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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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Upper Eyelid Gold Weight Implantation for Facial Nerve Palsy—Short-Term and Long-Term Results. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
PURPOSE OF REVIEW Periocular rehabilitation of the patient with a facial nerve palsy has evolved over time. Although protection of the ocular surface is paramount, application of disfiguring tarsorrhaphies should be utilized only in special situations. The purpose of this review is to discuss current surgical and medical strategies in treatment of the periocular area in patients with facial nerve palsy to give maximal functional and cosmetic results. RECENT FINDINGS Upper lid lagophthalmos is preferentially treated with upper eyelid weights. Platinum has distinct advantages over gold. A supratarsal position of the upper lid weight is preferred over a pretarsal location. Lower lid malposition should be treated as a retraction, rather than an ectropion. Recalcitrant ocular surface disease can be effectively managed with a scleral lens. Tearing in the patient with a facial nerve palsy is often multifactorial; small lumen Jones tubes and botulinum toxin injection to the lacrimal gland should be considered to treat epiphora in these patients. SUMMARY A facial nerve palsy can be devastating for patients from both a functional and cosmetic perspective. Although seismic shifts in treatment of the periocular subunit have not occurred, there are a number of small, yet significant, changes in treatment that should be adopted in taking care of these patients.
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Abstract
Facial nerve paralysis is a devastating condition arising from several causes with severe functional and psychological consequences. Given the complexity of the disease process, management involves a multispecialty, team-oriented approach. This article provides a systematic approach in addressing each specific sequela of this complex problem.
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Affiliation(s)
- Ali Razfar
- Division of Facial Plastic and Reconstructive Surgery, Center for Facial Cosmetic Surgery, University of Michigan School of Medicine, 19900 Haggerty Hwy, Livonia, MI 48152, USA
| | - Matthew K Lee
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, CA, 94305 USA
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 9401 Wilshire Blvd., Suite 650, Beverly Hills, CA 90212, USA
| | - Babak Azizzadeh
- Department of Head and Neck Surgery, Center for Advanced Facial Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles, 9401 Wilshire Blvd., Suite 650, Beverly Hills, CA 90212, USA.
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Gordin E, Lee TS, Ducic Y, Arnaoutakis D. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofac Trauma Reconstr 2015; 8:1-13. [PMID: 25709748 DOI: 10.1055/s-0034-1372522] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm.
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Affiliation(s)
- Eli Gordin
- Department of Otolaryngology-Head and Neck Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Thomas S Lee
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas ; Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Demetri Arnaoutakis
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Rajabi MT, Shadravan M, Mazloumi M, Tabatabaie SZ, Hosseini SS, Rajabi MB. Bupivacaine Injection for Management of Lagophthalmos Due to Long-Standing Idiopathic Facial Nerve Palsy. Ophthalmic Plast Reconstr Surg 2015; 31:459-62. [PMID: 25675168 DOI: 10.1097/iop.0000000000000387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the results of bupivacaine injection into the orbicularis oculi muscle to treat lagophthalmos in patients with long-standing Bell palsy. METHODS In this prospective interventional case series, bupivacaine, 5 ml of a 0.750% solution, was injected into the preseptal and pretarsal area of the orbicularis oculi in each of 10 patients with idiopathic peripheral facial nerve palsy. The measures of vertical eyelid apertures during open and closed eyes were made before the procedure and 1, 3, and 6 months after injection. RESULTS A total of 10 eyes including 2 men and 8 women with an average age of 43 years (26-64 years) were studied. The mean amount of lagophthalmos before injection and after 6 months of follow up were 3.9 mm and 2.3 mm, respectively (p = 0.01)). The mean amount of corneal exposure before injection and after 6 months of follow up was 1.05 mm and 0.25 mm, respectively (p < 0.01). The mean scleral show in open eyes before injection and after 6 months of follow up were 1.20 mm and 0.75 mm, respectively (p = 0.08). The mean scleral show in closed eyes before injection and after 6 months of follow up were 1.95 mm and 1.15 mm, respectively (p = 0.01). All the patients reported significant decrease in epiphora. CONCLUSION Bupivacaine injection in the paretic orbicularis oculi muscle improves eyelid closure and lagophthalmos and epiphora.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Department of Ophtalmology, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE OF REVIEW Facial nerve paralysis has a profound impact on patients' quality of life, of which one of the most important sequelae is a risk of corneal surface disease. Herein, we discuss methods to protect the eye following insult to the facial nerve. RECENT FINDINGS Protection of the ocular surface in patients with facial nerve injury is of paramount importance to prevent corneal injury and potential blindness. Many interventions on the eye are temporary and therefore easily reversible. A systematic approach to managing the eye is required in these patients. SUMMARY This article provides a review of current methods used for ocular protection in patients with facial nerve paralysis.
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Colbert S, Coombes D, Godden D, Cascarini L, Kerawala C, Brennan PA. How do I manage an acute injury to the facial nerve? Br J Oral Maxillofac Surg 2014; 52:67-71. [DOI: 10.1016/j.bjoms.2013.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/02/2013] [Indexed: 11/25/2022]
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Wang H, Fang F, Yi J, Xiang Z, Sun M, Jiang H. Establishment and assessment of the perinatal mouse facial nerve axotomy model via a subauricular incision approach. Exp Biol Med (Maywood) 2012; 237:1249-55. [PMID: 23239435 DOI: 10.1258/ebm.2012.012134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A reliable animal model of facial nerve (FN) injury forms the basis for effective scientific studies of injury and repair of the FN. Currently, rodents are the most widely used animal model for such studies, most of which adopt a postauricular incision approach. However, it is difficult to carry out the procedure on perinatal rodents owing to characteristics of anatomy and the direction of incision. Based on anatomical studies on the extracranial segment of the FN in mice, we established a FN axotomy model by using a subauricular incision (SI) approach. The effect and the outcome of the FN transection were evaluated by electrophysiology, behavioral assessment and histological observation in 20 healthy four-week-old BALB/c mice. Favorable results were obtained in all of the mice and none died during the operation or subsequent observation period. Compared with the classic postauricular incision approach, the SI approach possesses multiple advantages including easier access, more satisfactory exposure of the FN trunk, minimal invasion and providing a larger operation field, which would be critical for those studies on the rodent in early development or delicate surgical manipulations.
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Affiliation(s)
- Hui Wang
- Department of Plastic Surgery, Neuroscience Research Center, Chang Zheng Hospital, The Second Military Medical University, Shanghai 200433, People's Republic of China
| | - Fan Fang
- Department of Plastic Surgery, Neuroscience Research Center, Chang Zheng Hospital, The Second Military Medical University, Shanghai 200433, People's Republic of China
| | - Jing Yi
- Department of Plastic Surgery, Neuroscience Research Center, Chang Zheng Hospital, The Second Military Medical University, Shanghai 200433, People's Republic of China
| | - Zhenghua Xiang
- Department of Plastic Surgery, Neuroscience Research Center, Chang Zheng Hospital, The Second Military Medical University, Shanghai 200433, People's Republic of China
| | - Meiqing Sun
- Department of Plastic Surgery, Neuroscience Research Center, Chang Zheng Hospital, The Second Military Medical University, Shanghai 200433, People's Republic of China
| | - Hua Jiang
- Department of Plastic Surgery, Neuroscience Research Center, Chang Zheng Hospital, The Second Military Medical University, Shanghai 200433, People's Republic of China
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Militsakh ON, Sanderson JA, Lin D, Wax MK. Rehabilitation of a parotidectomy patient-A systematic approach. Head Neck 2012; 35:1349-61. [DOI: 10.1002/hed.23095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/10/2022] Open
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Watts TL, Chard R, Weber SM, Wax MK. Immediate Eye Rehabilitation at the Time of Facial Nerve Sacrifice. Otolaryngol Head Neck Surg 2011; 144:353-6. [DOI: 10.1177/0194599810394314] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. In the setting of known facial nerve sacrifice or injury, patients require precautions to prevent exposure keratitis and the morbidity that follows. One recommended treatment is surgical placement of a gold weight with or without lateral tarsal strip. In patients in whom the facial nerve has been sacrificed, it is unknown whether rehabilitation should be simultaneous or in the perioperative period. Study Design and Setting. Case series with chart review of patients who underwent immediate rehabilitation of the eye (gold weight and lateral tarsal strip) following facial nerve resection. Subjects and Methods. From 1998 to 2009, 52 patients were studied. Postoperative ophthalmologic complications and the need for revision surgeries were measured. Results. A gold weight was placed in all patients, and 48 of 52 (92%) simultaneous lateral tarsal strips were performed. The facial nerve was sacrificed in 51 of 52 (88%) patients, and the remaining patient had a known preoperative facial nerve paralysis. Thirty-six of 52 (69%) required free tissue transfer for reconstruction, underscoring the extensive resections performed. A 1.2-g gold weight was placed in 50 of 52 (96%) patients. Three (6%) patients required gold weight revision with a larger weight and 3 (6%) for extrusion. Eight (16.7%) patients underwent revision of the lateral tarsal strip for ectropion. Conclusions. No patients developed ophthalmologic complications. Patients undergoing radical surgical resections with known or suspected injury of the facial nerve should be considered for simultaneous rehabilitation of the upper and lower eye.
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Affiliation(s)
| | - Rachael Chard
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Mark K. Wax
- Oregon Health and Science University, Portland, Oregon, USA
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Abstract
Background Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons. The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques. On this background it is worthwhile to develop a standardized approach for diagnosis and treatment of patients asking for facial rehabilitation. Conclusion A standardized approach is feasible: Patients with chronic facial palsy first need an exact classification of the palsy's aetiology. A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy, an individual surgical concept is applicable using three main approaches: a) early extratemporal reconstruction, b) early reconstruction of proximal lesions if extratemporal reconstruction is not possible, c) late reconstruction or in cases of congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardized evaluation of the therapeutic results is recommended to evaluate the necessity for adjuvant surgical procedures or other adjuvant procedures, e.g. botulinum toxin application. Up to now controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies.
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Neuro-ophthalmologic Complications and Manifestations of Upper and Lower Motor Neuron Facial Paresis. Curr Neurol Neurosci Rep 2010; 10:448-58. [DOI: 10.1007/s11910-010-0143-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hazin R, Azizzadeh B, Bhatti MT. Medical and surgical management of facial nerve palsy. Curr Opin Ophthalmol 2009; 20:440-50. [PMID: 19696671 DOI: 10.1097/icu.0b013e3283313cbf] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the results of recently published studies on the medical management of Bell's palsy and highlight strategies in the surgical management of facial nerve palsy. RECENT FINDINGS Although corticosteroid and antiviral therapy have been proposed for the treatment of Bell's palsy for many years, the clinical efficacy of these treatments has been debated in the literature due to the lack of conclusive evidence from large-scale clinical trials. However, recently completed randomized, controlled studies have found that the early administration of corticosteroids improves the chances of full recovery in patients with Bell's palsy. But there remains insufficient evidence supporting the routine use of antiviral medications in the treatment of Bell's palsy. In addition, improvement in surgical techniques has allowed the introduction of a number of surgical procedures for patients with permanent facial nerve palsy. SUMMARY On the basis of the results of several recently completed randomized, controlled studies, corticosteroid therapy has proven to be efficacious in the treatment of Bell's palsy and should be offered to patients presenting within 72 h of symptom onset with consideration to the addition of antiviral therapy for severe cases. Currently available surgical procedures can minimize the complications associated with permanent facial nerve palsy.
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Affiliation(s)
- Ribhi Hazin
- Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts, USA
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