Bell's palsy: a summary of current evidence and referral algorithm

Recurrent Bell's Palsy: A Comprehensive Analysis of Associated Factors and Outcomes

Background: Bell's palsy is a common peripheral facial nerve disorder that manifests as sudden unilateral facial paralysis. The condition, believed to be caused by viral infections and ischemic processes, affects a significant portion of the population and is associated with various systemic comorbidities. This study aimed to analyze the clinical characteristics, risk factors, and prognosis in primary and recurrent Bell's palsy to identify factors associated with recurrence and outcomes. Methods: A retrospective study was conducted on patients diagnosed with Bell's palsy at tertiary hospital between 2018 and 2024. Data collected included demographic information, comorbid conditions, clinical features, and recovery outcomes. Statistical analyses were performed to determine the significance of various factors in the recurrence of Bell's palsy. Results: The study included 254 patients. Recurrence was observed in 20.9% of cases. Significant risk factors for recurrence included diabetes (33.3%), hypertension (41.0%), hypothyroidism (56.1%), autoimmune disorders (54.2%), and a family history of Bell's palsy (48.6%). The severity of initial paralysis also influenced recurrence rates. Complete recovery from the initial episode was achieved by 66.9% of patients, whereas prolonged recovery times were noted in recurrent cases. Conclusion: The study highlights the significant role of systemic comorbidities and the severity of initial presentation in the recurrence of Bell's palsy.

A Retrospective Review of Seasonal Patterns of Idiopathic Facial Nerve Paralysis in a Tertiary Care Center

Background The objective of this retrospective study was to investigate the seasonal patterns of idiopathic facial nerve paralysis, specifically Bell's palsy, in Riyadh, Saudi Arabia. The study aimed to determine if there is a correlation between cold weather and the incidence of Bell's palsy, as well as to examine the relationship between age, gender, comorbidities, and the development of the disease. Methodology Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2016 and 2021. Electronic medical records of adult patients diagnosed with idiopathic facial paralysis were reviewed. Patients with facial paralysis caused by known illnesses were excluded. Demographic information, clinical characteristics, and the course of the disease were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results The study included 136 Bell's palsy patients, with a mean age of 39.9 years. Males represented 58.1% (79) of the sample, and the right side of the face was more commonly affected in 71 (52.2%) patients. The majority of patients had House-Brackmann grade III (51, 37.5%). The monthly distribution showed a higher number of Bell's palsy cases during the winter months, particularly December, October, and November, but the seasonal distribution did not yield a statistically significant difference in incidence. Conclusions While this study observed a higher incidence of Bell's palsy during the winter months, it did not establish a statistically significant correlation between cold temperatures and the onset of Bell's palsy in Riyadh, Saudi Arabia. Furthermore, the study found that Bell's palsy predominantly affects middle-aged males, and comorbidities did not appear to be significant risk factors for the development of the disease. This research lays the groundwork for future investigations into the relationship between weather and the pathogenesis of Bell's palsy in the region.

Research trends of acupuncture therapy on facial paralysis in a decade spanning 2013-2023: A bibliometric analysis

OBJECTIVE

This study aimed to employ bibliometric approaches to assess the worldwide scientific achievements in acupuncture for facial paralysis research from 2013 to 2023, and explore the hotspots and frontiers.

METHODS

Articles related to acupuncture facial paralysis were retrieved from the Web of Science Core Collection (WoSCC). CiteSpace was utilized to examine journals, publication year, country, institution, cited authors, as well as authors.Research hotspots and trends were analyzed by mapping co-citation networks and keywords.

RESULTS

The period from January 1, 2013, to July 31, 2023, yielded nearly 145 research records on acupuncture treatment for facial paralysis, with a steady increase in the number of annual publications.In terms of the number of publications, OTOLARYNGOLOGY HEAD NECK had the highest publication count, while AM J CHINESE MED exhibited the highest centrality and citation frequency among the cited journals. Further, 54.4 % of publications originated from China, followed by USA (8.2 %) and Germany (8.2 %). Guangzhou University of Chinese Medicine stood out with the highest publication volume among institutions. Guntinas-lichius, Orlando was the most prolific author, and PEITERSEN E was the most cited author. The keywords "Randomized controlled trials" and "multicenter" displayed high frequency and centrality, indicating that clinical trials with a randomized controlled design and multicenter studies were prevalent research methods, likely to remain a future trend.

CONCLUSION

Acupuncture's potential in the treatment of facial paralysis merits further research. Authors from different countries/regions and organizations need to eliminate language and academic barriers and strengthen collaboration and communication. Current research hotspots focus on "brain", "nerve", "electrical stimulation", "RCT" and "guidelines". The study of acupuncture mechanisms, especially based on the central nervous system mechanism, may be the future research hotspot.

Effects of electroacupuncture therapy on intractable facial paralysis: A systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to assessment effects of electroacupuncture (EA) therapy on intractable facial paralysis.

METHODS

The articles of EA treatment for intractable facial paralysis were retrieved from seven databases, the publication period was from its inception to November 30, 2022. Primary measure was the total effective rate, and other measures included the cure rate, Portmann scores, House-Brackmann scores, Sunnybrook scores and adverse events. The effect size of meta-analysis was expressed using relative risk (RR) or standardized mean difference (SMD) with 95% confidence interval (CI).

RESULTS

A total of 18 studies with 1,119 participants were included, all of them had various aspects of bias risk. Meta-analysis results revealed that EA ways improved total effective rate more effectively compared with non-EA counterparts (RR 1.23, 95% CI 1.17-1.31, I2 = 0%, 18 studies, 1119 participants), and improved cure rate more significantly than non-EA groups (RR 2.04, 95% CI 1.70-2.44, I2 = 0%, 18 studies, 1119 participants). None of studies reported adverse events.

CONCLUSION

EA therapy is more beneficial for patients with intractable facial paralysis than non-EA, but we lack sufficient evidence to evaluate its safety and follow-up effect. Therefore, more clinical trials with high quality methodologies are needed to further verify long-term effects of EA for IFP and improve the level of evidence.

TRIAL REGISTRATION

Registration number: CRD42021278541.

Quantitative proteomic analysis of cerebrospinal fluid from patients with idiopathic facial nerve palsy

BACKGROUND AND PURPOSE

Idiopathic facial palsy (IFP) accounts for over 60% of peripheral facial palsy (FP) cases. The cause of IFP remains to be determined. Possible etiologies are nerve swelling due to inflammation and/or viral infection. In this study, we applied an integrative mass spectrometry approach to identify possibly altered protein patterns in the cerebrospinal fluid (CSF) of IFP patients.

METHODS

We obtained CSF samples from 34 patients with FP. In four patients, varicella-zoster virus was the cause (VZV-FP). Among the 30 patients diagnosed with IFP, 17 had normal CSF parameters, five had slightly elevated CSF cell counts and normal or elevated CSF protein, and eight had normal CSF cell counts but elevated CSF protein. Five patients with primary headache served as controls. All samples were tested for viral pathogens by PCR and subjected to liquid chromatography tandem mass spectrometry and bioinformatics analysis and multiplex cytokine/chemokine arrays.

RESULTS

All CSF samples, except those from VZV-FP patients, were negative for all tested pathogens. The protein composition of CSF samples from IFP patients with normal CSF was comparable to controls. IFP patients with elevated CSF protein showed dysregulated proteins involved in inflammatory pathways, findings which were similar to those in VZV-FP patients. Multiplex analysis revealed similarly elevated cytokine levels in the CSF of IFP patients with elevated CSF protein and VZV-FP.

CONCLUSIONS

Our study revealed a subgroup of IFP patients with elevated CSF protein that showed upregulated inflammatory pathways, suggesting an inflammatory/infectious cause. However, no evidence for an inflammatory cause was found in IFP patients with normal CSF.

Efficacy and safety of electric acupuncture in treatment of intractable facial paralysis: A protocol for systematic review and meta-analysis

BACKGROUND

Facial paralysis is a common clinical disease, it was named intractable facial paralysis when the clinical course more than 2 months. Intractable facial paralysis will produce anxiety and depression, which will seriously affect patients' life and work. Electric acupuncture has been widely used in the treatment of intractable facial paralysis. However, the results of clinical studies on the efficacy and safety have been inconsistent. This study aims to evaluate the efficacy and safety of electric acupuncture for intractable facial paralysis patients by systematic review and meta-analysis, so as to provide clinical decision-making based on evidence-based medicine.

METHODS

The following databases will be searched by electronic methods: PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database, Wan-fang Data and Chinese Biomedical Database. All of them will be retrieved from the establishment date of the electronic database to March 2022, all included studies will be evaluated risk of bias by the Cochrane Handbook. The total effective rate will be the primary outcome. The systematic review will be conducted with the use of the RevMan5.3 software in this study.

RESULTS

This study will obtain efficacy and safety of electric acupuncture for the treatment of intractable facial paralysis.

DISCUSSION

This study will provide clinical decision-making based on evidence-based medicine that whether electric acupuncture could be used to treat intractable facial paralysis, and when and how it might be more effective and safety. It will help standardize electric acupuncture treatment strategies for intractable facial paralysis.

PROSPERO REGISTRATION NUMBER

CRD42021278541.

A Comprehensive Approach to Facial Reanimation: A Systematic Review

Purpose: To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection. Methodological approach: A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles. Conclusions: A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.

Effects of social distancing on the incidence of Bell's palsy and sudden sensorineural hearing loss

BACKGROUND

The aetiology of idiopathic facial nerve palsy (Bell's palsy, BP) and sudden sensorineural hearing loss (SSNHL) are not known. It has been proposed that common respiratory tract viruses play a part in the pathophysiology of these diseases.

OBJECTIVES

The incidence of many infectious diseases decreased during the lockdown of the society that took place during the COVID-19 pandemic. We investigated a possible change in the incidence of BP and SSNHL during the lock-down.

MATERIAL AND METHODS

We searched the patient records for all BP and SSNHL cases between 1 Jan 2017 - 31 Aug 2020 at the hospital district of Helsinki and Uusimaa that covers a population of about 1.2 million.

RESULTS

The mean monthly incidence on BP decreased during the COVID-19 pandemic lock-down. No change in the SSNHL incidence was discovered.

CONCLUSIONS AND SIGNIFICANCE

There is reason to speculate that one aetiologic reason for BP are transmittable respiratory tract pathogens.

Research on the application of myofascial induction therapy in the rehabilitation of patients with acute facial palsy: A nonrandomized controlled trial

BACKGROUND

In the healthy body, the fascial system maintains elasticity and coordination of movements. If these functions are destroyed, facial paraly appears. Myofascial induction therapy (MIT), a manual physical therapy method that focuses on restoring altered fascial tissue, is prevalently and widely used in clinical treatment.

OBJECTIVE

The study aimed to observe the application of MIT in the rehabilitation of patients with acute facial palsy.

METHODS

Sixty-eight patients with acute facial palsy were divided into control group and manual treatment group. The control group received drug treatments, such as prednisone, methylcobalamin, and vitamin B1, and instrumental physical therapy, such as semiconductor laser, shortwave therapy, and facial muscle training. In addition to these treatments, the manual treatment group received MIT. Both groups were treated for 4 weeks. The patients were assessed using the following methods: the House-Brackmann facial nerve function evaluation, Sunnybrook facial grading system, facial nerve electrophysiological examination compound muscle action potential (CMAP) amplitude, and blink reflex (BR) R1 latency.

RESULTS

House-Brackmann and Sunnybrook scores and CMAP amplitude and BRR1 latencies were significantly different between the two groups (p <  0.05). Furthermore, the manual treatment group showed greater improvement than the control group (p <  0.05).

CONCLUSIONS

Treatment with MIT promoted better recovery of acute facial palsy and thus may be considered a valid rehabilitation intervention that is worthy of clinical application.

Seminal Studies in Facial Reanimation Surgery: Consensus and Controversies in the Top 50 Most Cited Articles

ABSTRACT

Facial paralysis can impair one's ability to form facial expressions that are congruent with internal emotion. This hinders communication and the cognitive processing of emotional experience. Facial reanimation surgery, which aims to restore full facial expressivity is a relatively recent undertaking which is still evolving. Due in large part to published techniques, refinements, and clinical outcomes in the scientific literature, consensus on best practice is gradually emerging, whereas controversies still exist.Taking stock of how the discipline reached its current state can help delineate areas of agreement and debate, and more clearly reveal a path forward. To do this, the authors have analyzed the 50 seminal publications pertaining to facial reanimation surgery. In longstanding cases, the free gracilis transfer emerges as a clear muscle of choice but the nerve selection remains controversial with prevailing philosophies advocating cross facial nerve grafts (with or without the support of an ipsilateral motor donor) or an ipsilateral motor donor only, of which the hypoglossal and nerve to masseter predominate. The alternative orthodoxy has refined the approach popularized by Gillies in 1934 and does not require the deployment of microsurgical principles. Although this citation analysis does not tell the whole story, surgeons with an interest in facial reanimation will find that this is a good place to start.

Hepatitis E virus and Bell's palsy

BACKGROUND AND PURPOSE

Acute hepatitis E virus (HEV) infections have been associated with various neurological disorders, including individual cases with Bell's palsy. Nonetheless, systematic studies in the latter are lacking. Therefore, this retrospective study systematically screened a cohort of patients with Bell's palsy for an acute HEV infection.

METHODS

Overall, 104 patients with Bell's palsy treated in our clinic between 2008 and 2018 were identified. Serum samples were analyzed for anti-HEV immunoglobulin (Ig)M and IgG antibodies by enzyme-linked immunosorbent assay. Additionally, serum samples were tested for HEV RNA by polymerase chain reaction in 92 of these 104 patients presenting within the first 7 days from symptom onset. A large group of 263 healthy individuals served as controls.

RESULTS

None of the patients with Bell's palsy but two healthy controls (0.8%) had an acute HEV infection. Anti-HEV IgG seroprevalence indicating previous infection was unexpectedly high in patients with Bell's palsy (34%) and revealed an age-dependent increase.

CONCLUSIONS

In this first systematic study, no cases of Bell's palsy in association with an acute HEV infection were identified. However, based on previous case descriptions, rare associations cannot be excluded. Therefore, large prospective multicenter studies will be necessary for conclusions that are more definitive.

Comparison of Facial Muscle Activation Patterns Between Healthy and Bell's Palsy Subjects Using High-Density Surface Electromyography

Facial muscle activities are essential for the appearance and communication of human beings. Therefore, exploring the activation patterns of facial muscles can help understand facial neuromuscular disorders such as Bell’s palsy. Given the irregular shape of the facial muscles as well as their different locations, it should be difficult to detect the activities of whole facial muscles with a few electrodes. In this study, a high-density surface electromyogram (HD sEMG) system with 90 electrodes was used to record EMG signals of facial muscles in both healthy and Bell’s palsy subjects when they did different facial movements. The electrodes were arranged in rectangular arrays covering the forehead and cheek regions of the face. The muscle activation patterns were shown on maps, which were constructed from the Root Mean Square (RMS) values of all the 90-channel EMG recordings. The experimental results showed that the activation patterns of facial muscles were distinct during doing different facial movements and the activated muscle regions could be clearly observed. Moreover, two features of the activation patterns, 2D correlation coefficient (corr2) and Centre of Gravity (CG) were extracted to quantify the spatial symmetry and the location of activated muscle regions respectively. Furthermore, the deviation of activated muscle regions on the paralyzed side of a face compared to the healthy side was quantified by calculating the distance between two sides of CGs. The results revealed that corr2 of the activated facial muscle region (classified into forehead region and cheek region) in Bell’s palsy subjects was significantly (p < 0.05) lower than that in healthy subjects, while CG distance of activated facial region in Bell’s palsy subjects was significantly (p < 0.05) higher than that in healthy subjects. The correlation between corr2 of these regions and Bell’s palsy [assessed by the Facial Nerve Grading Scale (FNGS) 2.0] was also significant (p < 0.05) in Bell’s palsy subjects. The spatial information on activated muscle regions may be useful in the diagnosis and treatment of Bell’s palsy in the future.

Usefulness of electrophysiology in the prediction of outcome of Bell’s palsy patients

Background

Bell’s palsy (BP) is a common idiopathic cranial mononeuropathy. The electrophysiological tests are one of supportive tools for localizing the site of facial nerve lesion, and to determine the severity and prognosis of the injury. The aim of this study was to evaluate the role of electrophysiology in the prediction of outcome of patients with Bell’s palsy. This study was carried out on 30 adult patients with Bell’s palsy. All study subjects were assessed clinically by Sunnybrook facial nerve grading score (SBS) and electrophysiologically by electroneurography (ENoG), blink reflex (BR), and electromyography (EMG); first evaluation was within 7th to10th day from onset, the second evaluation was done at 20th day, and the follow-up visit was after 1 month to assess the clinical grading system (SBS).

Results

At 1 month, 20 patients (66.7%) had good recovery, while 10 patients (33.3%) had poor recovery according to the Sunnybrook scale. Multiple logistic regression analysis showed that the most significant predictive indicator of BP recovery was ENoG value and R1 latency of BR test. The receiver operating characteristic (ROC) curves showed ENoG degeneration index of 74.6%, considered as a critical cutoff value of non-recovery, with the sensitivity 95% and specificity 90%, and the highest specificity was with blink reflex parameters (R1, R2 latency) 100%.

Conclusion

BR and ENoG were the best predictors of non-recovery of facial function, while EMG findings did not add any prognostic significance. The combination of both tests BR and ENoG, along with clinical findings can be considered a good indication in the acute phase of BP for the possibility to develop palsy residua.

Effectiveness and safety of acupuncture and moxibustion for peripheral facial paralysis: A protocol for an overview of systematic reviews and meta-analysis

BACKGROUND

Peripheral facial paralysis (PFP) seriously affects patients' quality of life and work and even causes psychological problems such as anxiety and depression for them. Acupuncture (ACU) and moxibustion have been widely used to treat the disease with satisfactory results. Several systematic reviews and meta-analyses have reported the effectiveness of acupuncture for patients with PFP. However, the evidence has not been systematically synthesized. This overview aims to synthesize and assess the reliability of evidence generated from these systematic reviews (SRs) and meta-analyses of ACU and moxibustion for PFP.

METHODS

We will make a comprehensive retrieval in 9 databases as following: (1) Embase; (2) Cochrane Library; (3) Pubmed; (4) Chinese databases SinoMed (previously called the Chinese Biomedical Database); (5) Chinese National Knowledge Infrastructure (CNKI); (6) Chinese Scientific Journals Database (VIP); (7) Wanfang Data (WF). The time is limited from the construction of the library to August 2020. We will use the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool to evaluate methodological quality. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) will be used in the report checklist to assess the quality of reports in the study. The Grading of the Classification of Recommendations, Evaluation, Development and Evaluation (GRADE) will be used to evaluate the included SRs and meta-analysis. Our reviewers will conduct systematic reviews, qualification evaluation, data extraction, methodological quality and evidence quality screening in pairs. The outcomes of interest include: the effective rate, the House-Brackmann (H-B) score, cure rate, and side effects. Or any other scale used to assess the level of illness. The evidence will be synthesized where appropriate based on patient subgroups and outcomes.

RESULTS

The results will be published in a peer-reviewed journal.

CONCLUSION

This overview will provide comprehensive evidence of ACU and moxibustion for patients with PFP.

TRIAL REGISTRATION NUMBER

INPLASY202080016.

Effectiveness comparisons of acupuncture treatments for Bell palsy in adults: A protocol for systematic review and Bayesian network meta-analysis

BACKGROUND

Bell palsy (BP) is a simple peripheral facial paralysis. A variety of acupuncture treatments have been reported effective for the recovery of BP. However, the relative effectiveness of these acupuncture treatments is still unclear. Therefore, we plan to summarize the evidence and determine the most effective acupuncture treatment for BP.

METHODS

We will search the following database, including The Cochrane Library, PubMed, Web of Science, EMBASE, China BioMedical Literature (CBM),China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang database, from their inceptions to April 30, 2020, in order to collect randomized controlled trials (RCTs) on acupuncture in the treatment of BP. We will use Stata16.0 and WinBUGS software for statistical analysis and draw surface under the cumulative ranking curve (SUCRA) graph for each outcome indicator to predict the order of curative effect of treatment measures.

RESULTS

This study will compare and rank the effectiveness of different acupuncture methods in the treatment of BP, and the outcome indicators will include House-Brackmann Grading Scale, sequelae, Facial Disability Index score, Sunnybrook facial grading system, Portmann score, and adverse events.

CONCLUSION

Our study will provide supports for clinical practice.INPLASY registration number: INPLASY202040019.

Evaluation of serum ischaemia-modified albumin levels in patients with Bell's palsy

OBJECTIVE

This prospective study aimed to evaluate the relationship between serum ischaemia-modified albumin levels and Bell's palsy severity.

METHODS

The study included 30 patients diagnosed with Bell's palsy and 30 healthy individuals. The patients were separated into three disease severity groups (grades 2, 3 and 4) according to House-Brackmann classification. Blood samples were collected from all participants and the results compared between groups.

RESULTS

Significant differences in serum ischaemia-modified albumin were found between the study and control groups (p < 0.001); values were significantly higher in the study group than in the control group.

CONCLUSION

The significantly higher levels of serum ischaemia-modified albumin in the study group suggest that Bell's palsy pathogenesis is associated with oxidative stress.

Comparison of the efficacy of various doses of steroids for acute facial palsy

BACKGROUND

Although steroids are effective for multiple types of acute facial palsies, an appropriate dosage remains to be established.

AIMS/OBJECTIVES

The objective of this study is to compare the efficacy of high, low, and moderate doses of steroids in patients with acute facial palsy.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 49 patients with Bell palsy, Ramsay Hunt syndrome, or traumatic facial palsy. The patients were divided into 3 groups. We determined the initial House-Brackmann (HB) grade of each patient and the HB grade at the 3-month follow-up to determine whether complete recovery was achieved.

RESULTS

Results of electroneurography showed that the average and maximum rates of degeneration were not statistically different among the groups. Although the HB grade showed improvement after 3 months, the initial score was not significantly different from that at the follow-up. The degree of recovery was not significantly different among the groups.

CONCLUSION AND SIGNIFICANCE

Our findings showed that a high dose of steroids did not achieve outcomes that were more clinically meaningful than did that of a moderate or a low-dose steroid. Therefore, moderate or low doses of steroids may be sufficient for the treatment of acute facial palsy.

Facial Rehabilitation as Noninvasive Treatment for Chronic Facial Nerve Paralysis

OBJECTIVES

This study aims to evaluate the effectiveness of facial rehabilitation (FR) in patients with chronic facial nerve paralysis (FNP) and describe factors that predict improved facial nerve function after FR in this patient population.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

PATIENTS

Around 241 patients were referred to a university hospital facial rehabilitation (FR) program for FNP between 1995 and 2016. Seventy-six patients met criteria, defined as diagnosis of FNP ≥12 months prior to initiation of FR.

INTERVENTIONS

Each received at least two sessions of directed FR by a single therapist. Techniques employed: neuromuscular retraining, stretching/massage, and active exercise.

MAIN OUTCOMES

Variables affecting outcomes were analyzed to determine association with success of FR as measured by improvement in Facial Grading System (FGS) scale.

RESULTS

Onset of FNP to initiation of FR ranged 12 to 384 months (mean latency = 64.7 months). All patients, age 20 to 89, showed improvement in FGS after FR (mean, 16.54 points, SD 9.35). Positive predictors of FGS improvement after therapy (p-values < 0.05): increased the number of therapy sessions, right side of face being treated for FNP, lower starting FGS score. When controlling for these important variables, time from diagnosis to initiation of therapy was not significantly associated with improvement in FGS score.

CONCLUSION

Facial rehabilitation was associated with improved FGS score regardless of patient age, gender, or latency to facial rehabilitation. As a noninvasive treatment option with positive outcomes, it should be offered to patients with facial nerve paralysis regardless of chronicity.

A study of affecting the recovery of Chinese patients with Bell palsy

We explored the risk factors for preventing recovery of Bell palsy (BP) in Chinese inpatients. Five hundred thirteen patients were included. The two end-points of assessment were the discharge and final follow-up results. Relationship between discharge and baseline: long patients delay (unhealed 4.03 ± 1.16 d vs improved 2.24 ± 1.0 d, P < .001), combined diseases (yes 77.06% vs no 86.71%, P = .01), and early use of acupuncture (yes 47.46% vs no 97.62%, P < .001) were bad factors. Therapeutic factors and discharge: only use of steroids was a positive factor (yes 92.54% vs no 57.30%, P < .001). Binary logistic regression found that early use of steroids was a favorable factor (P = .001), while early use of acupuncture (P < .001) and long patient delay (P < .001) were adverse factors. Subgroups analysis showed early use of steroids plus antivirals (steroids + antivirals vs antivirals + mecobalamin, P < .001) and early use of steroids plus mecobalamin were good choices (steroids + antivirals vs steroids + mecobalamin, P = .745), while early use of antivirals plus mecobalamin was a bad choice (vs other 2 groups, P < .001). Effect of drug dose and treatment course on discharge: long time use of steroids didn't mean good efficacy (unhealed 10.80 ± 1.53 d vs improved 10.38 ± 1.21 d, P = .026). Final follow-up results: improved patients were better than that of unhealed at discharge (P < .001). Risk factors of discharge included long patient delay, combined diseases, and early use of acupuncture. Steroids plus antivirals or steroids plus mecobalamin were good choices for treatment. Long time use of steroids didn't mean good effect. Improved patients at discharge had better results finally.

Evaluation of Pain Syndromes, Headache, and Temporomandibular Joint Disorders in Children

After a thorough review of the history and presentation of a child's facial pain, a targeted head and neck examination is critical to the appropriate diagnosis of facial pain and temporomandibular joint disorders. It is critical to distinguish between the structural (trauma, degenerative disease, and tumor) and nonstructural (neurogenic, myogenic, and psychological) causes of pain, which will allow for incorporation of appropriate strategies of medical, psychological, dental, and surgical therapies.

Oxidative Stress and Antioxidant Status in Patients with Bell's Palsy

Background

Bell's palsy (BP) is the most common acute mononeuropathy of unilateral facial paralysis. Immune, infective and ischaemic mechanisms are potential contributors to the development of BP, but the precise cause remains unclear. Recently, oxidative stress has been proposed as a risk factor of various idiopathic diseases. The aim of this study was to investigate the possible role of oxidative stress in patients with BP.

Methods

Thirty-two patients with BP and 30 healthy controls were included in this study. Serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were measured by the Erel method.

Results

Serum TOS activities and OSI values were significantly higher in patients with BP compared with the control group (P <0.003 for all comparisons), whereas there was no significant difference between the groups in terms of TAS levels (P >0.05).

Conclusions

The data suggest that oxidative stress is increased in BP. These results of high oxidative stress in patients with BP may be helpful to clarify the etiopathogenesis of BP and contribute to improvement in the management or prevention of the disease.

Bell's Palsy: Clinical Analysis of 372 Cases and Review of Related Literature

OBJECTIVE

To analyze some clinical and epidemiologic aspects of Bell's palsy (BP) and to develop relevant correlations between existing data in literature and those obtained in this research.

METHODS

From January 2012 to December 2014, 372 consecutive patients diagnosed with BP were studied retrospectively. We reviewed the patients' data including gender, age, occupation, clinical manifestations, comorbid disease, and the rate of recurrence.

RESULT

The highest incidence was identified in those between 39 and 50 years of age. BP was more frequent in warm seasons (spring and summer) with its incidence reaching a peak value in September. The seasonal incidence of BP was significantly higher in summer (p < 0.05). In addition, diabetes mellitus was the most common accompanying comorbid condition.

CONCLUSION

The peak age when BP showed up was in the fourth decade of life and 55.1% of patients belonged to the male gender. BP has been observed to have the highest incidence during warm seasons (spring and summer). Diabetes mellitus was the most common comorbid condition accompanying BP. In addition, a recurrence was more likely to occur in the first 1.5 years after its first incidence.

Concurrent pityriasis rosea and Bell's palsy

Pityriasis rosea is a dermatological disease with a well-documented clinical appearance, but less is known about causes and treatment. Bell's palsy is a neurological condition leading to acute idiopathic hemifacial paralysis. Recent studies indicate that human herpesvirus (HHV) 6-7 reactivation may be a contributing factor to both conditions. We report a case of the 2 concurrent diagnoses that supports a common contributing factor and suggests further awareness and research into the role HHV 6-7 may play in the aetiology of both conditions.

Plasma Fibrinogen in Patients With Bell Palsy

OBJECTIVE

To determine the plasma fibrinogen level in patients with Bell palsy and explore the significances of it in Bell palsy.

METHODS

One hundred five consecutive patients with facial paralysis were divided into 3 groups: group I (Bell palsy), group II (temporal bone fractures), and group III (facial nerve schwannoma). In addition, 22 volunteers were defined as control group. Two milliliters fasting venous blood from elbow was collected, and was evaluated by CA-7000 Full-Automatic Coagulation Analyzer.

RESULTS

The plasma fibrinogen concentration was significantly higher in the group of patients with Bell palsy (HB IV-VI) than that in the control group (P <0.05). There was no significant difference between group II and control group (P >0.05); similarly, there was also no marked difference between group III and control group (P >0.05). In group I, the plasma fibrinogen levels became higher with the HB grading increase. The plasma fibrinogen level of HB-VI was highest.

CONCLUSIONS

Plasma fibrinogen has an important clinical meaning in Bell palsy, which should be used as routine examination items. Defibrinogen in treatment for patients with high plasma fibrinogen content also should be suggested.

Evaluation of the acoustic (stapedius) reflex test in children and adolescents with peripheral facial nerve palsy

INTRODUCTION

The stapedius nerve is one of the branches of the facial nerve in the temporal bone. It supplies the stapedius muscle, which is responsible for the attenuation reflex that protects the inner ear from loud noises. The stapedius (acoustic) reflex (SR) test is useful in identifying the site of facial nerve injury. The return of the SR (acoustic) to normal after an injury is a good prognostic factor in the treatment of facial nerve palsy.

OBJECTIVE

The aim of this study was to evaluate the effect of FNP on the SR (acoustic) response and determine the acoustic reflex threshold (ART) levels on the affected side.

MATERIAL AND METHOD

In this study, 70 patients, 3-7 years old, were screened. The study population consisted of 26 boys (37%) and 44 girls (63%). Follow-up tests were performed 3-18 months after the initial tests.

RESULTS

Most patients in the study population had a negative SR (acoustic) response on the affected side. In other patients, mean ART values were statistically higher on the affected side. There was no statistically significant relationship between a reflex response and the time from the onset of facial nerve palsy.

DISCUSSION

In the available literature, the SR (acoustic) testing is limited in determining whether or not the reflex is present without stimulus frequency or ART measurements. It is estimated that the reflex response is negative with ipsilateral stimulation on the affected side in 35-80% patients.

CONCLUSIONS

The SR (acoustic) is absent in most patients on the affected side. The ART value was statistically higher on the affected side. The SR (acoustic) response was statistically time independent.

The effectiveness of ayurvedic oil-based nasal instillation (Nasya) medicines in the treatment of facial paralysis (Ardita): a systematic review

BACKGROUND

Ardita (facial paralysis) is a medical condition that disfigures or distorts the facial appearance of the sufferer causing facial asymmetry and malfunction. Ardita patients may benefit from considering alternative treatments such as Ayurveda, including Taila Nasya (nasal instillation of medicated oil).

OBJECTIVES

To synthesize the best available evidence on the effectiveness of different Nasya oils in the treatment of Ardita.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Studies conducted on adult sufferers (18-70 years) of Ardita (chronic or acute) in any setting were considered. Studies including participants who were pregnant or suffered allergic rhinitis, fever, intracranial tumor/hemorrhage and bilateral facial palsy were excluded.

INTERVENTION(S)/COMPARATOR(S)

Standalone treatment of Nasya (at all dosages and frequencies) compared to Nasya in combination with other Ayurvedic treatments was considered. Comparisons between different interventions including Taila Nasya alone, Taila Nasya in combination with other Ayurvedic interventions and Ayurvedic interventions that did not include Taila Nasya were also considered.

OUTCOMES AND MEASURES

Changes in Ardita symptoms, including facial distortion, speech disorders and facial pain, were measured.

TYPES OF STUDIES

All quantitative study designs (experimental, quasi-experimental and observational) were considered.

SEARCH STRATEGY

Relevant studies were identified following a comprehensive literature search. References provided within these key studies identified additional resources. Indian universities were also contacted for results of Ardita studies undertaken in their institutions.A three-step search strategy aimed to find studies of published and unpublished studies was undertaken. Studies published in the English language were considered for inclusion, irrespective of publication date/year. Following an initial limited search of MEDLINE and CINAHL, the text words contained in the title and abstract, and of the index terms used to describe each articles were analyzed. From the identified keywords and index terms, searches were undertaken across all relevant databases such as PubMed, CINHAL, Cochrane (CENTRAL), Scopus, Centre for Review and Dissemination databases, Turning Research into Practice (TRIP), EMBASE, EBM Reviews, DHARA, Google Scholar, MedNar and ProQuest Dissertations. Finally, reference lists of identified theses and articles were searched for additional studies. Universities and website operators related to Ayurvedic research in India were contacted, including the National Institute of Ayurveda for relevant studies. Besides this, the University of Adelaide librarian was contacted to retrieve those studies identified in the reference lists of theses and articles.

METHODOLOGICAL QUALITY

Studies were critically assessed by the review author and a secondary reviewer prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute.

DATA EXTRACTION

Data was extracted by the primary reviewer using the standardized data extraction tool from the Joanna Briggs Institute.

DATA SYNTHESIS

Different interventions and comparators across studies precluded meta-analysis. Narrative synthesis was performed.

RESULTS

Only two pseudo randomized studies with a small number of participants met inclusion criteria and were included in the review. One study with 20 participants, divided equally into two groups compared the effectiveness of two nasal instillations in alleviating four Ardita symptoms. The second study of 15 participants each in two groups compared the effectiveness of nasal instillation with placement of medicated oil on the head on seven Ardita symptoms. Observational measurements of Ardita symptoms were graded as Mild, Moderate or Marked at baseline and after one month. The study conducted on 30 participants using Nasya intervention showed participants had better relief from the symptoms of facial pain, speech disorder and earache within the range of 78.2% to 90.9%, graded as Marked. Along with statistical data available in the studies, this review found low levels of evidence favoring Taila Nasya intervention. The review did not include any studies examining effectiveness of Nasya compared to conventional treatment for Ardita.

CONCLUSIONS

This review presents extremely limited evidence from only two small experimental studies that administration of Nasya oil alone may provide some relief from Ardita symptoms of facial distortion, speech disorder, inability to shut eyelids/upward eye rolling and dribbling of saliva in adult patients. No strong conclusions may be drawn from the evidence included in the review due to the limited number of studies, limited number of participants and poor quality of studies.

IMPLICATIONS FOR PRACTICE

Practitioners should advice Ardita patients that there is extremely limited evidence suggesting the potential effectiveness of Nasya oils alone or Nasya in conjunction with other Ayurvedic treatments in managing symptoms. However, given the absence of a strong evidence base, practitioners should be guided by clinical wisdom and patient preference.

IMPLICATIONS FOR RESEARCH

Well controlled clinical trials comparing standalone Nasya therapy to other Ayurvedic treatments and/or conventional medicine for Ardita symptoms need to be conducted to examine the relative effectiveness of different Nasya oils in treating Ardita.