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O'Rourke SP, Miller MQ. Predicting Depressor Anguli Oris Excision Outcomes Using Local Muscle Block. Facial Plast Surg Aesthet Med 2022. [DOI: 10.1089/fpsam.2022.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Samuel P. O'Rourke
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Matthew Q. Miller
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Charters E, Coulson S. Oral competence following facial nerve paralysis: Functional and quality of life measures. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:113-123. [PMID: 32116032 DOI: 10.1080/17549507.2020.1728380] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Oral competence refers to the maintenance of lip closure with sufficient strength to prevent anterior spillage of saliva, food and fluid, and to clearly articulate labial sounds. Despite facial nerve paralysis having an impact on eating, drinking and communicating, little research has been done in this area. METHOD Studies examining oral competence associated with a diagnosis of facial nerve paralysis were considered using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement checklists and evaluated for their risk of bias using the RevMan Risk of Bias Tool. RESULT 44 articles were examined. There was an over-representation of case-series and cohort studies. All studies carried a high risk of bias due to lack of (a) validated outcome measures, (b) comparison group and (c) blinding or randomised assessors and participants. Studies primarily examined facial nerve intervention for the purpose of restoring smiling or facial aesthetics rather than oral competence. CONCLUSION Whilst oral competence is often compromised after a facial nerve paralysis, it is inconsistently measured, managed and described. Further studies are required to examine the (a) incidence, (b) severity and (c) impact on quality of life relating to oral incompetence using validated measures at consistent time intervals.
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Affiliation(s)
- Emma Charters
- University of Sydney, Lidcombe, Australia
- Chris O'Brien Lifehouse, Sydney, Australia
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Miller MQ, Hadlock TA. Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy. Facial Plast Surg Aesthet Med 2020; 22:65-70. [DOI: 10.1089/fpsam.2020.0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew Q. Miller
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Tessa A. Hadlock
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
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Blandford AD, Ansari W, Young JM, Maley B, Plesec TP, Hwang CJ, Perry JD. Deoxycholic Acid and the Marginal Mandibular Nerve: A Cadaver Study. Aesthetic Plast Surg 2018; 42:1394-1398. [PMID: 29869228 DOI: 10.1007/s00266-018-1164-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/22/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND One of the rare but serious complications observed with deoxycholic acid administration is damage to the marginal mandibular nerve. In this study, we evaluated if deoxycholic acid directly induces histologic damage to fresh cadaveric marginal mandibular nerve. METHODS A segment of marginal mandibular nerve was harvested from 12 hemifaces of 6 fresh cadavers. The nerve specimen was exposed to either 0.9% sterile saline for 24 h, deoxycholic acid (10 mg/ml) for 20 min, or deoxycholic acid (10 mg/ml) for 24 h. The nerve specimens were then fixed in glutaraldehyde for a minimum of 24 h. Toluidine blue stained sections were evaluated for stain intensity using light microscopy and color deconvolution image analysis. Supraplatysmal fat was harvested as a positive control and exposed to the same treatments as the marginal mandibular nerve specimens, then evaluated using transmission electron microscopy. RESULTS Toluidine blue staining was less in the marginal mandibular nerve exposed to deoxycholic acid when compared to saline. The specimen exposed to deoxycholic acid for 24 h showed less toluidine blue staining than that of the nerve exposed to deoxycholic acid for 20 min. Transmission electron microscopy of submental fat exposed to deoxycholic acid revealed disruption of adipocyte cell membrane integrity and loss of cellular organelles when compared to specimens only exposed to saline. CONCLUSIONS Deoxycholic acid (10 mg/ml) damages the marginal mandibular nerve myelin sheath in fresh human cadaver specimens. Direct deoxycholic acid neurotoxicity may cause marginal mandibular nerve injury clinically. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Alexander D Blandford
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA.
| | - Waseem Ansari
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA
| | - Jason M Young
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA
| | - Bruce Maley
- Department of Anatomy and Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Thomas P Plesec
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine J Hwang
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA
| | - Julian D Perry
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA
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Akulov MA, Orlova OR, Orlova AS, Usachev DJ, Shimansky VN, Tanjashin SV, Khatkova SE, Yunosha-Shanyavskaya AV. IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery. J Neurol Sci 2017; 381:130-134. [DOI: 10.1016/j.jns.2017.08.3244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/21/2017] [Accepted: 08/22/2017] [Indexed: 11/24/2022]
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Pucks N, Thomas A, Hallam MJ, Venables V, Neville C, Nduka C. Cutaneous cooling to manage botulinum toxin injection-associated pain in patients with facial palsy: A randomised controlled trial. J Plast Reconstr Aesthet Surg 2015; 68:1701-5. [PMID: 26385134 DOI: 10.1016/j.bjps.2015.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/21/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Botulinum toxin injections are an effective, well-established treatment to manage synkinesis secondary to chronic facial palsy, but they entail painful injections at multiple sites on the face up to four times per year. Cutaneous cooling has long been recognised to provide an analgesic effect for cutaneous procedures, but evidence to date has been anecdotal or weak. This randomised controlled trial aims to assess the analgesic efficacy of cutaneous cooling using a cold gel pack versus a room-temperature Control. MATERIAL AND METHODS The analgesic efficacy of a 1-min application of a Treatment cold (3-5 °C) gel pack versus a Control (room-temperature (20 °C)) gel pack prior to botulinum toxin injection into the platysma was assessed via visual analogue scale (VAS) ratings of pain before, during and after the procedure. RESULTS Thirty-five patients received both trial arms during two separate clinic appointments. Cold gel packs provided a statistically significant reduction in pain compared with a room-temperature Control (from 26.4- to 10.2-mm VAS improvement (p < 0.001)), with no variance noted secondary to age, the hemi-facial side injected or the order in which the Treatment or Control gel packs were applied. CONCLUSION Cryoanalgesia using a fridge-cooled gel pack provides an effective, safe and cheap method for reducing pain at the botulinum toxin injection site in patients with facial palsy.
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Affiliation(s)
- N Pucks
- Department of Acute General Medicine, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - A Thomas
- Division of Surgery, Imperial College London, 10th Floor QEQM Building, London, UK; Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK.
| | - M J Hallam
- Department of Plastic Surgery, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK
| | - V Venables
- Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK
| | - C Neville
- Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK
| | - C Nduka
- Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK
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8
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Lee JM, Choi KH, Lim BW, Kim MW, Kim J. Half-mirror biofeedback exercise in combination with three botulinum toxin A injections for long-lasting treatment of facial sequelae after facial paralysis. J Plast Reconstr Aesthet Surg 2014; 68:71-8. [PMID: 25444667 DOI: 10.1016/j.bjps.2014.08.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 08/12/2014] [Accepted: 08/24/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS The present study was conducted to develop a new method for maintaining the effect of botulinum toxin treatment for facial sequelae. We used a combination strategy including the administration of botulinum toxin three times at 6-8-month intervals followed by daily newly developed half-mirror biofeedback rehabilitation for about 2 years from the first injection. STUDY DESIGN This was a prospective study. METHODS Seventeen patients with unilateral facial palsy for >1 year were included in the study. The amount injected per site varied from 1.5 to 3 U. The purpose of the first injection was to reduce the most inconvenient facial problem such as facial synkinesis or hyperkinetic movement at the points of the periocular area and the zygomaticus major and minor muscles with an average dosage of 17.4 ± 13.9 U. The second injection was to enhance facial symmetry at prominent hypertrophic areas on the contralateral side with 36.5 ± 15.4 U, and the third injection was to add cosmetic configuration at the points of deep furrows and creases caused by facial muscular hyperkinesis or atrophy with 15.6 ± 8.4 U. RESULT After three injections of botulinum toxin A and 2 years of half-mirror biofeedback exercises, all patients showed marked relief of facial synkinesis and facial asymmetry. Before treatment, the mean ± standard deviation (SD) Sunnybrook (SB) score was 36.8 ± 8.76. After the first injection, the score increased by 11.4. After the second injection, the score increased by 14.6; it further increased by 15.6 after the third injection. CONCLUSION This facial rehabilitation strategy, consisting of three injections of botulinum toxin and half-mirror biofeedback exercises, proceeds over the course of 2 years and offers a long-lasting cure for facial synkinesis and facial symmetry as well as improved facial aesthetics.
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Affiliation(s)
- Jun Myung Lee
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Ki Hoon Choi
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Byung Woo Lim
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Myung Woo Kim
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jin Kim
- Department of Otorhinolaryngology, Inje University College of Medicine, 2240 Daehwa-dong, IlsanSeo-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
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Mandavia R, Dessouky O, Dhar V, D'Souza A. The use of botulinum toxin in Otorhinolaryngology: an updated review. Clin Otolaryngol 2014; 39:203-9. [DOI: 10.1111/coa.12275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 11/26/2022]
Affiliation(s)
- R. Mandavia
- Academic Surgery; Northwest Thames Foundation School; London UK
| | - O. Dessouky
- Department of Otolaryngology; University Hospital Lewisham; London UK
| | - V. Dhar
- Department of Otolaryngology; University Hospital Lewisham; London UK
| | - A. D'Souza
- Department of Otolaryngology; University Hospital Lewisham; London UK
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Orlova OR, Akulov MA, Usachev DI, Taniashin SV, Zakharov VO, Saksonova EV, Mingazova LR, Surovykh SV. [The use of botulinum toxin type a in the acute phase of facial nerve injury after neurosurgical surgery]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2014; 78:50-54. [PMID: 25809169 DOI: 10.17116/neiro201478650-54] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the role of botulinum toxin type A in the acute phase of facial nerve injury after neurosurgical surgery. MATERIALS AND METHODS The study involved 55 patients with acute facial muscle paresis caused by facial nerve injury during surgery on the posterior cranial fossa and cerebello-pontine angle (CPA). The first group consisted of 35 patients (mean age, 48.14±1.26 years) who were administered botulinum toxin type A (xeomin) at a dose of 2-3 U per point in muscles of the intact side of the face. The control group included 20 patients (mean age, 49.85±1.4 years) who underwent standard rehabilitation treatment of this pathology. The treatment efficacy was evaluated using the House-Brackmann Scale, the Yanagihara facial grading system, the Facial Disability Index (FDI), and the Sunnybrook Facial Grading (SFG) Scale. RESULTS Before treatment, patients of both groups experienced severe dysfunction according to the House-Brackmann Scale. A month after the botulinium toxin type A therapy had been started, a significant improvement in the group of patients who received botulinum toxin was observed at all scales (p<0.05), whereas improvement in the facial nerve function in the second group was observed only by the 3rd month of rehabilitation treatment (p<0.05). The number of synkineses in the patients who did not receive botulinum toxin was 46% higher than that in the first group (p=0.019) one year after the surgery, and it was higher by 91% after 2 years (p<0.001). CONCLUSIONS The use of botulinum toxin type A is reasonable in acute facial nerve injury and should be mandatory in combined therapy of these patients.
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Affiliation(s)
- O R Orlova
- GBOU VPO "Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.I. Sechenova" Minzdrava Rossii, Moskva; Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva
| | - M A Akulov
- FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva
| | - D Iu Usachev
- FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva
| | - S V Taniashin
- FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva
| | - V O Zakharov
- FGBNU "NII neĭrokhirurgii im. akad. N.N. Burdenko" RAMN, Moskva
| | - E V Saksonova
- Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva
| | - L R Mingazova
- Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva
| | - S V Surovykh
- Tsentr mezhdistsiplinarnoĭ stomatologii i nevrologii, Moskva
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Contralateral botulinum toxin injection to improve facial asymmetry after acute facial paralysis. Otol Neurotol 2013; 34:319-24. [PMID: 23444480 DOI: 10.1097/mao.0b013e31827c9f58] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS The application of botulinum toxin to the healthy side of the face in patients with long-standing facial paralysis has been shown to be a minimally invasive technique that improves facial symmetry at rest and during facial motion, but our experience using botulinum toxin therapy for facial sequelae prompted the idea that botulinum toxin might be useful in acute cases of facial paralysis, leading to improve facial asymmetry. BACKGROUND In cases in which medical or surgical treatment options are limited because of existing medical problems or advanced age, most patients with acute facial palsy are advised to await spontaneous recovery or are informed that no effective intervention exists. The purpose of this study was to evaluate the effect of botulinum toxin treatment for facial asymmetry in 18 patients after acute facial palsy who could not be optimally treated by medical or surgical management because of severe medical or other problems. METHODS From 2009 to 2011, nine patients with Bell's palsy, 5 with herpes zoster oticus and 4 with traumatic facial palsy (10 men and 8 women; age range, 22-82 yr; mean, 50.8 yr) participated in this study. Botulinum toxin A (Botox; Allergan Incorporated, Irvine, CA, USA) was injected using a tuberculin syringe with a 27-gauge needle. The amount injected per site varied from 2.5 to 3 U, and the total dose used per patient was 32 to 68 U (mean, 47.5 +/- 8.4 U). RESULT After administration of a single dose of botulinum toxin A on the nonparalyzed side of 18 patients with acute facial paralysis, marked relief of facial asymmetry was observed in 8 patients within 1 month of injection. Decreased facial asymmetry and strengthened facial function on the paralyzed side led to an increased HB and SB grade within 6 months after injection. CONCLUSION Use of botulinum toxin after acute facial palsy cases is of great value. Such therapy decreases the relative hyperkinesis contralateral to the paralysis, leading to greater symmetric function. Especially in patients with medical problems that limit the medical or surgical treatment options, botulinum toxin therapy represents a useful alternative.
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Sadiq SA, Khwaja S, Saeed SR. Botulinum toxin to improve lower facial symmetry in facial nerve palsy. Eye (Lond) 2012; 26:1431-6. [PMID: 22975654 DOI: 10.1038/eye.2012.189] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION In long-standing facial palsy, muscles on the normal side overcontract causing difficulty in articulation, eating, drinking, cosmetic embarrassment, and psychological effects as patients lack confidence in public. METHODS We injected botulinum toxin A (BTXA) into the normal contralateral smile muscles to weaken them and restore symmetry to both active and passive movements by neutralising these overacting muscles. RESULTS A total of 14 patients received BTXA (79% women, median age 47 years, average length of palsy 8 years). They were all difficult cases graded between 2 and 6 (average grade 3 House-Brackmann). All 14 patients reported improved facial symmetry with BTXA (dose altered in some to achieve maximum benefit). Average dose was 30 units, but varied from 10 to 80 units. Average time to peak effect was 6 days; average duration of effect was 11 weeks. Three patients had increased drooling (resolved within a few days). CONCLUSION The improvement in symmetry was observed by both patient and examining doctor. Patients commented on increased confidence, being more likely to allow photographs taken of themselves, and families reported improved legibility of speech. Younger patients have more muscle tone than older patients; the effect is more noticeable and the benefit greater for them. BTXA improves symmetry in patients with facial palsy, is simple and acceptable, and provides approximately 4 months of benefit. The site of injection depends on the dynamics of the muscles in each individual patient.
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Affiliation(s)
- S A Sadiq
- Manchester Royal Eye Hospital, Manchester, UK.
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Botulinum Toxin-A–Induced Protective Ptosis in the Treatment of Lagophthalmos Associated With Facial Paralysis. Ophthalmic Plast Reconstr Surg 2012; 28:256-60. [DOI: 10.1097/iop.0b013e31824ee702] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Majid O. Clinical use of botulinum toxins in oral and maxillofacial surgery. Int J Oral Maxillofac Surg 2010; 39:197-207. [DOI: 10.1016/j.ijom.2009.10.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 06/15/2009] [Accepted: 10/30/2009] [Indexed: 12/12/2022]
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Salles AG, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: improvement of facial symmetry observed up to 6 months. Aesthetic Plast Surg 2009; 33:582-90. [PMID: 19330369 DOI: 10.1007/s00266-009-9337-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 03/05/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite modern reanimation surgical techniques, facial paralysis presents with functional and aesthetic deficits. We evaluated facial symmetry after treating with botulinum toxin the healthy side of the face of 25 patients with long-standing facial paralysis who had previously been treated by surgical methods, with 6 months follow-up. METHODS Evaluation consisted of a clinical score, the two subscales of the Facial Disability Index, and surface electromyography. The mean botulinum toxin dose was 38 +/- 5 U (range = 15-69 U). RESULTS The clinical score showed significant reduction of asymmetry of 48.4% at 1 month and 16.8% after 6 months. The initial result was a consequence of reduced motion on the treated side combined with better motion on the paralyzed side. At 6 months, the treated side returned to basal scores. The residual effect seen in symmetry was due to an increase (18%) of motion in the paralyzed side. There was a significant decrease in the action potential of muscles on the nonparalyzed side 1 month post injection but completely reverted after 6 months. The Physical Function Index increased, but not significantly. The Social/Well-Being Function Index showed a significant increase at 6 months compared to pretreatment. CONCLUSION The proposed treatment improved facial symmetry for up to 6 months. Even after the end of the clinical effect of the drug, the paralyzed side's clinical score was 18% higher than pretreatment, with an increased quality of life.
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Mehta RP, Hadlock TA. Botulinum Toxin and Quality of Life in Patients With Facial Paralysis. ACTA ACUST UNITED AC 2008; 10:84-7. [DOI: 10.1001/archfaci.10.2.84] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ritvik P. Mehta
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Tessa A. Hadlock
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Abstract
Facial nerve palsy affects individuals of all ages, races, and sexes. Psychological and functional implications of the paralysis present a devastating management problem to those afflicted, as well as the carriers. Since Sir Charles Bell's original description of facial palsy in 1821, our understanding and treatment options have expanded. It is essential that a multidisciplinary approach, encompassing ophthalmologists; Ear, Nose, and Throat surgeons; plastic surgeons; and psychologists work closely to optimize patient management in a staged approach. Although the etiology remains unknown, strong histological, cerebral spinal fluid, and radiological evidence suggests a possible association with herpes simplex virus in idiopathic facial nerve palsy (Bell's palsy). The use of steroids has been suggested as a means of limiting facial nerve damage in the acute phase. Unfortunately, no single randomized control trial has achieved an unquestionable benefit with the use of oral steroid therapy and thus remains controversial. In the acute phase, ophthalmologists play a pivotal role in preventing irreversible blindness from corneal exposure. This may be successfully achieved by using intensive lubrication, medical therapy (botulinum toxin), or surgery (upper lid weighting or tarsorraphy). Once the cornea is adequately protected and recovery deemed unlikely, longer term planning for eyelid and facial reanimation may take place in an individualized manner. Onset is sudden and management potentially lengthy. Physician empathy, knowledge, and experience are essential in averting long-term lifestyle and psychological discomfort for patients.
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Affiliation(s)
- Imran Rahman
- Manchester Royal Eye Hospital, Manchester, United Kingdom
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Hadlock TA, Greenfield LJ, Wernick-Robinson M, Cheney ML. Multimodality Approach to Management of the Paralyzed Face. Laryngoscope 2006; 116:1385-9. [PMID: 16885741 DOI: 10.1097/01.mlg.0000225980.38147.c6] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite the ability of facial reanimation techniques to introduce meaningful movement to the paralyzed face, dynamic methods do not address all zones of the face. Our objective was to retrospectively review outcomes after multimodality management of the patient with facial paralysis, to describe several novel surgical methods that introduce subtle improvements in static facial balance, and to present an algorithm for comprehensive management of the paralyzed face. METHODS/RESULTS Three hundred thirty-seven patients with facial paralysis were seen and treated in a busy facial nerve center setting over a 3-year period using a range of standard muscle transfers, physical therapy, chemodenervation with botulinum toxin, and static surgical techniques. Three adjunct techniques emerged as novel and useful procedures that more fully addressed facial balance issues than existing techniques. Of patients proceeding with physical therapy, greater than 80% of patients experienced a benefit, and 97% of those who proceeded with botulinum toxin therapy experienced a benefit. CONCLUSIONS Facial paralysis is best managed using a multimodality approach that includes surgical interventions, physical therapy, and chemodeneveration. We describe three adjunctive surgical techniques for management of the paralyzed face and present a comprehensive algorithm for management of the paralyzed face. That may provide improved function and cosmesis in all zones of the paralyzed face.
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Affiliation(s)
- Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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Abstract
PURPOSE OF REVIEW Facial paralysis often has a significant emotional impact on patients. Along with the myriad of new surgical techniques in managing facial paralysis comes the challenge of selecting the most effective procedure for the patient. This review delineates common surgical techniques and reviews state-of-the-art techniques. RECENT FINDINGS The options for dynamic reanimation of the paralyzed face must be examined in the context of several patient factors, including age, overall health, and patient desires. The best functional results are obtained with direct facial nerve anastomosis and interpositional nerve grafts. In long-standing facial paralysis, temporalis muscle transfer gives a dependable and quick result. Microvascular free tissue transfer is a reliable technique with reanimation potential whose results continue to improve as microsurgical expertise increases. Postoperative results can be improved with ancillary soft tissue procedures, as well as botulinum toxin. SUMMARY The paper provides an overview of recent advances in facial reanimation, including preoperative assessment, surgical reconstruction options, and postoperative management.
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Affiliation(s)
- James R Tate
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, 95817, USA
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