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Alharbi R, Kashoo FZ, Ahmed M, Alqahtani M, Aloyuni S, Alzhrani M, Alanazi AD, Sidiq M, Alharbi BH, Nambi G. Effect of neural mobilisation in Bell's palsy: A randomised controlled trial. Hong Kong Physiother J 2023; 43:93-103. [PMID: 37583924 PMCID: PMC10423671 DOI: 10.1142/s1013702523500063] [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: 07/03/2021] [Accepted: 01/17/2023] [Indexed: 03/12/2023] Open
Abstract
Background Neural mobilisation technique is effective in spinal nerve rehabilitation. However, no study has reported the effect of facial nerve mobilisation in acute Bell's palsy. Objectives The objective of our study was to evaluate the effect of facial neural mobilisation over conventional therapy in improving facial symmetry in patients with acute Bell's palsy. Methods A randomised controlled trial was conducted in the physical therapy department for 62 patients with acute Bell's palsy. The intervention included 10 days of drug therapy including 3 weeks of conventional therapy to the experimental and the control group. However, the experimental group received additional nerve mobilisation technique aimed at mobilising the facial nerve at the origin of external auditory meatus. All participants were assessed at baseline and after three weeks using the Sunnybrook facial grading system (SBS) and Kinovea Movement Analysis Software (KMAS). Results For primary outcome, analysis of covariance with baseline data as covariate showed a significant difference between groups for the post-test mean scores of SBS after 3 weeks (between-group difference, 9.2 [95% CI, 5.1-13.3], p = 0 . 001 . Importantly, the effect size calculated by partial η 2 for neural mobilisation was 0.258 (small effect size). For secondary outcomes, independent sample t-test showed a significant difference between groups for the scores on KMAS after 3 weeks for zygomatic muscle (between-group difference, - 27 . 2 [95% CI, - 31 to - 22 . 6 ], p = 0 . 001 ), frontalis muscle - 16 . 7 [95% CI, - 9 . 9 to - 23 . 4 ], p = 0 . 001 , and orbicularis oris muscle - 15 . 0 [95% CI, - 11 . 1 to - 18 . 8 ], p = 0 . 001 . Conclusion Facial neural mobilisation is likely to be an effective adjunctive intervention in addition to conventional therapy in improving facial symmetry in acute Bell's palsy.
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Affiliation(s)
- Raed Alharbi
- Department of Public Health, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmed
- Department of Nursing, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Saleh Aloyuni
- Department of Public Health, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Ahmad Dhahawi Alanazi
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Mohammad Sidiq
- Department of Physiotherapy, Medical and Allied Health Sciences Galgotias University, Greater Noida, Uttar Pradesh, 203201, India
| | - Bander Hamud Alharbi
- Director of Medical Records Department King Khalid Hospital Majmaah, Saudi Arabia
| | - Gopal Nambi
- Department of Health and Rehabilitation Sciences College of Applied Medical Sciences Prince Sattam Bin Abdulaziz University, Al kharj, Saudi Arabia
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Knoedler L, Baecher H, Kauke-Navarro M, Prantl L, Machens HG, Scheuermann P, Palm C, Baumann R, Kehrer A, Panayi AC, Knoedler S. Towards a Reliable and Rapid Automated Grading System in Facial Palsy Patients: Facial Palsy Surgery Meets Computer Science. J Clin Med 2022; 11:jcm11174998. [PMID: 36078928 PMCID: PMC9457271 DOI: 10.3390/jcm11174998] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS). Methods: Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm. Results: The algorithm showed an accuracy of 100%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100% vs. 99%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100% vs. 96% vs. 97%). Conclusions: Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon’s workflow.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-151-448-249-58
| | - Helena Baecher
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Philipp Scheuermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing Lab, Ostbayrische Technische Hochschule Regensburg, 93053 Regensburg, Germany
| | - Raphael Baumann
- Regensburg Medical Image Computing Lab, Ostbayrische Technische Hochschule Regensburg, 93053 Regensburg, Germany
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Adriana C. Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Rita MRH, Deepa M, Gitanjali VC, Tinu SR, Subbulakshmi B, Sujitha D, Palthya G, Saradha M, Vedhavalli T, Sowmiya B, Akalya R, Mathivadhani LS, Uma M, Bhavani R, Violet JR. Lagophthalmos: An etiological lookout to frame the decision for management. Indian J Ophthalmol 2022; 70:3077-3082. [PMID: 35918976 PMCID: PMC9672712 DOI: 10.4103/ijo.ijo_3017_21] [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] [Indexed: 11/28/2022] Open
Abstract
Purpose: To describe the etiology, clinical profile, duration of lagophthalmos cases and thereby, framing a decision for the management based on the severity of Exposure keratitis (EK), Facial palsy (FP) with each etiology and to describe the outcome of the management options. Methods: The method was a prospective review of 120 lagophthalmos cases treated at a single tertiary center from January 2018 to January 2019. The main outcome measures were analysing the association between age, etiology, duration and management of lagophthalmos. Results: Of the 120 patients studied, paralytic etiology was noted in 86 and eyelid etiology in 34 patients. The percentage of various lagophthalmos etiology documented were Bell’s palsy (35.83%), lagophthalmos in ICU patients (15%), traumatic facial palsy(FP) (10.80%), stroke associated FP (6.67%), infection associated FP (6.67%), iatrogenic FP, cicatricial lagophthalmos (5%), lagophthalmos post eyelid surgeries (5%), neoplastic FP(3.33%), congenital FP (1.67%), proptosis induced lagophthalmos (1.67%), floppy eyelid syndrome induced lagophthalmos (0.83%) and lid coloboma associated lagophthalmos (0.83%). A statistically significant correlation was noted between exposure keratitis and age, with an increased prevalence age advances. The management showed significant variation with individual etiology, with some etiologies unquestionably requiring surgical management. Surgical management is crucial as the duration of lagophthalmos increases more than 6 weeks, EK involving pupillary axis and poor FP recovery. Conclusion: This study concludes that the conservative management was sufficient in all cases when the duration is less than 1 week, Exposure keratitis not involving the pupillary axis (EK< Grade II) and FP with good functional recovery ( FP < Grade III). The predominant causes being Bell’s palsy, lagophthalmos in ICU patients and vascular FP. Whereas, cases with poor functional recovery of facial palsy(FP) and permanent eyelid deformation require definitive surgical management like Traumatic FP & cicatricial lagophthalmos.
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Affiliation(s)
- M Rani H Rita
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - M Deepa
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - V C Gitanjali
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - S R Tinu
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - B Subbulakshmi
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - D Sujitha
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - Gopinayik Palthya
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - M Saradha
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - T Vedhavalli
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - B Sowmiya
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - R Akalya
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - L S Mathivadhani
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - M Uma
- Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India
| | - R Bhavani
- Research Analyst, Queen Mary's College, Tamil Nadu, India
| | - Joy R Violet
- Research Analyst, Queen Mary's College, Tamil Nadu, India
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4
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Dana R, Farid M, Gupta PK, Hamrah P, Karpecki P, McCabe CM, Nijm L, Pepose JS, Pflugfelder S, Rapuano CJ, Saini A, Gibbs SN, Broder MS. Expert consensus on the identification, diagnosis, and treatment of neurotrophic keratopathy. BMC Ophthalmol 2021; 21:327. [PMID: 34493256 PMCID: PMC8425140 DOI: 10.1186/s12886-021-02092-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Neurotrophic keratopathy (NK) is a relatively uncommon, underdiagnosed degenerative corneal disease that is caused by damage to the ophthalmic branch of the trigeminal nerve by conditions such as herpes simplex or zoster keratitis, intracranial space-occupying lesions, diabetes, or neurosurgical procedures. Over time, epithelial breakdown, corneal ulceration, corneal melting (thinning), perforation, and loss of vision may occur. The best opportunity to reverse ocular surface damage is in the earliest stage of NK. However, patients typically experience few symptoms and diagnosis is often delayed. Increased awareness of the causes of NK, consensus on when and how to screen for NK, and recommendations for how to treat NK are needed. Methods An 11-member expert panel used a validated methodology (a RAND/UCLA modified Delphi panel) to develop consensus on when to screen for and how best to diagnose and treat NK. Clinicians reviewed literature on the diagnosis and management of NK then rated a detailed set of 735 scenarios. In 646 scenarios, panelists rated whether a test of corneal sensitivity was warranted; in 20 scenarios, they considered the adequacy of specific tests and examinations to diagnose and stage NK; and in 69 scenarios, they rated the appropriateness of treatments for NK. Panelist ratings were used to develop clinical recommendations. Results There was agreement on 94% of scenarios. Based on this consensus, we present distinct circumstances when we strongly recommend or may consider a test for corneal sensitivity. We also present recommendations on the diagnostic tests to be performed in patients in whom NK is suspected and treatment options for NK. Conclusions These expert recommendations should be validated with clinical data. The recommendations represent the consensus of experts, are informed by published literature and experience, and may improve outcomes by helping improve diagnosis and treatment of patients with NK.
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Affiliation(s)
- Reza Dana
- Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, MA, 02114, USA
| | - Marjan Farid
- University of California, Irvine School of Medicine, 850 Health Sciences Rd, Irvine, CA, 92697, USA
| | - Preeya K Gupta
- Duke University Eye Center, 4709 Creekstone Drive, Suite 100, Durham, NC, 27703, USA
| | - Pedram Hamrah
- Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| | - Paul Karpecki
- UPike College of Optometry/Kentucky Eye Institute, 147 Sycamore Street, Pikeville, KY, 41501, USA
| | | | - Lisa Nijm
- Warrenville EyeCare and LASIK, 2S631 Illinois Route 59, Suite A, Warrenville, IL, 60555, USA.,University of Illinois Eye and Ear Infirmary, 1855 W Taylor St, Chicago, IL, 60612, USA
| | - Jay S Pepose
- Pepose Vision Institute, 1815 Clarkson Rd, Chesterfield, MO, 63017, USA.,Washington University School of Medicine, Department of Ophthalmology and Visual Science, 660 Euclid Avenue, St. Louis, MO, 63110, USA
| | - Stephen Pflugfelder
- Cullen Eye Institute, Baylor College of Medicine, 6565 Fannin St, NC-505, Houston, TX, 77030, USA
| | | | - Arvind Saini
- Integrity Eye, 1955 Citracado Parkway, Escondido, CA, 92029, USA
| | - Sarah N Gibbs
- Partnership for Health Analytic Research (PHAR), LLC, 280 S Beverly Dr Suite 404, Beverly Hills, CA, 90212, USA
| | - Michael S Broder
- Partnership for Health Analytic Research (PHAR), LLC, 280 S Beverly Dr Suite 404, Beverly Hills, CA, 90212, USA.
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Chang CWD. Bell Palsy and COVID-19: Overcoming the Fear of "Known Unknowns". JAMA Otolaryngol Head Neck Surg 2021; 147:743-744. [PMID: 34165521 DOI: 10.1001/jamaoto.2021.1261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- C W David Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia
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Black SB, Law B, Chen RT, Dekker CL, Sturkenboom M, Huang WT, Gurwith M, Poland G. The critical role of background rates of possible adverse events in the assessment of COVID-19 vaccine safety. Vaccine 2021; 39:2712-2718. [PMID: 33846042 PMCID: PMC7936550 DOI: 10.1016/j.vaccine.2021.03.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
Beginning in December of 2019, a novel coronavirus, SARS-CoV-2, emerged in China and is now a global pandemic with extensive morbidity and mortality. With the emergence of this threat, an unprecedented effort to develop vaccines against this virus began. As vaccines are now being introduced globally, we face the prospect of millions of people being vaccinated with multiple types of vaccines many of which use new vaccine platforms. Since medical events happen without vaccines, it will be important to know at what rate events occur in the background so that when adverse events are identified one has a frame of reference with which to compare the rates of these events so as to make an initial assessment as to whether there is a potential safety concern or not. Background rates vary over time, by geography, by sex, socioeconomic status and by age group. Here we describe two key steps for post-introduction safety evaluation of COVID-19 vaccines: Defining a dynamic list of Adverse Events of Special Interest (AESI) and establishing background rates for these AESI. We use multiple examples to illustrate use of rates and caveats for their use. In addition we discuss tools available from the Brighton Collaboration that facilitate case evaluation and understanding of AESI.
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Affiliation(s)
- Steven B Black
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA.
| | - Barbara Law
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Robert T Chen
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Cornelia L Dekker
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | | | - Wan-Ting Huang
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
| | - Marc Gurwith
- The Brighton Collaboration, a program of the Task Force for Global Health, Decatur, Georgia USA
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Rao D, Fiester P, Rahmathulla G, Makary R, Tavanaiepour D. A case of a facial nerve venous malformation presenting with crocodile tear syndrome. Surg Neurol Int 2020; 11:3. [PMID: 31966922 PMCID: PMC6969373 DOI: 10.25259/sni_570_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Crocodile tears syndrome, also known as Bogorad syndrome, is characterized by lacrimation secondary to olfactory and gustatory stimuli and mastication. Crocodile tear syndrome is typically encountered as an uncommon complication of Bell’s palsy and usually occurs during the recovery phase of the disease course. Case Description: We present a case of a 39-year-old male who presented with facial paralysis with ipsilateral crocodile tear syndrome caused by a slow flow venous malformation of the petrous bone and facial nerve. Conclusion: We present a case of crocodile tear syndrome caused by a facial nerve venous malformation. To the best of our knowledge, this is the only case reported in literature.
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Affiliation(s)
- Dinesh Rao
- Departments of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Peter Fiester
- Departments of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Gazanfar Rahmathulla
- Departments of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Rafaat Makary
- Departments of Pathology, University of Florida College of Medicine, Jacksonville, Florida, United States
| | - Daryoush Tavanaiepour
- Departments of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, United States
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Thielker J, Geißler K, Granitzka T, Klingner CM, Volk GF, Guntinas-Lichius O. Acute Management of Bell’s Palsy. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Lee SMK, Lee S, Park JH, Park JJ, Lee S. A close look at an integrative treatment package for Bell's palsy in Korea. Complement Ther Clin Pract 2017; 26:76-83. [DOI: 10.1016/j.ctcp.2016.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/20/2016] [Indexed: 01/23/2023]
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