent
- Otolaryngology-Head & Neck Surgery, Eisenhower Army Medical Center, Augusta, Georgia, USA
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12
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Bruins TE, Lammens RF, van Veen MM, Tamási K, Dijkstra PU, Werker PMN, Broekstra DC. Assessing Facial Palsy: Does Feedback Improve Assessment Using the eFACE and Sunnybrook Facial Grading System? Laryngoscope 2024; 134:3105-3111. [PMID: 38217435 DOI: 10.1002/lary.31269] [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: 04/20/2023] [Revised: 11/05/2023] [Accepted: 12/27/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE(S) To explore learning effects when applying the clinician-graded electronic facial function scale (eFACE) and the Sunnybrook Facial Grading System (Sunnybrook). METHODS Surgeons, facial rehabilitation therapists, and medical students were randomly allocated to the eFACE (n = 7) or Sunnybrook (n = 6) and graded 60 videos (Massachusetts Eye and Ear Infirmary open-source standard set); 10 persons with normal facial function and 50 patients with a wide variation of facial palsy severity. Participants received an introduction and individual feedback after each set of 10 videos. Scores were compared to the reference score provided with the set. Multilevel analysis was performed to analyze learning effect. RESULTS A learning effect was only found for the eFACE, with significant difference scores in set 1 and 2 compared to set 6, and no significant difference scores in the following sets. The difference score was associated with the reference score (severity of facial palsy) for eFACE (β = -0.19; SE = 0.04; p < 0.001) and Sunnybrook (β = -0.15; SE = 0.04; p < 0.001). Age of participants was also associated with the difference score in the eFACE group (β = 0.18; SE = 0.03; p < 0.001). No differences in scores were found between groups of participants. CONCLUSION The eFACE showed a learning effect of feedback while the Sunnybrook did not. LEVEL OF EVIDENCE NA Laryngoscope, 134:3105-3111, 2024.
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Affiliation(s)
- Tessa E Bruins
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Romy F Lammens
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martinus M van Veen
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Katalin Tamási
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pieter U Dijkstra
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paul M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dieuwke C Broekstra
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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13
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Xu L, Guo T, Sheng X, Du H, Tang Y. Predictive Value of the Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Idiopathic Facial Nerve Palsy. Int J Gen Med 2024; 17:2635-2642. [PMID: 38863739 PMCID: PMC11166163 DOI: 10.2147/ijgm.s458808] [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: 03/11/2024] [Accepted: 05/01/2024] [Indexed: 06/13/2024] Open
Abstract
Objective This study aims to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in patients with idiopathic facial nerve palsy. Methods The clinical data of patients with idiopathic facial nerve palsy were retrospectively analyzed. After three months of follow-up, patients were divided into good prognosis and poor prognosis, and the correlation between NLR, CRP and idiopathic facial nerve palsy was analyzed. Results Negative correlation of NLR with Portmann score in idiopathic facial nerve palsy (r=-0.788, P<0.05); In contrast to the group with poor prognosis, patients in good prognosis group had low levels of body mass index (BMI), NLR, and C-reactive protein (CRP), and high Portmann score (P<0.05); Multivariate logistic regression analysis showed Portmann score (OR=1.268, 95% CI (1.005-1.616)), NLR (OR=0.262, 95% CI (0.128-0.533)) and CRP levels (OR=0.949, 95% CI (0.895-0.989)) were risk factors of poor prognosis for patients with idiopathic facial nerve palsy. The area under the receiver operator characteristic (ROC) curve of NLR and CRP levels in predicting poor facial nerve function was 0.764 and 0.697, the specificity was 85.5% and 75.0%, and the sensitivity was 74. 0% and 76.0%, respectively. The ROC curve of the combined diagnosis was 0.829, the specificity was 80.7%, and the sensitivity was 82.0%. Conclusion Elevated NLR and CRP are associated with a poor prognosis of idiopathic facial nerve palsy and can serve as an indicator for clinical prognosis, and can be widely used in clinical.
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Affiliation(s)
- Longdong Xu
- Department of Neurology, Changshu NO.5 People’s Hospital, Changshu, Jiangsu, 215500, People’s Republic of China
| | - Tingting Guo
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Xihua Sheng
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Huaping Du
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Ying Tang
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
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14
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Wang W, Kong L, Zhang W, Shao Y. Clinical Experience With Acute Phase Repair of Facial Nerve Dissections. J Craniofac Surg 2024; 35:1276-1279. [PMID: 38709061 DOI: 10.1097/scs.0000000000010176] [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: 09/02/2023] [Accepted: 02/27/2024] [Indexed: 05/07/2024] Open
Abstract
The purpose of this study was to evaluate the facial nerve recovery of patients with traumatic facial nerve transections after tension-free end-to-end nerve epineural anastomosis during the acute phase. A total of 11 patients with traumatic facial nerve transections during the acute phase were surgically treated in the authors' department from November 2016 to August 2022. The case data and imaging data were collected from the patients, and the House-Brackman evaluation system of the facial nerve was applied to assess the recovery of facial nerve function, and the higher the grade, the worse the facial nerve function. Of the patients, 90.9% recovered to H-B grade II or below, and there were differences in the degree of recovery of the facial nerve function among the branches, and the ones that recovered to H-B grade II or below after surgery were 100% of the zygomatic branch, of which 80% were H-B grade I, 100% of the buccal branch, of which 44.4% were H-B grade I, 88.9% of the marginal mandibular branch, and 66.7% of the temporal branch. The study showed that the recovery rate of young patients was better than that of middle-aged and old people, and the best recovery of each branch of the facial nerve was the zygomatic branch, followed by the buccal branch, the marginal mandibular branch, and the worse was the temporal branch.
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Affiliation(s)
- Weihao Wang
- Department of Plastic and Reconstructive Surgery, the First Hospital of Jilin University, Changchun, Jilin, China
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15
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Melhem AM, Leshgold N, Pokress H, Younan RA, Haddad M, Kantar RS, Azizzadeh B. Etiology and Management of 800 Patients With Facial Palsy at a Private Practice Setting Over a 5-Year Period. J Craniofac Surg 2024:00001665-990000000-01640. [PMID: 38810236 DOI: 10.1097/scs.0000000000010317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/15/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Very few papers investigated the etiologic breakdown and demographic characteristics of patients with facial nerve (FN) palsy. Our paper aims to present the etiologic breakdown and demographic characteristics of patients with FN palsy, presenting at a private care center between 2014 and 2019, along with the treatment modalities that were offered to them. METHODS Charts of 800 patients with facial palsy (FP) were reviewed. Data included the etiology of their diagnosis, family history, recurrent FP, demographic information, and treatment provided before and after presentation. RESULTS Seventy-five percent of our study population were females. The average period between diagnosis with FP and presentation at our center was 10.8 years. The most commonly identified etiology was Bell's palsy, followed by acoustic neuroma. Eighty-one percent of the study subjects were prescribed steroids and/or antivirals. Facial neuromuscular retraining, electrical stimulation, chemodenervation, and surgical intervention were also part of some treatment plans for our population. DISCUSSION Recommendations for the treatment of idiopathic FP include steroids with adjuvant antiviral medications. Data remains uncertain whether the combination therapy of steroids and antivirals has better results compared to steroids alone. Electrical stimulation is still a controversial therapeutic tool for facial paralysis with a potential role in exacerbating synkinesis. The difference in referral patterns between tertiary and private care centers can explain the disparity in the ranking of the etiologies between our study and what has been published. CONCLUSION Management of FP is a complex process. The FN community must develop a common database to improve its understanding of the different presentations.
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Affiliation(s)
- Antonio M Melhem
- Global Smile Foundation, Norwood, MA
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn
| | - Nicole Leshgold
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Robert A Younan
- Global Smile Foundation, Norwood, MA
- Department of Plastics Surgery, Augusta University Medical Center, Augusta, GA
| | - Mario Haddad
- Global Smile Foundation, Norwood, MA
- Department of Plastics & Reconstructive Surgery, University of California-Irvine, Irvine, CA
- Department of Plastics Surgery, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Rami S Kantar
- Global Smile Foundation, Norwood, MA
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York City, NY
| | - Babak Azizzadeh
- Global Smile Foundation, Norwood, MA
- Department of Plastics Surgery, Cedars-Sinai Health System
- Department of Plastics Surgery, David Geffen School of Medicine, UCLA, Los Angeles
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16
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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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McEntire CRS, Chwalisz BK. Cranial nerve involvement, visual complications and headache syndromes in Lyme disease. Curr Opin Ophthalmol 2024; 35:265-271. [PMID: 38518069 DOI: 10.1097/icu.0000000000001031] [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: 03/24/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of the visual manifestations and cranial neuropathies seen in Lyme disease. RECENT FINDINGS Lyme facial palsy remains the most common manifestation of Lyme neuroborreliosis. Recent investigations show likely evidence of vagal involvement in Lyme disease. SUMMARY The literature on Lyme neuroborreliosis continues to evolve. Lyme disease can affect nearly any cranial nerve in addition to causing various headache syndromes. The most common manifestation is Lyme disease facial palsy, occurring in up to 5-10% of patients with documented Lyme disease. Headache syndromes are common in the context of facial palsy but can occur in isolation, and more specific headache syndromes including trigeminal and geniculate neuralgias can occur rarely. Signs and symptoms indicative of vestibulocochlear nerve involvement are relatively common, although it could be that these represent other vestibular involvement rather than a specific cranial neuropathy. Optic neuritis is a controversial entity within Lyme disease and is likely overdiagnosed, but convincing cases do exist. Physicians who see any cranial neuropathy, including optic neuritis, in an endemic area can consider Lyme disease as a possible cause.
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Affiliation(s)
- Caleb R S McEntire
- Massachusetts General Hospital-Harvard Medical School
- Brigham and Women's Hospital-Harvard Medical School, Department of Neurology
| | - Bart K Chwalisz
- Massachusetts General Hospital-Harvard Medical School
- Massachusetts Eye and Ear-Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts, USA
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18
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Scherrer E, Chaloupka K. Future treatment options for facial nerve palsy: a review on electrical stimulation devices for the orbicularis oculi muscle. Neurol Sci 2024; 45:1969-1977. [PMID: 38114854 PMCID: PMC11021255 DOI: 10.1007/s10072-023-07226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Abstract
Facial nerve palsy can cause diminished eyelid closure (lagophthalmos). This occurs due to functional deficits of the orbicularis oculi muscle, potentially leading to sight-threatening complications due to corneal exposure. Current management options range from frequent lubrication with eye drops, to the use of moisture chambers and surgery. However, achieving functional restoration may not always be possible. Recent efforts have been directed towards the support of orbicularis oculi muscle function through electrical stimulation. Electrical stimulation of the orbicularis oculi muscle has been demonstrated as feasible in human subjects. This article offers a comprehensive review of electrical stimulation parameters necessary to achieve full functionality and a natural-looking eye blink in human subjects. At present, readily available portable electrical stimulation devices remain unavailable. This review lays the foundation for advancing knowledge from laboratory research to clinical practice, with the ultimate objective of developing a portable electrical stimulation device. Further research is essential to enhance our understanding of electrical stimulation, establish safety standards, determine optimal current settings, and investigate potential side effects.
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Affiliation(s)
- Elena Scherrer
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Karla Chaloupka
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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19
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Misra I, Rath B, Rath I, Mondal H. Predictors of Recovery in Facial Nerve Palsy: Insights From an Observational Study in Odisha, India. Cureus 2024; 16:e58949. [PMID: 38800142 PMCID: PMC11127665 DOI: 10.7759/cureus.58949] [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: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Background Facial nerve paralysis, leading to the loss of facial expression, poses significant discomfort to patients. While most individuals exhibit a favorable response to treatment, a subset experiences enduring facial deformities without clearly defined etiology. This study aimed to identify prognostic factors influencing outcomes and quality of life in facial nerve palsy patients, contributing to enhanced clinical management. Methods A prospective observational study was conducted in the Otorhinolaryngology Department of Maharaja Krishna Chandra Gajapati Medical College and Hospital, a tertiary care hospital. We included patients presenting with any clinical variety of facial nerve palsy, irrespective of age and gender. Only moribund and noncompliant cases were excluded. Patients underwent clinical assessment using the House-Brackmann (HB) grading at presentation and were subsequently monitored at three weeks, three months, and six months post-onset to assess recovery. Results Out of 66 patients, 18 (27.27%) fully recovered at three weeks, 50 (75.76%) recovered at three months, and 54 (81.82%) at six-month follow-up. Incomplete recovery was observed in 13 (19.69%) patients. Factors associated with favorable outcomes included younger age of onset (p = 0.003), lower baseline HB grade (IV or less) (p = 0.001), Electroneurography Degeneration Index (ENoG DI) of <70% (p < 0.0001), early initiation of treatment (within five days of onset) (p = 0.0003), and absence of comorbid conditions (p = 0.03). Gender and affected side (left or right) did not influence the outcome. Conclusion In summary, age, associated comorbid conditions, baseline HB grade, and extent of facial nerve degeneration are crucial predictors of outcomes in facial nerve palsy. This knowledge can guide clinicians in optimizing treatment strategies for improved patient care.
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Affiliation(s)
- Ikhita Misra
- Otorhinolaryngology, Shri Jagannath Medical College and Hospital, Puri, IND
| | - Bandana Rath
- Pharmacology, Saheed Laxman Nayak Medical College and Hospital, Koraput, IND
| | - Ishani Rath
- Biochemistry, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, IND
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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20
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Xue R, Xie M, Wu Z, Wang S, Zhang Y, Han Z, Li C, Tang Q, Wang L, Li D, Wang S, Yang H, Zhao RC. Mesenchymal Stem Cell-Derived Exosomes Promote Recovery of The Facial Nerve Injury through Regulating Macrophage M1 and M2 Polarization by Targeting the P38 MAPK/NF-Κb Pathway. Aging Dis 2024; 15:851-868. [PMID: 37548941 PMCID: PMC10917525 DOI: 10.14336/ad.2023.0719-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Facial nerve (FN) injury seriously affects human social viability and causes a heavy economic and social burden. Although mesenchymal stem cell-derived exosomes (MSC-Exos) promise therapeutic benefits for injury repair, there has been no evaluation of the impact of MSC-Exos administration on FN repair. Herein, we explore the function of MSC-Exos in the immunomodulation of macrophages and their effects in repairing FN injury. An ultracentrifugation technique was used to separate exosomes from the MSC supernatant. Administrating MSC-Exos to SD rats via local injection after FN injury promoted axon regeneration and myelination and alleviated local and systemic inflammation. MSC-Exos facilitated M2 polarization and reduced the M1-M2 polarization ratio. miRNA sequencing of MSC-Exos and previous literature showed that the MAPK/NF-κb pathway was a downstream target of macrophage polarization. We confirmed this hypothesis both in vivo and in vitro. Our findings show that MSC-Exos are a potential candidate for treating FN injury because they may have superior benefits for FN injury recovery and can decrease inflammation by controlling the heterogeneity of macrophages, which is regulated by the p38 MAPK/NF-κb pathway.
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Affiliation(s)
- Ruoyan Xue
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Mengyao Xie
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhiyuan Wu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shu Wang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yongli Zhang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zhijin Han
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Chen Li
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qi Tang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Liping Wang
- Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Peking Union Medical College Hospital, Center of Excellence in Tissue Engineering Chinese Academy of Medical Sciences, Beijing Key Laboratory, Beijing, China.
| | - Di Li
- Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Peking Union Medical College Hospital, Center of Excellence in Tissue Engineering Chinese Academy of Medical Sciences, Beijing Key Laboratory, Beijing, China.
| | - Shihua Wang
- Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Peking Union Medical College Hospital, Center of Excellence in Tissue Engineering Chinese Academy of Medical Sciences, Beijing Key Laboratory, Beijing, China.
| | - Hua Yang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Robert Chunhua Zhao
- Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Peking Union Medical College Hospital, Center of Excellence in Tissue Engineering Chinese Academy of Medical Sciences, Beijing Key Laboratory, Beijing, China.
- School of Life Sciences, Shanghai University, Shanghai, China.
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Kaufman-Goldberg T, Flynn JP, Trzcinski LO, McGonagle ER, Banks CA, Hadlock TA. Pre-Operative Factors May Predict Outcome in Selective Neurectomy for Synkinesis. Facial Plast Surg Aesthet Med 2024; 26:166-171. [PMID: 37738387 DOI: 10.1089/fpsam.2022.0412] [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: 09/24/2023] Open
Abstract
Background: While there has been great interest in offering selective neurectomy (SN) to patients with nonflaccid facial palsy (NFFP), postoperative outcomes are inconsistent. Objective: To assess overall SN outcome in NFFP patients and to examine correlation between preoperative factors and SN outcome. Methods: SN cases were retrospectively identified between 2019 and 2021. Patient factors and facial function were assessed using chart review, the Facial Clinimetric Evaluation (FaCE), the electronic clinician-graded facial function tool (eFACE), and an automated computer-aided facial assessment tool (Emotrics). Correlations between preoperative factors and patients outcome were established. Results: Fifty-eight SN cases were performed; 88% were females, and median age was 53 years (range 11-81). Outcome assessment was 8 months on average (1-24 months). Postoperatively, multiple eFACE and Emotrics parameters improved significantly, including ocular, perioral, and synkinesis metrics. In preoperative factors assessment, age >50, facial palsy (FP) duration >2 years, poor preoperative facial function, and nontrauma etiology all correlated with greater improvements compared with younger patients, those with shorter duration facial palsy, trauma etiology, and better preoperative facial function. Conclusions: SN can significantly improve facial function; we have identified several preoperative factors that correlated to outcome.
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Affiliation(s)
- Tal Kaufman-Goldberg
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John P Flynn
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elizabeth R McGonagle
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Caroline A Banks
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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22
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Li T, Wang S, Yin X, Zhang S, Yang Z, Wu J, Huang Z. Electroacupuncture with intermittent wave stimulation as rehabilitation approach for chronic Bell's palsy: a randomized controlled trial. Postgrad Med J 2024; 100:151-158. [PMID: 38134327 DOI: 10.1093/postmj/qgad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To evaluate the effectiveness and safety of electroacupuncture (EA) using intermittent wave stimulation in enhancing facial symmetry and nerve function in chronic Bell's palsy patients. METHODS A 6-week assessor-blinded, randomized trial followed by an 18-week observational period was conducted. Sixty individuals with chronic Bell's palsy, showing no signs of recovery after 12 months, were equally divided to receive either 18 sessions of EA using intermittent wave stimulation or Transcutaneous Electrical Stimulation (TES), administered thrice weekly over 6 weeks. The primary outcome measure was the change in the total facial nerve index (TFNI) score from baseline to Week 6, with secondary outcomes including TFNI scores at Weeks 12 and 24, as well as the change in Sunnybrook Facial Grading System (SFG) score from baseline to Week 6, and SFG scores at Weeks 12 and 24. RESULTS The EA group showed a significant improvement, with a mean total facial nerve index score increase of 24.35 (4.77) by Week 6 compared with 14.21 (5.12) in the Transcutaneous Electrical Stimulation group (P<.001). This superiority persisted during the 24-week follow-up. While no significant difference was observed in the Sunnybrook Facial Grading System score change from baseline to Week 6, variations were noted at Weeks 12 and 24. No major adverse effects were reported. CONCLUSION EA with intermittent wave stimulation notably enhanced facial symmetry in chronic Bell's palsy patients over Transcutaneous Electrical Stimulation by Week 6, maintaining this edge throughout the follow-up.
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Affiliation(s)
- Tian Li
- Shanghai Pudong Hospital of Traditional Chinese Medicine, Department of Acupuncture and Moxibustion, Shanghai 201299, China
| | - Siyao Wang
- Shanghai Pudong Hospital of Traditional Chinese Medicine, Department of Acupuncture and Moxibustion, Shanghai 201299, China
| | - Xuan Yin
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Department of Acupuncture and Moxibustion, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
| | - Shen Zhang
- Shanghai Pudong Hospital of Traditional Chinese Medicine, Department of Acupuncture and Moxibustion, Shanghai 201299, China
| | - Zhen Yang
- Shanghai Pudong Hospital of Traditional Chinese Medicine, Department of Acupuncture and Moxibustion, Shanghai 201299, China
| | - Junyi Wu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Department of Acupuncture and Moxibustion, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
| | - Zouqin Huang
- Shanghai Pudong Hospital of Traditional Chinese Medicine, Department of Acupuncture and Moxibustion, Shanghai 201299, China
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23
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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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24
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Lee MY, Kim YJ, Kim YS, Roh TS, Yun IS. Demographic review of aesthetic surgery for patients with facial palsy. Arch Craniofac Surg 2024; 25:22-26. [PMID: 38461825 PMCID: PMC10924796 DOI: 10.7181/acfs.2023.00591] [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: 11/06/2023] [Revised: 11/17/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND This study analyzed the demographic characteristics of patients with facial palsy who were treated using either dynamic or static procedures. This study aimed to compare the frequency of procedure implementation and age distribution between the two groups. METHODS This study retrospectively analyzed the medical records of patients treated for facial palsy at a single institution from 2014 to 2022. Among cases included in our study, dynamic procedures involved cross-facial nerve graft and latissimus dorsi or gracilis muscle flap transfer. Static procedures included gold weight insertion, canthopexy, browlift, and thread lift/static slings. RESULTS Among the 31 patients included in our study, eight (25.8%) incorporated dynamic techniques, and the average age of patients was 44.75 years (range, 24-68 years) with a male to female ratio of 1:4. The remaining 23 patients (74.2%) underwent a static procedure, of which the average age was 59.17 years (range, 23-81 years) which was statistically significantly higher than the average age of 44.75 of dynamic patients (p= 0.013). Regarding the timing of treatment after diagnosis, no patient underwent dynamic procedures more than 20 years after initial diagnosis. A greater diversity in the timing of treatment was observed in the static group. All patients who underwent dynamic procedures were treated using static procedures during the study period. CONCLUSION Because aesthetics-based static techniques are typically quick outpatient procedures that can be performed under local anesthesia, our study shows that these are often preferred treatments for all age groups, especially for debilitated or older patients. Further research is required to investigate the long-term functional outcomes of these surgical techniques in a wider population of patients.
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Affiliation(s)
- Min Young Lee
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Jung Kim
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tai Suk Roh
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Sik Yun
- Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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25
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Kalavacherla S, Du E, de Cos V, Meller L, Ostrander B, Davis M, Greene J. The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort. Laryngoscope 2024; 134:911-918. [PMID: 37470296 PMCID: PMC11023743 DOI: 10.1002/lary.30895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/06/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES We characterize occult lesion diagnosis rates after initial Bell's palsy diagnoses. METHODS A de-identified database of all facial palsy patients who presented to an extensive health care system across 22 years was created using Epic SlicerDicer. Among patients with Bell's palsy diagnoses, we extracted demographic and any subsequent occult lesion diagnosis data across various clinical sites. Descriptive and multivariable regression analyses comparing patients with occult lesion diagnoses made at different time points were included. RESULTS Among the total 3912 facial palsy patients, 2240 had Bell's palsy diagnoses, of which 217 (9.7%) had subsequent lesion diagnoses at a median (IQR) of 12.3 (4.2, 23.8) months, consisting of cranial nerve neoplasms (62.2%), parotid gland neoplasms (34.1%), and cholesteatomas (3.7%). Although a large proportion of total lesions were diagnosed within the first 3 months (19.8%), 69.5% were diagnosed after 6 months. There were no demographic differences among patients diagnosed with different lesion types, but Asian patients were more likely to be diagnosed with occult lesions after 12 months after Bell's palsy diagnosis compared with white patients (odds ratio = 6.2, p = 0.001). CONCLUSIONS In one of the largest Bell's palsy cohorts to date, we identified a 9.7% occult lesion diagnosis rate at a median of 12.3 months after Bell's palsy diagnosis. These data underscore the importance of timely workup for occult lesions in cases of facial palsy with no signs of recovery after 3-4 months. LEVEL OF EVIDENCE 4 Laryngoscope, 134:911-918, 2024.
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Affiliation(s)
- Sandhya Kalavacherla
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Eric Du
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Víctor de Cos
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Leo Meller
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Benjamin Ostrander
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Morgan Davis
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Jacqueline Greene
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
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26
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Woo SH, Kim YC, Oh TS. Facial palsy reconstruction. Arch Craniofac Surg 2024; 25:1-10. [PMID: 38461822 PMCID: PMC10924795 DOI: 10.7181/acfs.2023.00528] [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: 10/17/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 03/12/2024] Open
Abstract
The facial nerve stimulates the muscles of facial expression and the parasympathetic nerves of the face. Consequently, facial nerve paralysis can lead to facial asymmetry, deformation, and functional impairment. Facial nerve palsy is most commonly idiopathic, as with Bell palsy, but it can also result from a tumor or trauma. In this article, we discuss traumatic facial nerve injury. To identify the cause of the injury, it is important to first determine its location. The location and extent of the damage inform the treatment method, with options including primary repair, nerve graft, cross-face nerve graft, nerve crossover, and muscle transfer. Intracranial proximal facial nerve injuries present a challenge to surgical approaches due to the complexity of the temporal bone. Surgical intervention in these cases requires a collaborative approach between neurosurgery and otolaryngology, and nerve repair or grafting is difficult. This article describes the treatment of peripheral facial nerve injury. Primary repair generally offers the best prognosis. If primary repair is not feasible within 6 months of injury, nerve grafting should be attempted, and if more than 12 months have elapsed, functional muscle transfer should be performed. If the affected nerve cannot be utilized at that time, the contralateral facial nerve, ipsilateral masseter nerve, or hypoglossal nerve can serve as the donor nerve. Other accompanying symptoms, such as lagophthalmos or midface ptosis, must also be considered for the successful treatment of facial nerve injury.
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Affiliation(s)
- Soo Hyun Woo
- Department of Plastic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Chul Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Suk Oh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hadford SP, Genther DJ, Byrne PJ. Pediatric Facial Reanimation. Facial Plast Surg Clin North Am 2024; 32:169-180. [PMID: 37981412 DOI: 10.1016/j.fsc.2023.07.003] [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] [Indexed: 11/21/2023]
Abstract
Pediatric facial palsy is rare but severely debilitating and results in profound functional, developmental, psychosocial, and esthetic consequences. Identifying the specific cause of the palsy is important in directing the treatment course. The most common etiologies of pediatric facial palsy are distinct from those of adults. Facial reanimation interventions are targeted to address the zones of the face, with oral/smile rehabilitation the most common region requiring intervention in pediatric patients. Gracilis microneurovascular free tissue transfer is safe and highly effective in the pediatric population, providing significant functional, psychosocial, and esthetic benefits.
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Affiliation(s)
- Stephen P Hadford
- Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA
| | - Dane J Genther
- Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA; Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA
| | - Patrick J Byrne
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA; Chair, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA; Chief, Cleveland Clinic Integrated Surgical Institute, Cleveland, OH 44195, USA.
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Ragaban A, Alsharif L, Alshaikh NA, Jafar RJ, Hemeq Z, Khan MA, Gharawi RA, Aldosary T. Prevalence, Etiology, Risk Factors, and Complications of Facial Nerve Palsy at King Abdulaziz Medical City: A Multicenter Study. Cureus 2024; 16:e53403. [PMID: 38435234 PMCID: PMC10908361 DOI: 10.7759/cureus.53403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Facial nerve palsy is a condition of nerve damage that results in impaired facial movement on one or both sides of the face. OBJECTIVES This multicenter study aimed to determine the prevalence of facial nerve palsy and evaluate the association between its risk factors and complications to identify its etiology among patients admitted to King Abdulaziz Medical City in Jeddah and Riyadh, Saudi Arabia, between 2016 and 2023. METHODS A retrospective cross-sectional study was conducted to obtain data from medical records using the best care system for patients with facial nerve palsy. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States), Chi-square test, t-test, and ANOVA. The level of statistical significance was set at p<0.05. RESULTS The study involved 123 patients, with 0.0164% prevalence. Bell's palsy was the most common etiology, accounting for 81.8% of cases, followed by head injuries, dental trauma, otitis media, stroke, and head and neck tumors. Obesity was the most significant risk factor, followed by upper respiratory problems. Hypertension and diabetes exert similar effects. Facial asymmetry, ophthalmic complications, and eye twitching were the most common complaints followed by speech difficulties, psychological and social effects, mouth twitching, and synkinesis. CONCLUSION Facial nerve palsy is common in this region. We recommend health education sessions to increase public awareness and provide preventive strategies to reduce the complications of facial nerve damage. We recommend further research on the association between the risk factors and complications of facial nerve palsy.
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Affiliation(s)
- Ali Ragaban
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Lana Alsharif
- Department of Medical Rehabilitation Sciences/Physiotherapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | | | | | - Ziyad Hemeq
- Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
| | - Muhammad A Khan
- Medical Education, King Saud Bin Abdulaziz University, Jeddah, SAU
| | - Raidaa A Gharawi
- Dental Clinic, Jeddah University Medical Centre, Jeddah University, Jeddah, SAU
| | - Taghreed Aldosary
- Medical Sciences-Oral Biology, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
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Rajangam J, Lakshmanan AP, Rao KU, Jayashree D, Radhakrishnan R, Roshitha B, Sivanandy P, Sravani MJ, Pravalika KH. Bell Palsy: Facts and Current Research Perspectives. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:203-214. [PMID: 36959147 DOI: 10.2174/1871527322666230321120618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Abstract
Bell palsy is a non-progressive neurological condition characterized by the acute onset of ipsilateral seventh cranial nerve paralysis. People who suffer from this type of facial paralysis develop a droop on one side of their face, or sometimes both. This condition is distinguished by a sudden onset of facial paralysis accompanied by clinical features such as mild fever, postauricular pain, dysgeusia, hyperacusis, facial changes, and drooling or dry eyes. Epidemiological evidence suggests that 15 to 23 people per 100,000 are affected each year, with a recurrence rate of 12%. It could be caused by ischaemic compression of the seventh cranial nerve, which could be caused by viral inflammation. Pregnant women, people with diabetes, and people with respiratory infections are more likely to have facial paralysis than the general population. Immune, viral, and ischemic pathways are all thought to play a role in the development of Bell paralysis, but the exact cause is unknown. However, there is evidence that Bell's hereditary proclivity to cause paralysis is a public health issue that has a greater impact on patients and their families. Delay or untreated Bell paralysis may contribute to an increased risk of facial impairment, as well as a negative impact on the patient's quality of life. For management, antiviral agents such as acyclovir and valacyclovir, and steroid treatment are recommended. Thus, early diagnosis accompanied by treatment of the uncertain etiology of the disorder is crucial. This paper reviews mechanistic approaches, and emerging medical perspectives on recent developments that encounter Bell palsy disorder.
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Affiliation(s)
- Jayaraman Rajangam
- AMITY Institute of Pharmacy, AMITY University, Lucknow, Uttar Pradesh, 226028, India
| | | | - K Umamaheswara Rao
- Department of Pharmacology, Sri Venkateswara Institute of Medical Sciences, Sri Padmavati Mahila Visvavidyalayam, Tirupati, Andhra Pradesh, 517507, India
| | - D Jayashree
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, P.O Box 505055, Dubai, UAE
| | - B Roshitha
- Sri Venkateswara Institute of Cancer Care and Advanced Research, Tirupati, Andhra Pradesh, 517507, India
| | - Palanisamy Sivanandy
- School of Pharmacy, International Medical University, No 126, Jalan Jalil Perkasa 19, Bukit Jalil 57000 Kuala Lumpur, Malaysia
| | - M Jyothi Sravani
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - K Hanna Pravalika
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
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30
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Knoedler S, Knoedler L, Hoch CC, Kauke-Navarro M, Kehrer A, Friedman L, Prantl L, Machens HG, Orgill DP, Panayi AC. An ACS-NSQIP Data Analysis of 30-Day Outcomes Following Surgery for Bell's Palsy. J Craniofac Surg 2024; 35:23-28. [PMID: 37695075 PMCID: PMC10841222 DOI: 10.1097/scs.0000000000009739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND There exists a paucity of large-scale, multi-institutional studies that investigate the outcomes of surgery for Bell's palsy (BP). Here, we utilize a large, multi-institutional database to study the risk factors and early-stage outcomes following surgical procedures in BP. METHODS We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008-2019) to identify patients who underwent surgery for the diagnosis of BP. We extracted data on comorbidities and preoperative blood values, and 30-day postoperative outcomes. RESULTS Two hundred fifty-seven patients who underwent surgery for BP symptoms over the 12-year review period were identified. Muscle grafts (n=50; 19%) and fascial grafts (n=48; 19%) accounted for the majority of procedures. The most common comorbidities were hypertension (n=89; 35%) and obesity (n=79; 31%). Complications occurred in 26 (10.1%) cases. Additionally, length of hospital stay was significantly associated with both surgical and medical complications (3.9±4.7 versus 1.5±2.0; P <0.01) and (3.2±3.8 versus 1.4±2.0; P <0.01), respectively. Preoperative creatinine, blood urea nitrogen, and alkaline phosphatase were identified as potential predictors of poor postoperative outcomes. CONCLUSION Based on multi-institutional analysis, complication rates following surgery for BP were found to be overall low and seen to correlate with length of hospital stay. Reoperations and readmissions were the most frequent complications after surgery for BP. The preoperative evaluation of routine laboratory values may help refine patient eligibility and risk stratification. In addition, our findings call for future large-scale prospective studies in the field of facial palsy surgery to further improve the quality of care and optimize perioperative protocols.
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Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Cosima C. Hoch
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Leigh Friedman
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Hans-Guenther Machens
- Department of Plastic and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dennis P. Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Seeberger S, Schlattmann P, Guntinas-Lichius O. Surgery for patients with facial palsy in Germany: a diagnosis-related-groups-based nationwide analysis, 2005-2019. Eur Arch Otorhinolaryngol 2024; 281:451-459. [PMID: 37755497 PMCID: PMC10764378 DOI: 10.1007/s00405-023-08259-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE Chronic flaccid paralysis of the facial nerve leads to permanent dysfunction of eye closure, problems with drinking and eating, and lack of emotional expression. Modern facial surgery can help those affected. An analysis of the development of facial surgery in Germany over time is presented. METHODS Nation-wide population-baes diagnosis-related case group (DRG) data of virtually all inpatients who underwent facial surgery for facial palsy between 2005 and 2019 were included. Binomial regression models for changes in surgery rates over time were calculated in relation to gender and treating specialty. RESULTS Between 2005 and 2019, there were 28,622 inpatient stays for facial surgery. Most surgeries were provided by otolaryngology (39%) and ophthalmology or dentistry, oral and maxillofacial surgery (20% each). The mean treatment rate was 2.33 ± 0.53 surgeries per 100,000 person-years. The surgery rate was highest for nerve reconstruction surgery (0.46 ± 0.15) and static sling surgery (0.44 ± 0.0.16). The greatest increase was seen in men for nerve surgery (3.9-fold; relative risk [RR] = 3.68; confidence interval [CI] = 3.18-4.26) and sling surgery (5.0-fold; RR = 4.25; CI = 3.38-5.33). CONCLUSIONS While nerve and sling surgery increased significantly over time, this was less true or not true at all for surgical techniques. Surgical rates and their change over time were greater in men, without explanation from the data.
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Affiliation(s)
- Susanna Seeberger
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, 07747, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Facial-Nerve-Center, Jena University Hospital, 07747, Jena, Germany.
- Center for Rare Diseases, Jena University Hospital, 07747, Jena, Germany.
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Saro-Buendía M, Mellidez Acosta R, Bancalari Díaz C, Mazón M, de Paula Vernetta C, Armengot Carceller M. Labyrinthine Bifurcation of the Facial Nerve. Indian J Otolaryngol Head Neck Surg 2023; 75:4086-4089. [PMID: 38027537 PMCID: PMC10646062 DOI: 10.1007/s12070-023-03977-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 12/01/2023] Open
Abstract
The labyrinthine bifurcation of the facial nerve is extremely rare. Diverse congenital temporal bone anomalies usually coexist, and a detailed preoperative evaluation is needed to detect them. We report a case of labyrinthine bifurcation of the facial nerve detected on the preoperative evaluation of a patient with congenital aural atresia.
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Affiliation(s)
- Miguel Saro-Buendía
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, València, España
- Departament de Cirugia, Facultat de Medicina i Odontología, Universitat de València, València, España
| | - Raúl Mellidez Acosta
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, València, España
| | - Catalina Bancalari Díaz
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, València, España
| | - Miguel Mazón
- Servicio de Radiología, Hospital Universitario y Politécnico La Fe, València, España
| | - Carlos de Paula Vernetta
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, València, España
- Departament de Cirugia, Facultat de Medicina i Odontología, Universitat de València, València, España
| | - Miguel Armengot Carceller
- Servicio de Otorrinolaringología, Hospital Universitario y Politécnico La Fe, València, España
- Departament de Cirugia, Facultat de Medicina i Odontología, Universitat de València, València, España
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Huang H, Lin Q, Rui X, Huang Y, Wu X, Yang W, Yu Z, He W. Research status of facial nerve repair. Regen Ther 2023; 24:507-514. [PMID: 37841661 PMCID: PMC10570629 DOI: 10.1016/j.reth.2023.09.012] [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: 07/19/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
The facial nerve, also known as the seventh cranial nerve, is critical in controlling the movement of the facial muscles. It is responsible for all facial expressions, such as smiling, frowning, and moving the eyebrows. However, damage to this nerve can occur for a variety of reasons, including maxillofacial surgery, trauma, tumors, and infections. Facial nerve injuries can cause severe functional impairment and can lead to different degrees of facial paralysis, significantly affecting the quality of life of patients. Over the past ten years, significant progress has been made in the field of facial nerve repair. Different approaches, including direct suture, autologous nerve grafts, and tissue engineering, have been utilized for the repair of facial nerve injury. This article mainly summarizes the clinical methods and basic research progress of facial nerve repair in the past ten years.
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Affiliation(s)
- Haoyuan Huang
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Qiang Lin
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Xi Rui
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Yiman Huang
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Xuanhao Wu
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Wenhao Yang
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Zhu Yu
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Wenpeng He
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
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Bengur FB, Komatsu C, Fedor CN, Loder S, Baker JS, Totwani A, Irgebay Z, Nerone WV, Solari MG, Marra KG. Biodegradable Nerve Guide with Glial Cell Line-Derived Neurotrophic Factor Improves Recovery After Facial Nerve Injury in Rats. Facial Plast Surg Aesthet Med 2023; 25:478-486. [PMID: 36877591 PMCID: PMC10664574 DOI: 10.1089/fpsam.2022.0346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Background: Bioengineered nerve guides with glial cell line-derived neurotrophic factor (GDNF) support recovery after facial nerve injury by acting as regenerative scaffolds. Objective: To compare functional, electrophysiological, and histological outcomes after repair of rat facial nerve transection in control, empty nerve guide, and nerve guide with GDNF conditions. Methods: Rats underwent transection and primary repair of the buccal branch of the facial nerve and were divided into (1) transection and repair only, (2) transection and repair augmented with empty guide, (3) transection and repair augmented with GDNF-guide groups. Weekly measurements of the whisking movements were recorded. At 12 weeks, compound muscle action potentials (CMAPs) at the whisker pad were assessed, and samples were collected for histomorphometric analysis. Results: Rats in GDNF-guide group displayed the earliest peak in normalized whisking amplitude. CMAPs were significantly higher after GDNF-guide placement. Mean fiber surface area of the target muscle, axonal count of the injured branch, and the number of Schwann cells were highest with GDNF guides. Conclusion: The biodegradable nerve guide containing double-walled GDNF microspheres enhanced recovery after facial nerve transection and primary repair.
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Affiliation(s)
- Fuat Baris Bengur
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chiaki Komatsu
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caroline Nadia Fedor
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn Loder
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jocelyn S. Baker
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aanchal Totwani
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zhazira Irgebay
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - W. Vincent Nerone
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mario G. Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kacey G. Marra
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hayler R, Charters E, Coulson S, Hubert Low TH. Sex differences in perceived speech intelligibility in patients with facial nerve palsy. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-6. [PMID: 37907077 DOI: 10.1080/17549507.2023.2259136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
PURPOSE Facial nerve palsy (FNP) affects physical and social function, including speech. There exists discrepancy between professional and patient perception of appearance following FNP; however, speech differences remain unknown. We aimed to compare ratings of speech intelligibility by different listeners. METHOD Patients were identified through the Sydney Facial Nerve Service. FNP related scoring was obtained using the Sunnybrook Facial Grading System, Sydney Facial Grading Score, Facial Disability Index, and Speech Handicap Index. Intelligibility was scored by a speech-language pathologist, member of the public, and patient using a standardised passage. FNP scoring and intelligibility were compared using interclass coefficients (ICC). RESULT Forty patients were recruited (females = 20). There was no difference in FNP scoring, nor between the frequency or types of phonemic errors. Observers' rating of intelligibility had an ICC of 0.807, compared with 0.266 and 0.344 for patients compared to the member of the public and speech-language pathologist respectively. Observers rated males and females intelligibility similar (p > 0.05), but females rated their intelligibility lower than males (74.5 ± 12.8 vs. 82.5 ± 8.4, p = 0.025). CONCLUSION Patients, particularly females, perceive their speech to be less intelligible than observers. Clinicians should be aware of this discrepancy, which does not correlate with physical function.
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Affiliation(s)
- Raymond Hayler
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Department of Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Macquarie University, Sydney, Australia
| | - Emma Charters
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, Australia
| | - Susan Coulson
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- School of Physiotherapy
| | - Tsu-Hui Hubert Low
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, Macquarie University, Sydney, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
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Boochoon K, Mottaghi A, Aziz A, Pepper JP. Deep Learning for the Assessment of Facial Nerve Palsy: Opportunities and Challenges. Facial Plast Surg 2023; 39:508-511. [PMID: 37290452 DOI: 10.1055/s-0043-1769805] [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: 06/10/2023] Open
Abstract
Automated evaluation of facial palsy using machine learning offers a promising solution to the limitations of current assessment methods, which can be time-consuming, labor-intensive, and subject to clinician bias. Deep learning-driven systems have the potential to rapidly triage patients with varying levels of palsy severity and accurately track recovery over time. However, developing a clinically usable tool faces several challenges, such as data quality, inherent biases in machine learning algorithms, and explainability of decision-making processes. The development of the eFACE scale and its associated software has improved clinician scoring of facial palsy. Additionally, Emotrics is a semiautomated tool that provides quantitative data of facial landmarks on patient photographs. The ideal artificial intelligence (AI)-enabled system would analyze patient videos in real time, extracting anatomic landmark data to quantify symmetry and movement, and estimate clinical eFACE scores. This would not replace clinician eFACE scoring but would offer a rapid automated estimate of both anatomic data, similar to Emotrics, and clinical severity, similar to the eFACE. This review explores the current state of facial palsy assessment, recent advancements in AI, and the opportunities and challenges in developing an AI-driven solution.
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Affiliation(s)
- Kieran Boochoon
- Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ali Mottaghi
- Department of Electrical Engineering, Stanford University, Stanford, California
| | - Aya Aziz
- Department of Human Biology, Stanford University, Stanford, California
| | - Jon-Paul Pepper
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Janes LE, Kelsey LJ, Sasson DC, Applebaum S, Ledwon JK, Gosain AK. Drop-off in axonal regeneration along the length of a cross-face nerve graft: An experimental study in rats. Microsurgery 2023; 43:694-701. [PMID: 37162480 DOI: 10.1002/micr.31053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/09/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION The average nerve graft length utilized in cross-face nerve grafting for reconstruction of facial nerve palsy is 20-22 cm. While the graft length is thought to be one of the greatest determinants of muscle strength, the mechanism through which this happens remains unknown. We studied changes in axonal regeneration along the length of a 2 cm cross-face nerve graft in a rat model. The hypothesis was that axon count would decrease along the length of the graft. METHODS A 2 cm nerve graft (sciatic nerve) was used as a cross-face nerve graft in 16 adult female, 210-250 g, Sprague Dawley rats. Thirteen weeks later, 5 mm nerve biopsies were taken at four sites: the facial nerve trunk (control), proximal graft, midpoint of graft (1 cm distal to coaptation) and distal graft (2 cm distal to coaptation). Retrograde nerve labeling with FluoroGold was performed at the biopsied nerve site and the facial motor nucleus was taken 1 week later. Microscopic imaging and manual counting of axons and labeled motor nuclei was performed. RESULTS Retrograde-labeled motor neuron counts were decreased at the midway point of the graft compared to the facial trunk (1517 ± 335 axons, Δ% = 92.5, p = .01) and even further decreased at the distal end of the graft (269 ± 293 axons, Δ% = 175.5, p = .006). Analysis of the nerve biopsies demonstrated no significant differences in myelinated axon count between the nerve trunk and over the length of the nerve graft (range 6207-7179 axons, Δ% = 14.5, p = .07). CONCLUSION In a rat model, the number of regenerating motor neurons drops off along the length of the graft and axon count is preserved due to axon sprouting. How this pattern correlates to ultimate muscle strength remains unknown, but this study provides insight into why shorter grafts may afford better outcomes.
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Affiliation(s)
- Lindsay E Janes
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren J Kelsey
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel C Sasson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Applebaum
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joanna K Ledwon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Arun K Gosain
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Aronson S, Applebaum SA, Kelsey LJ, Gosain AK. Evidence-Based Practices in Facial Reanimation Surgery. Plast Reconstr Surg 2023; 152:520e-533e. [PMID: 37647378 DOI: 10.1097/prs.0000000000010539] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the causes and preoperative evaluation of facial paralysis. 2. Discuss techniques to restore corneal sensation and eyelid closure, elevation of the upper lip for smile, and depression of the lower lip for lip symmetry. 3. Outline treatment goals, surgical treatment options, timing of repair, and other patient-specific considerations in appropriate technique selection. SUMMARY Congenital facial paralysis affects 2.7 per 100,000 children; Bell palsy affects 23 per 100,000 people annually; and even more people are affected when considering all other causes. Conditions that impair facial mimetics impact patients' social functioning and emotional well-being. Dynamic and static reconstructive methods may be used individually or in concert to achieve adequate blink restoration, smile strength and spontaneity, and lower lip depression. Timing of injury and repair, patient characteristics such as age, and cause of facial paralysis are all considered in selecting the most appropriate reconstructive approach. This article describes evidence-based management of facial paralysis.
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Affiliation(s)
- Sofia Aronson
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Sarah A Applebaum
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Lauren J Kelsey
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Arun K Gosain
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
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Wu Y, Lan Y, Mao J, Shen J, Kang T, Xie Z. The interaction between the nervous system and the stomatognathic system: from development to diseases. Int J Oral Sci 2023; 15:34. [PMID: 37580325 PMCID: PMC10425412 DOI: 10.1038/s41368-023-00241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/16/2023] Open
Abstract
The crosstalk between the nerve and stomatognathic systems plays a more important role in organismal health than previously appreciated with the presence of emerging concept of the "brain-oral axis". A deeper understanding of the intricate interaction between the nervous system and the stomatognathic system is warranted, considering their significant developmental homology and anatomical proximity, and the more complex innervation of the jawbone compared to other skeletons. In this review, we provide an in-depth look at studies concerning neurodevelopment, craniofacial development, and congenital anomalies that occur when the two systems develop abnormally. It summarizes the cross-regulation between nerves and jawbones and the effects of various states of the jawbone on intrabony nerve distribution. Diseases closely related to both the nervous system and the stomatognathic system are divided into craniofacial diseases caused by neurological illnesses, and neurological diseases caused by an aberrant stomatognathic system. The two-way relationships between common diseases, such as periodontitis and neurodegenerative disorders, and depression and oral diseases were also discussed. This review provides valuable insights into novel strategies for neuro-skeletal tissue engineering and early prevention and treatment of orofacial and neurological diseases.
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Affiliation(s)
- Yuzhu Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Yanhua Lan
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiajie Mao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jiahui Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Ting Kang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
| | - Zhijian Xie
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China.
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Crawford KL, Lee YJ, Hom M, Rosenthal EL, Orosco RK, Nguyen QT. Identification of Degenerated Murine Facial Nerves With Fluorescence Labeling After Transection Injury. Otolaryngol Head Neck Surg 2023; 169:234-242. [PMID: 36758958 DOI: 10.1002/ohn.262] [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: 08/22/2022] [Revised: 12/08/2022] [Accepted: 12/24/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Delayed peripheral nerve repair is complicated by nerve degeneration and atrophy that can prevent identification. We use a murine facial nerve transection model to demonstrate the efficacy of ALM-488 (bevonescein) in labeling degenerated facial nerves with quantitative image analysis and qualitative survey data. STUDY DESIGN Prospective cohort study. SETTING Laboratory. METHODS Ten wild-type mice underwent transection of the lower facial nerve division with subsequent degeneration. Either 9 (n = 5 mice) or 12 (n = 5 mice) weeks later, mice underwent intravenous infusion of ALM-488 with in vivo real-time fluorescence imaging (FL) of the facial nerve. Using ImageJ, the mean gray value of each nerve segment under white light reflectance (WLR) and FL was compared to that of adjacent soft tissue to calculate the signal-to-background ratio (SBR). A survey was distributed to evaluate the perceived utility of ALM-488 in surgeon identification of degenerated nerves. RESULTS The mean SBR of degenerated nerves was 1.08 (standard deviation [SD]: 0.07) under WLR and 2.11 (SD: 0.31) under FL (p < 0.001). In mice with degenerated nerves, survey participants identified on average 3.01 (SD: 1.84) nerve branches under WLR and 5.73 (SD: 1.88) under FL (p < 0.0001). Under FL, 47 of 48 survey responses correctly identified isolated, degenerated nerves; in contrast, only 12 responses identified degenerated nerves under WLR (p < 0.0001). CONCLUSION Preoperative intravenous infusion of ALM-488 with FL improves the identification of degenerated facial nerves. ALM-488 also improves surgeon confidence in nerve identification, particularly in degenerated nerve branches that are not visible with WLR.
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Affiliation(s)
- Kayva L Crawford
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Marisa Hom
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Ryan K Orosco
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
- Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California San Diego, California, San Diego, USA
| | - Quyen T Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
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Montgomery EA, Patel JA, Boone RE, Teixeira JC, Vincent AG, Hohman MH. Rare Manifestation of Sjögren's Syndrome as Unilateral Facial Paralysis: A Case Report and Literature Review. Mil Med 2023; 188:e2805-e2808. [PMID: 36106512 DOI: 10.1093/milmed/usac272] [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: 06/23/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 02/18/2024] Open
Abstract
Herein, we present a unique case of Sjögren's syndrome (SS) first presenting as facial palsy, as well as a literature review of case reports describing SS-associated facial paralysis. A PubMed search for papers containing the keywords Sjögren's syndrome or Sjögren's disease, as well as facial paralysis, facial paresis, facial palsy, or Bell's palsy, was performed. Articles not in English and cases of SS not involving facial paralysis were excluded. Appropriate articles were reviewed for patient demographics and symptoms of SS, including laterality of facial paralysis, cranial nerve involvement, and comorbid diseases. House-Brackmann grades were annotated based on either assignment by individual case reports or the authors' descriptions when sufficient details were present. Of 43 peer-reviewed articles found, 14 were both in the English language and provided adequate information on a total of 16 patients with facial paralysis and SS diagnosis. Ultimately, SS and other systemic autoimmune disorders should be considered in the differential diagnosis of patients presenting with insidious onset facial paralysis.
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Affiliation(s)
- Emily A Montgomery
- Department of Surgery, Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, MD 20814, USA
| | - Jagatkumar A Patel
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA
| | - Rachel E Boone
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA
| | - Jeffrey C Teixeira
- Department of Surgery, Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, MD 20814, USA
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA
| | - Aurora G Vincent
- Department of Surgery, Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, MD 20814, USA
- Otolaryngology-Head & Neck Surgery, Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Marc H Hohman
- Department of Surgery, Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, MD 20814, USA
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA
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Yoo MC, Kim JH, Kim YJ, Jung J, Kim SS, Kim SH, Yeo SG. Effects of Electrical Stimulation on Facial Paralysis Recovery after Facial Nerve Injury: A Review on Preclinical and Clinical Studies. J Clin Med 2023; 12:4133. [PMID: 37373826 DOI: 10.3390/jcm12124133] [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: 01/31/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Various methods have been used to improve function and manage facial nerve injury. Although electrical stimulation therapy is frequently used to treat facial paralysis, its effects have been found to vary and no clear standards have been developed. The current review describes the results of preclinical and clinical studies evaluating the effectiveness of electrical stimulation therapy in promoting the recovery of a peripheral facial nerve injury. Evidence is presented showing the efficacy of electrical stimulation in promoting nerve regeneration after peripheral nerve injuries in both animal models and human patients. The ability of electrical stimulation to promote the recovery of facial paralysis was found to depend on the type of injury (compression or transection), the species of animal tested, the type of disease, the frequency and method of electrical stimulation, and the duration of the follow-up. Electrical stimulation, however, can also have potential negative outcomes, such as reinforcing synkinesis, including mistargeted axonal regrowth via inappropriate routes; excessive collateral axonal branching at the lesion site; and multiple innervations at neuromuscular junctions. Because of the inconsistencies among studies and the low quality of evidence, electrical stimulation therapy is not currently regarded as a primary treatment of facial paralysis in patients. However, understanding the effects of electrical stimulation, as determined in preclinical and clinical studies, is important for the potential validity of future research on electrical stimulation.
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Affiliation(s)
- Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jeong Hee Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Yong Jun Kim
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Junyang Jung
- Department of Anatomy and Neurobiology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sung Soo Kim
- Department of Biochemistry and Molecular Biology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sang Hoon Kim
- Department of Otorhinolaryngology Head & Neck Surgery, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology Head & Neck Surgery, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
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Baude M, Guihard M, Gault-Colas C, Bénichou L, Coste A, Méningaud JP, Schmitz D, Natella PA, Audureau E, Gracies JM. Guided Self-rehabilitation Contract vs conventional therapy in chronic peripheral facial paresis: VISAGE, a multicenter randomized controlled trial. BMC Neurol 2023; 23:148. [PMID: 37038105 PMCID: PMC10084642 DOI: 10.1186/s12883-023-03096-8] [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: 08/29/2022] [Accepted: 01/27/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND One year after persistent peripheral facial paresis (PFP), prescriptions of conventional rehabilitation are often downgraded into maintenance rehabilitation or discontinued, the patient entering what is seen as a chronic stage. This therapeutic choice is not consistent with current knowledge about behavior-induced plasticity, which is available all life long and may allow intense sensorimotor rehabilitation to remain effective. This prospective, randomized, multicenter single-blind study in subjects with chronic unilateral PFP evaluates changes in facial motor function with a Guided Self-rehabilitation Contract (GSC) vs. conventional therapy alone, carried out for six months. METHODS Eighty-two adult subjects with chronic unilateral PFP (> 1 year since facial nerve injury) will be included in four tertiary, maxillofacial surgery (2), otolaryngology (1) and rehabilitation (1) centers to be randomized into two rehabilitation groups. In the experimental group, the PM&R specialist will implement the GSC method, which for PFP involves intensive series of motor strengthening performed daily on three facial key muscle groups, i.e. Frontalis, Orbicularis oculi and Zygomatici. The GSC strategy involves: i) prescription of a daily self-rehabilitation program, ii) teaching of the techniques involved in the program, iii) encouragement and guidance of the patient over time, in particular by requesting a quantified diary of the work achieved to be returned by the patient at each visit. In the control group, participants will benefit from community-based conventional therapy only, according to their physician's prescription. The primary outcome measure is the composite score of Sunnybrook Facial Grading System. Secondary outcome measures include clinical and biomechanical facial motor function quantifications (Créteil Scale and 3D facial motion analysis through the Cara system), quality of life (Facial Clinimetric Evaluation and Short-Form 12), aesthetic considerations (FACE-Q scale) and mood representations (Hospital Anxiety and Depression scale). Participants will be evaluated every three months by a blinded investigator, in addition to four phone calls (D30/D60/D120/D150) to monitor compliance and tolerance to treatment. DISCUSSION This study will increase the level of knowledge on the effects of intense facial motor streng- Facial paralysisthening prescribed through a GSC in patients with chronic peripheral facial paresis. TRIAL REGISTRATION ClinicalTrials.gov, NCT04074018 . Registered 29 August 2019. PROTOCOL VERSION Version N°4.0-04/02/2021.
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Affiliation(s)
- Marjolaine Baude
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France.
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France.
| | - Marina Guihard
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France
| | - Caroline Gault-Colas
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
| | - Ludovic Bénichou
- Hôpital Paris Saint-Joseph, Service de Chirurgie Maxillo-Faciale Stomatologie, 75015, Paris, France
| | - André Coste
- Centre Hospitalier Intercommunal Créteil, Service d'ORL, Stomatologie Et Chirurgie Cervico-Faciale, 94000, Créteil, France
| | - Jean-Paul Méningaud
- AP-HP, Service de Chirurgie Plastique, Reconstructrice, Esthétique Et Maxillo-Faciale, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - David Schmitz
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - Pierre-André Natella
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - Etienne Audureau
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
- AP-HP, Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
- DHU A-TVB, IRMB- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris Est-Créteil, 94000, Créteil, France
| | - Jean-Michel Gracies
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
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Kleinveld VEA, Platzgummer S, Wanschitz J, Horlings CGC, Löscher WN. Transcranial Magnetic Stimulation in the Differential Diagnosis of Unilateral Peripheral Facial Nerve Palsy. Brain Sci 2023; 13:brainsci13040624. [PMID: 37190588 DOI: 10.3390/brainsci13040624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
(1) Background: This study aims to assess the diagnostic accuracy of parameters based on a combination of transcranial magnetic stimulation (TMS) and electrical stimulation (ES) in the differentiation between idiopathic and secondary facial palsy in a large cohort of patients. (2) Methods: Patients with unilateral facial palsy ≤7 days after symptom onset were included. Compound muscle action potential (CMAP) amplitudes were measured after stimulation of both facial nerves at (A) the internal acoustic meatus using TMS, CMAP-TMS, and (B) at the stylomastoid foramen using electrical stimulation, CMAP-ES. To express the degree of nerve dysfunction in the facial canal specifically, the amplitude reduction of the CMAP-TMS in relation to CMAP-ES was calculated and expressed as a percentage (amplitude reduction over the facial canal, ARFC). Receiver Operating Characteristic (ROC) curves were constructed to assess the diagnostic accuracy of ARFC as a marker to discriminate between patients with idiopathic and secondary facial palsy. (3) Results: Data from 498 patient records were analyzed. Idiopathic facial palsy was diagnosed in 424 patients, and secondary facial palsy in 74 patients. The area under the ROC curve for ARFC was 0.398. (4) Conclusions: The overall diagnostic accuracy of this method to differentiate secondary from idiopathic facial palsy is low.
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Affiliation(s)
| | - Sarah Platzgummer
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Julia Wanschitz
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
| | | | - Wolfgang N. Löscher
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria
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Guerrero-de Ferran C, Valdez-García JE, Rivera-Alvarado IJ, González-García ÁE, Bastán-Fabián D, Rangel-Trejo M. Ocular and Palpebral Manifestations of Facial Palsy: An Epidemiologic Descriptive Study. Clin Ophthalmol 2023; 17:1007-1011. [PMID: 37035515 PMCID: PMC10076617 DOI: 10.2147/opth.s398190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/27/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose We describe the ocular and periocular clinical features in patients with a facial palsy diagnosis of any etiology and to report the demographics, relevant medical history and treatment modalities in these patients. Patients and Methods Retrospective and descriptive observational study. A total of 60 patients with a facial palsy diagnosis in the last 5 years were recruited from an ophthalmological clinic in northeastern Mexico. Demographic data, such as age, sex, disease evolution and etiology, visual acuity, ocular symptoms and ocular and periocular clinical features were obtained. Personal history of previous ophthalmologic surgery, as well as ocular and systemic diseases, were also recorded. Finally, a comparative analysis was done to determine association between signs, symptoms and treatment modalities. Results A prevalence of 0.14% was reported, 56.7% of patients were female, and mean age of presentation was 55.63±17.2 years. 76.7% of facial palsy was idiopathic in origin, followed by vascular disease in 8.30% and iatrogenic in 6.70%. 40% of patients had a history of arterial hypertension, 36.3% were diabetic, and 6.70% had cerebrovascular disease. Conclusion Early diagnosis of facial palsy is crucial in establishing an effective treatment plan and avoiding complications. The impact of this disease in patients' quality of life cannot be overlooked, and steps should be taken to address the different impairments that this ailment entails.
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Affiliation(s)
- Caroline Guerrero-de Ferran
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Department of Ophthalmology, Monterrey, México
- Correspondence: Caroline Guerrero-de Ferran, Tecnológico de Monterrey, School of Medicine and Health Sciences, Av. Ignacio Morones Prieto 3000. Colonia Los Doctores. CP 64710, Monterrey, Nuevo León, México, Tel +52 (81) 88 88 05 51, Email
| | - Jorge E Valdez-García
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Department of Ophthalmology, Monterrey, México
| | - I Jocelyn Rivera-Alvarado
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Department of Ophthalmology, Monterrey, México
| | - Ángel E González-García
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Department of Ophthalmology, Monterrey, México
| | - Daniel Bastán-Fabián
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Department of Ophthalmology, Monterrey, México
| | - Melissa Rangel-Trejo
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Department of Ophthalmology, Monterrey, México
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Shikara M, Bridgham K, Ludeman E, Vakharia K, Justicz N. Selective Neurectomy for Treatment of Post-Facial Paralysis Synkinesis: A Systematic Review. Facial Plast Surg 2023; 39:190-200. [PMID: 36155895 DOI: 10.1055/a-1950-4483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Synkinesis is commonly encountered after flaccid facial paralysis and can have a detrimental impact on a patient's life. First-line treatment of synkinesis is chemodenervation with botulinum toxin (Botox) and neuromuscular retraining. Surgical options include selective myectomy, selective neurectomy (SN), cross-facial nerve grafting, nerve substitution, and free gracilis muscle transfer. Data on surgical management of synkinesis using SN is limited. EVIDENCE REVIEW PubMed, Embase, Cochrane CENTRAL, Cochrane Neuromuscular Register, Clinicaltrials.gov, and World Health Organization International Clinical Trials Registry Platform were searched using a comprehensive keyword strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All English-only texts published in the past 20 years were included. Two independent investigators reviewed 906 abstracts and 7 studies met inclusion criteria. Demographics, etiology of paralysis, time to surgery, and primary outcomes studied were collected. FINDINGS A total of 250 patients were included across 7 studies. In 6 out of 7 studies, Botox was used prior to surgical intervention. Two studies showed significant reduction in Botox dosage postoperatively, while one study showed no difference. Other primary outcomes included the House-Brackmann Score, palpebral fissure width, electronic clinician-graded facial function scale (eFACE) score, Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Three studies showed significant improvement in the eFACE score, two studies showed significant improvement in the FaCE scale, while one study showed improvement in quality of life measured by the SAQ. CONCLUSION SN can be considered as an adjunct to other management options including neuromuscular retraining, Botox, selective myectomy, and reanimation procedures. While there is great heterogeneity of study design in the studies included, many cohorts showed improvement in facial symmetry, facial function, and quality of life. There remains a great gap in knowledge in this subject matter and a need for large well-designed prospective studies comparing this technique to other management options.
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Affiliation(s)
- Meryam Shikara
- Department of Otorhinolaryngology- Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland
| | - Kelly Bridgham
- Department of Otorhinolaryngology- Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Emilie Ludeman
- Health Sciences and Human Services Library, University of Maryland Graduate School, Baltimore, Maryland
| | - Kalpesh Vakharia
- Department of Otorhinolaryngology- Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Natalie Justicz
- Department of Otorhinolaryngology- Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland
- University of Maryland School of Medicine, Baltimore, Maryland
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McCoul ED, Megwalu UC, Joe S, Gray R, O'Brien DC, Ference EH, Lee VS, Patel PS, Figueroa-Morales MA, Shin JJ, Brenner MJ. Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngol Head Neck Surg 2023; 168:643-657. [PMID: 35349383 DOI: 10.1177/01945998221087664] [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: 11/30/2021] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Stephanie Joe
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Raluca Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C O'Brien
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag S Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Figueroa-Morales
- Department of Otolaryngology-Head and Neck Surgery, Mexican Social Security Institute, Mexico City, Mexico
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Yoshida A, Tsuzuki N, Kanzaki S. Association Between Multiple Sclerosis and the Symptoms of Vertigo and Facial Nerve Palsy. EAR, NOSE & THROAT JOURNAL 2023:1455613221148310. [PMID: 36899449 DOI: 10.1177/01455613221148310] [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: 03/12/2023] Open
Abstract
Patients with vertigo and facial nerve palsy as initial symptoms are rarely diagnosed with multiple sclerosis. A 43-year-old woman presented to our department with symptoms of vertigo and right facial nerve palsy (Yanagihara 16-point system [total score, 40] or House- Brackmann grade IV [obvious facial weakness]). On the day of the visit, she presented with right eye abduction, left eye adduction, and complaints of diplopia. Based on magnetic resonance imaging findings, she was diagnosed with clinically isolated syndrome, which is an early manifestation of multiple sclerosis. She was treated with intravenous methylprednisolone. Otolaryngologists often suspect Hunt's syndrome in patients who present with facial nerve palsy combined with vertigo. However, herein, we report our experience with an extremely rare case of a patient with atypical nystagmus symptoms, eye movement disorder, and diplopia secondary to facial palsy and vertigo, who presented with a clinical course different from that of Hunt's syndrome.
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Affiliation(s)
- Alyssa Yoshida
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyoshi Tsuzuki
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Sho Kanzaki
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Retrospective study of peripheral facial paralysis in a tertiary hospital over 3 years. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:132-141. [PMID: 36738919 DOI: 10.1016/j.oftale.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/21/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To identify clinical and epidemiological characteristics of patients with peripheral facial palsy (PFP) at a tertiary care hospital. METHOD This is a retrospective observational study of patients with PFP treated at a tertiary medical center. We gathered demographic data, etiology, laterality, recurrence, recovery, clinical ophthalmology, severity according to the House-Brackmann (HB) scale, electrophysiological tests, medical services attended, medical and surgical treatment. RESULTS Two hundred and eighty-three PFP were included, 135 (48%) were men and 148 (52%) were women p = 0.47). All patients had unilateral involvement. The mean age was 54 ± 20 years. The main etiology was idiopathic in 215 (76%) patients. Median recovery time was 7 weeks. Recovery was complete in 190 (67%) patients. One hundred and seventy (84%) patients with idiopathic PFP had complete recovery, versus 30 (16%) patients with non-idiopathic PFP (p < 0.01). The 84% of patients with HB grade II, recovered completely, while with HB grade VI only 17% recovered (p = 0.003). Two hundred and twenty-nine patients (81%) had lagophthalmos. The majority received ocular surface care treatment in 271 (96%) patients and of these 249 (88%) patients received oral corticosteroid therapy. Thirteen patients (5%) required ophthalmologic surgery. CONCLUSIONS PFP affects all age ranges, without predilection for sex and unilateral. Its main cause is idiopathic. Recovery is complete in most cases, being more favorable in mild and idiopathic affections. Most only require medical treatment.
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The Rise of Facial Palsy on Social Media Over the Last 5 Years. J Craniofac Surg 2023; 34:564-570. [PMID: 36730871 DOI: 10.1097/scs.0000000000009106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Social media (SoMe) has become a powerful platform for distributing health information. Facial palsy (FP) results in functional and social impairment and lowers quality of life. Social media may help to raise awareness of FP sequalae. This study aims to determine the FP information growth on SoMe platforms and parameters that influence user engagement on FP content. METHODS Five commonly used SoMe platforms (Facebook, Instagram, TikTok, Twitter, and Reddit) were analyzed. Data on 18 FP hashtags and their social interaction parameters (posts, likes, reaches, comments, shares, language, and country of origin) over the past 5 years (July 31, 2016, to July 31, 2021) were collected. In-depth account analysis was performed on the 5 most popular Instagram profiles associated with FP. RESULTS The annual growth curve was positive on each platform. Facial Palsy Awareness Week 2021 trended best on TikTok. Facebook accumulated 315,411 likes and 1,922,678 reaches on 8356 posts. On Instagram, 24,968 posts gathered 4,904,124 likes and 9,215,852 reaches. TikTok users interacted on 3565 posts, accumulating 4,304,155 likes and 4,200,368 reaches. The implementation of reels ( P <0.001) and the profile host interacting with their followers by liking ( P <0.001) and replying ( P <0.001) to users' comments significantly increased the engagement rate. CONCLUSIONS Facial palsy is of increasing interest on SoMe. Facial palsy surgeons may post reels, interact with their community, and engage into FPAW to promote user engagement.
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