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Di Stadio A, Ralli M, De Luca P, Sossamon J, Frohman TC, Altieri M, La Mantia I, Ferlito S, Frohman EM, Brenner MJ. Combining early lower eyelid surgery with neuromuscular retraining for synkinesis prevention after facial palsy: the role of the eye in aberrant facial nerve regeneration. Front Neurol 2024; 15:1443591. [PMID: 39359872 PMCID: PMC11445145 DOI: 10.3389/fneur.2024.1443591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 09/06/2024] [Indexed: 10/04/2024] Open
Abstract
Background Facial synkinesis (FS) is a distressing sequela of facial palsy (FP) characterized by involuntary, simultaneous movements of facial muscles occurring during voluntary facial expressions. Treatment of synkinesis is challenging, and preventive methods are needed. Aim This study evaluated the efficacy of physical facial nerve rehabilitation (PFNR) therapy alone vs. PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis. Methods Twenty five outpatients were randomized to receive either PFNR alone (neuromuscular retraining and Kabat proprioceptive neuromuscular facilitation) or PNFR and early (90 days after FP onset) eyelid surgery (involving a conservative oculoplastic correction for lagophthalmos with epiphora or ectropion). Comprehensive otolaryngological assessments and Magnetic Resonance Imaging (MRI) were conducted. Synkinesis progression was measured using Another Disease Scale (ADS) at baseline, 3-, 6-, 12-, and 24-months post-treatment. The data were analyzed with ANOVA, τ-test, Chi-Square analyses. Results Patients undergoing eyelid surgery with PFNR showed faster (p < 0.001) and better recovery of facial movements (p < 0.05) than patients receiving PFNR alone comparing T0 and T12 (p < 0.0001). No synkinesis were observed in the PFNR plus surgery group while 37% of patients in PFNR alone had synkinesis (p = 0.03). At 24 months, none of the patients in the surgery group presented synkinesis. Conclusion Combining early surgical treatment of paralytic lagophthalmos or epiphora with PFNR accelerated functional recovery and reduced synkinesis in patients with FP compared to facial rehabilitation alone. Further investigations in larger populations with long-term follow-up are needed. Clinical trial registration https://clinicaltrials.gov/study/NCT06538103, NCT06538103.
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Affiliation(s)
- Arianna Di Stadio
- Otolaryngology Unit, Department GF Ingrassia, University of Catania, Catania, Italy
| | - Massimo Ralli
- Organ of Sense Department, University La Sapienza, Rome, Italy
| | - Pietro De Luca
- Otolaryngology Department, Fatebenefratelli-Isola Hospital, Rome, Italy
| | - Jake Sossamon
- Medical University of South Carolina, Charleston, SC, United States
| | - Teresa C. Frohman
- Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marta Altieri
- Neurology Department, University La Sapienza, Rome, Italy
| | - Ignazio La Mantia
- Otolaryngology Unit, Department GF Ingrassia, University of Catania, Catania, Italy
| | - Salvatore Ferlito
- Otolaryngology Unit, Department GF Ingrassia, University of Catania, Catania, Italy
| | - Elliot M. Frohman
- Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Michael J. Brenner
- Department of Otolaryngology—Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
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Aronson S, Applebaum SA, Kelsey LJ, Gosain AK. Evidence-Based Practices in Facial Reanimation Surgery. Plast Reconstr Surg 2023; 152:520e-533e. [PMID: 37647378 DOI: 10.1097/prs.0000000000010539] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the causes and preoperative evaluation of facial paralysis. 2. Discuss techniques to restore corneal sensation and eyelid closure, elevation of the upper lip for smile, and depression of the lower lip for lip symmetry. 3. Outline treatment goals, surgical treatment options, timing of repair, and other patient-specific considerations in appropriate technique selection. SUMMARY Congenital facial paralysis affects 2.7 per 100,000 children; Bell palsy affects 23 per 100,000 people annually; and even more people are affected when considering all other causes. Conditions that impair facial mimetics impact patients' social functioning and emotional well-being. Dynamic and static reconstructive methods may be used individually or in concert to achieve adequate blink restoration, smile strength and spontaneity, and lower lip depression. Timing of injury and repair, patient characteristics such as age, and cause of facial paralysis are all considered in selecting the most appropriate reconstructive approach. This article describes evidence-based management of facial paralysis.
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Affiliation(s)
- Sofia Aronson
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Sarah A Applebaum
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Lauren J Kelsey
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Arun K Gosain
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
- Division of Pediatric Plastic Surgery, Ann & Robert H. Lurie Children's Hospital
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Comparison of Medical and Surgical Treatment in Severe Bell's Palsy. J Clin Med 2022; 11:jcm11030888. [PMID: 35160337 PMCID: PMC8836601 DOI: 10.3390/jcm11030888] [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: 12/18/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The effectiveness of decompression surgery for Bell’s palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell’s palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with Bell’s palsy who visited the Kyung Hee University Hospital between January 2005 and December 2021. Of these, 45 patients with severe Bell’s palsy were divided into two groups; 30 patients were treated conservatively with steroids and antiviral agents alone, while 15 patients underwent additional decompressive surgery after the conservative treatment. Outcomes were measured using House–Brackmann (H–B) grade for least 6 months after treatment was finished and conducted until full recovery was achieved. (3) Results: There was no significant difference in the rate of favorable recovery (H–B grade 1 or 2) between the surgery group and the conservative treatment group (75% vs. 70.0%, p > 0.05). Although H–B grade improvement occurred in both groups, the degree of improvement was not significantly different between groups. (4) Conclusions: Facial nerve decompression surgery in severe Bell’s palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone. Additional surgical decompression may not be necessary in patients with severe Bell’s palsy if they receive sufficient conservative treatment.
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Wang Z, Chai Y, Chen Z, Wu H, Wang Z. Endoscopic transcanal facial nerve decompression in Bell's palsy: A pilot study. Am J Otolaryngol 2022; 43:103167. [PMID: 34371460 DOI: 10.1016/j.amjoto.2021.103167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/01/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the surgical effects of endoscopic facial nerve decompression in Bell's palsy. MATERIALS AND METHODS This retrospective study included 15 patients with Bell's palsy. All had grade VI (House-Brackmann grading system) complete unilateral facial paralysis before surgery and a >95% reduction in amplitude on electroneurography testing compared to the unaffected side. Their MRI results indicated perineural edema in the geniculate ganglion area. Endoscopic decompression surgery was performed soon after they presented at our hospital. The time between onset of facial paralysis and surgery ranged from 25 to 93 days. All patients had no relevant surgical history or ear diseases. RESULTS At 1-year follow-up, 13 of the 15 (87%) patients had recovered to normal or near-normal facial function (House-Brackmann grade I-II), and all patients had reached House-Brackmann grade III or lower facial function. No obvious air-bone gap or sensorineural hearing loss occurred after surgery, and there were no severe complications or synkinesis. CONCLUSIONS Endoscopic transcanal facial nerve decompression provides a less traumatic and improved exposure of the geniculate ganglion, and may also help prevent permanent severe facial sequela. Results of intraoperative facial nerve stimulation may be related to the length of time required for recovery. The optimal time of surgery after onset of paralysis needs to be investigated further, to identify a post-drug surgical therapy which may be more acceptable for patients. Patients' response to conservative treatments should be assessed as soon as possible so as not to delay surgery.
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Yuan J, Johari S, Seneviratna A, Chong YK. Bell's palsy workup: Does audiometry add value? J Otol 2021; 16:61-64. [PMID: 33777116 PMCID: PMC7985008 DOI: 10.1016/j.joto.2020.10.002] [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: 06/16/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate if routine audiometry in Bell’s palsy patients has prognostic value. Methods Retrospective case review was conducted on all Bell’s palsy patients (n=191) seen at the tertiary otolaryngology specialist outpatient clinic from 2015 to 2017. Correlation of ipsilesional audiometric thresholds with patients’ time-to-recovery and initial clinical severity (measured by House-Brackmann (HB) scoring) were used for the prognostic outcome measure. Audiometry results were analyzed using three contiguous frequency pure-tone average (1kHz, 2kHz, 4kHz). Statistical analysis was done via Stata (v13.1), significance tests were 2-sided at 5% significance level. Results There was no significant difference between audiometric thresholds between the ipsilesional ear and the contralateral ear (p=0.87). Time-to-recovery was significantly longer for patients with severe initial presentation as compared to mild and moderate severity (p<0.01). There was no correlation found between the audiometry results and HB score at presentation (p=0.39). There was no correlation found between ipsilesional audiometric thresholds and time-to-recovery (p=0.58). Conclusion Our study suggests that routine audiometry has limited prognostic value in Bell’s palsy patients.
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Affiliation(s)
- Jing Yuan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Shirish Johari
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
| | - Aruni Seneviratna
- Clinical Research & Innovation Office, Tan Tock Seng Hospital, Singapore
| | - Yaw Khian Chong
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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Berania I, Awad M, Saliba I, Dufour JJ, Nader ME. Delayed facial nerve decompression for severe refractory cases of Bell's palsy: a 25-year experience. J Otolaryngol Head Neck Surg 2018; 47:1. [PMID: 29301560 PMCID: PMC5755416 DOI: 10.1186/s40463-017-0250-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 12/15/2017] [Indexed: 11/22/2022] Open
Abstract
Background This study aims to assess the effectiveness of delayed facial nerve decompression for Bell’s palsy (BP). Methods We performed a retrospective case review of all patients having undergone facial nerve decompression for severe refractory BP between 1984 and 2009 at our tertiary referral center. Demographics, timing between onset of symptoms and surgical decompression, degree of facial nerve dysfunction pre- and post-operatively, follow-up length after surgery and postoperative complications were recorded. Facial nerve dysfunction was assessed using the House-Brackmann (HB) scale. Electroneuronography, electromyography and imaging results were assessed when available. Results Eighteen patients had surgery between 21 and 60 days after onset of BP (group I), and 18 patients had surgery more than 60 days after onset of symptoms (group II). In group II, 11 patients had surgery between 61 and 89 days and 7 patients after 90 days. Groups I and II showed similar functional gain and rates of improvement to HB 3 or better (11/18 vs. 11/18, p > 0.05). In group II, patients operated 60 to 89 days after onset of BP showed a significantly higher rate of improvement to HB 3 or better (9/11 vs. 2/6, p = 0.049) with higher functional gain compared to those operated after 90 days (p = 0.0293). Conclusions When indicated, facial nerve decompression for BP is usually recommended within the first 2 weeks of onset of facial paralysis. Nonetheless, our results suggest that patients with severe BP could benefit from decompression surgery within 90 days after onset of symptoms in the absence of an opportunity to proceed earlier to surgery. Further investigation is still required to confirm our findings. Trial registration Retrospective registered. IRB# 2016–6154, CE 15.154 – CA
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Affiliation(s)
- Ilyes Berania
- Division of Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street, Montreal, QC, H2L 4M1, Canada
| | - Mohamed Awad
- Division of Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street, Montreal, QC, H2L 4M1, Canada
| | - Issam Saliba
- Division of Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street, Montreal, QC, H2L 4M1, Canada
| | - Jean-Jacques Dufour
- Division of Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street, Montreal, QC, H2L 4M1, Canada
| | - Marc-Elie Nader
- Division of Otolaryngology - Head and Neck Surgery, Université de Montréal, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, 1560 Sherbrooke Street, Montreal, QC, H2L 4M1, Canada. .,Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Abstract
Bell's palsy is unilateral, acute onset facial paralysis that is a common condition. One in every 65 people experiences Bell's palsy in the course of their lifetime. The majority of patients afflicted with this idiopathic disorder recover facial function. Initial treatment involves oral corticosteroids, possible antiviral drugs, and protection of the eye from desiccation. A small subset of patients may be left with incomplete recovery, synkinesis, facial contracture, or hemifacial spasm. A combination of medical and surgical treatment options exist to treat the long-term sequelae of Bell's palsy.
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Effects of Electroacupuncture on Facial Nerve Function and HSV-1 DNA Quantity in HSV-1 Induced Facial Nerve Palsy Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:693783. [PMID: 24991226 PMCID: PMC4065775 DOI: 10.1155/2014/693783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/20/2014] [Indexed: 01/28/2023]
Abstract
Acupuncture is a common and effective therapeutic method to treat facial nerve palsy (FNP). However, its underlying mechanism remains unclear. This study was aimed to investigate the effects of electroacupuncture on symptoms and content of HSV-1 DNA in FNP mice. Mice were randomized into four groups, an electroacupuncture treatment group, saline group, model animal group, and blank control group. Electroacupuncture was applied at Jiache (ST6) and Hegu (LI4) in electroacupuncture group once daily for 14 days, while electroacupuncture was not applied in model animal group. In electroacupuncture group, mice recovered more rapidly and HSV-1 DNA content also decreased more rapidly, compared with model animal group. We conclude that electroacupuncture is effective to alleviate symptoms and promote the reduction of HSV-1 in FNP.
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Lamina S, Hanif S. Pattern of facial palsy in a typical Nigerian specialist hospital. Afr Health Sci 2012; 12:514-7. [PMID: 23515232 DOI: 10.4314/ahs.v12i4.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data on incidence of facial palsy is generally lacking in Nigeria. OBJECTIVE To assess six years' incidence of facial palsy in Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria. METHOD The records of patients diagnosed as facial problems between January 2000 and December 2005 were scrutinized. Data on diagnosis, age, sex, side affected, occupation and causes were obtained. RESULTS A total number of 698 patients with facial problems were recorded. Five hundred and ninety four (85%) were diagnosed as facial palsy. Out of the diagnosed facial palsy, males (56.2%) had a higher incidence than females; 20-34 years age group (40.3%) had a greater prevalence; the commonest cause of facial palsy was found out to be Idiopathic (39.1%) and was most common among business men (31.6%). Right sided facial palsy (52.2%) was predominant. Incidence of facial palsy was highest in 2003 (25.3%) and decreased from 2004. CONCLUSION It was concluded that the incidence of facial palsy was high and Bell's palsy remains the most common causes of facial (nerve) paralysis.
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Affiliation(s)
- S Lamina
- Department of Biomedical Technology, School of Health Technology, Federal University of Technology, Owerri, Nigeria.
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Evaluation of the early phase of Bell’s palsy using 3 T MRI. Eur Arch Otorhinolaryngol 2011; 268:1493-500. [DOI: 10.1007/s00405-011-1498-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
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Lee WS, Kim J. Facial Nerve Paralysis and Surgical Management. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.8.807] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Won Sang Lee
- Department Otolaryngology, Yonsei University College of Medicine, Korea.
| | - Jin Kim
- Department Otolaryngology, Yonsei University College of Medicine, Korea.
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Abstract
Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell's palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell's palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell's palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell's palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell's palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae.
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Affiliation(s)
- Josef Finsterer
- Neurological Department, Krankenanstalt Rudolfstiftung, Postfach 20, 1180, Vienna, Austria.
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Rath B, Linder T, Cornblath D, Hudson M, Fernandopulle R, Hartmann K, Heininger U, Izurieta H, Killion L, Kokotis P, Oleske J, Vajdy M, Wong V. “All that palsies is not Bell's [1]”—The need to define Bell's palsy as an adverse event following immunization. Vaccine 2007; 26:1-14. [DOI: 10.1016/j.vaccine.2007.10.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 10/16/2007] [Accepted: 10/18/2007] [Indexed: 12/01/2022]
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