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Engin O, Kızılırmak Karataş AS, Taşpınar B, Taşpınar F. Evaluation of YouTube videos as a source of information on facial paralysis exercises. NeuroRehabilitation 2024:NRE240027. [PMID: 39302386 DOI: 10.3233/nre-240027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND YouTube has emerged as an important source for obtaining information regarding health issues. OBJECTIVE The study aimed to assess the reliability and quality of facial paralysis exercise videos that are accessible on the YouTube platform. METHODS The investigation was carried out on Youtube, utilizing the keyword "facial paralysis exercises". We listed the first 100 videos based on relevancy. The quality and reliability of the videos were assessed using DISCERN, the Journal of the American Medical Association (JAMA) Benchmark Criteria, the Global Quality Scale (GQS), and the Video Power Index (VPI). RESULTS Out of 100 studies, we excluded 52 and included the remaining 48. The scores we obtained for the videos were as follows: DISCERN Quality (2.92±0.91), DISCERN Total (39.16±6.75), JAMA (2.09±0.55), and GQS (3.00±0.89). Our study also revealed that videos uploaded by healthcare professionals had significantly higher DISCERN total, JAMA and VPI scores compared to those uploaded by non-healthcare professionals (p = 0.018, 0.001 and 0.023, respectively). Additionally, we observed a positive and statistically significant correlation between the DISCERN quality score, total score, JAMA, and video features. CONCLUSION The facial paralysis exercise videos were determined to be of medium to low quality. Higher-quality videos need to be produced.
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Affiliation(s)
- Onur Engin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Izmir Democracy University, Izmir, Turkey
| | - Ayşe Sezgi Kızılırmak Karataş
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Izmir Democracy University, Izmir, Turkey
| | - Betül Taşpınar
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Izmir Democracy University, Izmir, Turkey
| | - Ferruh Taşpınar
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Izmir Democracy University, Izmir, Turkey
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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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Tedeschi R, Donati D, Giorgi F. Beyond the smile: a systematic review of diagnostic tools for peripheral facial paralysis. Acta Neurol Belg 2024:10.1007/s13760-024-02630-w. [PMID: 39198355 DOI: 10.1007/s13760-024-02630-w] [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: 07/08/2024] [Accepted: 08/15/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Effective rehabilitation of peripheral facial paralysis (PFP) requires reliable assessment tools. This systematic review aimed to identify and validate instruments used in PFP rehabilitation, categorizing them according to the ICF framework. METHODS A comprehensive search was conducted across PubMed, Cinahl, Web of Science, and Scopus up to April 2024. Observational analytical studies and one non-randomized controlled trial that validated tools for assessing PFP were included. RESULTS Thirty-three studies were included, covering twenty different tools. Seventeen tools were related to the "Structure and Function" domain, while three addressed "Activity and Participation." The Sunnybrook and House-Brackmann scales were the most extensively studied. The Sunnybrook scale exhibited excellent intra- and inter-rater reproducibility and internal validity, making it suitable for clinical use. The House-Brackmann scale was user-friendly but had limitations in reproducibility and sensitivity to subtle differences, which newer versions like the FNGS 2.0 aimed to address. The FAME scale showed promise by reducing subjective scoring. Computerized tools, such as eFACE and A-FPG, and instruments for lip asymmetry and ocular involvement demonstrated potential but require further validation. The Facial Disability Index and the FaCE Scale were validated for assessing disability and participation restrictions. CONCLUSION This review identified several validated tools for PFP assessment, with the Sunnybrook and House-Brackmann scales being the most reliable. While emerging tools and computerized programs show promise, they need further validation for routine clinical use. Integrating validated tools into clinical practice is essential for comprehensive assessment and effective rehabilitation of PFP.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126, Bologna, Italy.
| | - Danilo Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Giorgi
- Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences of Bologna, Via Altura 3, Bologna, Italy, IRCCS Institute of Neurological Sciences of Bologna, Via Altura 3, Bologna, Italy
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Ou R, Tan Z, Liu L. Bilateral facial nerve palsy complicating Kawasaki disease: A case report and literature review. Medicine (Baltimore) 2024; 103:e39389. [PMID: 39151496 PMCID: PMC11332778 DOI: 10.1097/md.0000000000039389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/27/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024] Open
Abstract
RATIONALE Kawasaki disease (KD) manifests as an acute, self-limited vasculitis disease that constitutes the primary cause of acquired heart disease in children under 5 years of age. Facial nerve palsy (FNP) is a rare complication associated with coronary artery lesions (CALs) in patients with KD. Patients with KD and FNP usually present atypically, leading to a delayed diagnosis and treatment of KD. PATIENT CONCERNS A 4-month-old boy with fever, left FNP and bilateral conjunctival injection with spontaneous resolution, was admitted to the hospital, received a short course of intravenous dexamethasone, and experienced rapid FNP recovery on the first admission. The patient experienced a resurgence of fever, bilateral conjunctival injection, and right FNP, which led to readmission. Physical examination revealed redness at the site of Bacillus Calmette-Guérin inoculation, reddening of lips, and desquamation of the distal extremities. Echocardiography revealed right-sided CALs. DIAGNOSES The patient initially missed KD on the first admission, and was later diagnosed with complete KD with FNP on the second admission. INTERVENTIONS AND OUTCOMES After a short course of intravenous dexamethasone, the left FNP resolved quickly. However, right FNP recurred after corticosteroids withdrawal. Meanwhile, more typical symptoms were observed, and KD was diagnosed. Treatment ensued with intravenous immunoglobulin (IVIG), aspirin, and dexamethasone. The patient achieved rapid remission, without recurrence. Echocardiography continued to show normal findings during 1-year follow-up after discharge. LESSONS The clinical symptoms of FNP complicating KD in children are atypical and can easily lead to delayed diagnosis and treatment. FNP in patients with KD may serve as a risk factor for CALs, which are more challenging to resolve than the FNP itself. Adding corticosteroids to IVIG may be recommended to reduce IVIG resistance, decrease the risk of developing CALs, and alleviate CALs.
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Affiliation(s)
- Rong Ou
- Department of Pediatrics, Chongqing University Three Gorges Hospital, Chongqing, China
- School of Medicine, Chongqing University, Chongqing, China
| | - Zhongyou Tan
- Department of Pediatrics, Chongqing University Three Gorges Hospital, Chongqing, China
- School of Medicine, Chongqing University, Chongqing, China
| | - Ling Liu
- Department of Pediatrics, Chongqing University Three Gorges Hospital, Chongqing, China
- School of Medicine, Chongqing University, Chongqing, China
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Xu JR, Vos DJ, Yaffe NM, Arianpour KX, Byrne PJ, Ciolek PJ. Longitudinal Analysis of the Use of Facial Reanimation Procedures for Bell's Palsy. Facial Plast Surg Aesthet Med 2024. [PMID: 38949954 DOI: 10.1089/fpsam.2024.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background: Treatment of Bell's palsy ranges from medical management with high-dose corticosteroids to complex facial reanimation procedures. Objective: To characterize the number of static, dynamic, and combined facial reanimation procedures for the management of Bell's palsy using a national database over time. Methods: This retrospective cohort study included patients in the 2013-2020 National Surgical Quality Improvement Project database with a postoperative diagnosis of Bell's palsy. Cases were categorized as involving only static, only dynamic, and a combination of static and dynamic procedures. Chi-square or Fisher's exact tests were performed for patient demographics, and linear regressions were created to evaluate utilization trends. Results: In total, 294 patients were identified. There was no significant difference in patient sex and comorbidities between these treatment groups. Of the 294 patients, 101 received both types of procedures, 107 received only dynamic procedures, and 86 received only static procedures. The trendlines for all treatment groups were significantly positive (B = 1.27 for both, B = 0.89 for dynamic only, and B = 1.01 for static only). Conclusion: In this study of a national surgical database, an increase in static, dynamic, and combined treatments for patients with Bell's palsy was found.
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Affiliation(s)
- James R Xu
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Derek J Vos
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Noah M Yaffe
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Khashayar X Arianpour
- Division of Facial Plastics and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick J Byrne
- Division of Facial Plastics and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter J Ciolek
- Division of Facial Plastics and Reconstructive Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Liu RH, Yau J, Derakhshan A, Xiao R, Hadlock TA, Lee LN. Facial Filler in Facial Paralysis: A Prospective Case Study and Multidimensional Assessment. Facial Plast Surg Aesthet Med 2024; 26:426-430. [PMID: 37428541 DOI: 10.1089/fpsam.2023.0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background: Facial filler is emerging as a nonsurgical alternative for addressing static asymmetry in facial paralysis (FP). Objectives: To elucidate the patient experience for facial filler and to facilitate preprocedure counseling and education. Materials and Methods: Patients receiving hyaluronic acid filler for FP at a tertiary academic medical center were prospectively recruited. Primary outcomes included patient-reported pain, facial symmetry (on a visual analog scale), and the results of quality-of-life surveys (FACE-Q satisfaction with facial appearance [SFA], FACE-Q psychosocial distress [PSD], Patient Health Questionnaire-9 [PHQ-9], and Euro Quality of Life 5-Dimension [EQ5D]) preprocedure and at 1 and 14 days postprocedure. Results: Twenty patients (90% women, average age 55 ± 11) completed the study. Sites of filler included the cheek, lower lip, nasolabial fold, chin, and temple regions. Patients reported minimal pain at postprocedure days (PPDs) 1 and 14. Patient-perceived symmetry scores improved significantly (p < 0.0001), as did FACE-Q SFA and FACE-Q PSD scores (p < 0.0001, <0.0001) when comparing preprocedure with PPD 14. Depression, assessed by PHQ-9, and the anxiety/depression domain of EQ5D, decreased after treatment (p = 0.016, 0.014) but no change was observed in the other domains of EQ5D. Conclusion: Facial filler for FP can be performed with minimal morbidity (pain, impact on daily routine, and complications) and leads to improvements across multiple psychosocial domains.
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Affiliation(s)
- Rui Han Liu
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jenny Yau
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Adeeb Derakhshan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Roy Xiao
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Linda N Lee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Xu L, Guo T, Sheng X, Du H, Tang Y. Predictive Value of the Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Idiopathic Facial Nerve Palsy. Int J Gen Med 2024; 17:2635-2642. [PMID: 38863739 PMCID: PMC11166163 DOI: 10.2147/ijgm.s458808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/01/2024] [Indexed: 06/13/2024] Open
Abstract
Objective This study aims to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in patients with idiopathic facial nerve palsy. Methods The clinical data of patients with idiopathic facial nerve palsy were retrospectively analyzed. After three months of follow-up, patients were divided into good prognosis and poor prognosis, and the correlation between NLR, CRP and idiopathic facial nerve palsy was analyzed. Results Negative correlation of NLR with Portmann score in idiopathic facial nerve palsy (r=-0.788, P<0.05); In contrast to the group with poor prognosis, patients in good prognosis group had low levels of body mass index (BMI), NLR, and C-reactive protein (CRP), and high Portmann score (P<0.05); Multivariate logistic regression analysis showed Portmann score (OR=1.268, 95% CI (1.005-1.616)), NLR (OR=0.262, 95% CI (0.128-0.533)) and CRP levels (OR=0.949, 95% CI (0.895-0.989)) were risk factors of poor prognosis for patients with idiopathic facial nerve palsy. The area under the receiver operator characteristic (ROC) curve of NLR and CRP levels in predicting poor facial nerve function was 0.764 and 0.697, the specificity was 85.5% and 75.0%, and the sensitivity was 74. 0% and 76.0%, respectively. The ROC curve of the combined diagnosis was 0.829, the specificity was 80.7%, and the sensitivity was 82.0%. Conclusion Elevated NLR and CRP are associated with a poor prognosis of idiopathic facial nerve palsy and can serve as an indicator for clinical prognosis, and can be widely used in clinical.
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Affiliation(s)
- Longdong Xu
- Department of Neurology, Changshu NO.5 People’s Hospital, Changshu, Jiangsu, 215500, People’s Republic of China
| | - Tingting Guo
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Xihua Sheng
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Huaping Du
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Ying Tang
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
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Al-Hashimi I, Okon E. West Nile Virus: A Neglected Cause of Bell's Palsy? Cureus 2024; 16:e62486. [PMID: 39015861 PMCID: PMC11251707 DOI: 10.7759/cureus.62486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/18/2024] Open
Abstract
The West Nile virus (WNV) is the leading cause of mosquito-borne disease in the United States. Bell's palsy (BP) is a clinical syndrome associated with viral infections, but an association with West Nile virus (WNV) is not well-described, with only two cases reported in the literature. We present a case of a 68-year-old woman presenting with fevers and encephalopathy. Cerebrospinal fluid was positive for WNV. Following improvement, she developed facial weakness and was diagnosed with BP secondary to the WNV infection. Identifying BP associated with WNV infection may have significant clinical implications, but further studies are needed to fully characterize a causative relationship.
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Affiliation(s)
- Ibrahim Al-Hashimi
- Department of Internal Medicine, University of Texas (UT) at Tyler Health Science Center, UT Health East Texas, Tyler, USA
| | - Emmanuel Okon
- Department of Infectious Diseases, Christus Trinity Clinic, Tyler, USA
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Sawarbandhe PA, Mohod S, Batra MR, Basra AS. Exploring Non-invasive Therapies for Bell's Palsy: A Case Report. Cureus 2024; 16:e63071. [PMID: 39055433 PMCID: PMC11272154 DOI: 10.7759/cureus.63071] [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: 05/19/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Unknown in origin, Bell's palsy is a common acute facial nerve paralysis that is usually characterized by unilateral facial weakening or paralysis. People of all ages are affected by this illness, which peaks in the fourth decade of life. Although the precise etiology is yet unknown, viral infections - particularly type 1 herpes simplex virus - are frequently linked to the problem. Based on the evidence of abrupt onset facial weakness and the elimination of other neurological diseases, the diagnosis is essentially clinical. The goals of management techniques are to lessen related symptoms, encourage nerve regeneration, and lessen inflammation. Corticosteroids, antiviral drugs, physical therapy, and supportive measures are available as treatment alternatives. The majority of patients experience spontaneous recovery within weeks to months, and the prognosis is generally excellent. Nonetheless, a portion may experience long-term consequences, highlighting the significance of individualized follow-up care. Bell's palsy is succinctly summarized in this abstract to aid in better comprehension and well-informed clinical practice decision-making.
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Affiliation(s)
- Prem A Sawarbandhe
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil Mohod
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mahek R Batra
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arshjot S Basra
- Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wang Z, Zhang J, Zhang Z, Liu Y, Ren S, Sun H, Meng D, Liu R, Zhang Y. Effects of acupuncture for Bell's palsy patients in the acute phase and its impact on facial nerve edema: a study protocol for a randomized, controlled trial. Front Neurol 2024; 15:1327206. [PMID: 38689877 PMCID: PMC11058209 DOI: 10.3389/fneur.2024.1327206] [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: 11/01/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
Background Bell's palsy is an acute peripheral facial neuropathy, which is one of the most common causes of facial palsy of lower motor neurons. Facial nerve swelling is commonly observed in Bell's palsy. Acupuncture therapy has been widely used in the treatment of Bell's palsy. However, whether acupuncture can be effectively used in the acute stage is still controversial. There are no clinical trials conducted previously to evaluate the effect of acupuncture on facial nerve edema in Bell's palsy patients. The study aims to evaluate the potential efficacy of different acupuncture modalities on Bell's palsy patients in the acute phase, its effect on facial nerve edema, and to preliminarily explore its possible mechanism. Methods and analysis In this randomized, controlled trial, 165 Bell's palsy patients with unilateral onset within 3 days will be recruited and randomly assigned to either the electroacupuncture group (n = 33), the acupuncture group (n = 33), the sham acupuncture group (n = 33), the blank control group (n = 33), or the acupuncture control group (n = 33) in a 1:1:1:1:1 ratio. The participants will receive 4 weeks of treatment and 8 weeks of follow-up. The five groups of participants will receive the following treatments: A: Electroacupuncture + Medication (prednisone acetate tablets, mecobalamin tablets, and vitamin B1 tablets); B: Acupuncture + Medication; C: Sham Acupuncture + Medication; D: Medication only; and E: Acupuncture only. The primary outcome will be the effectiveness rate of different acupuncture modalities in improving facial nerve function after the intervention period. The secondary outcomes will be the recovery speed, the diameter of the facial nerve, the echo intensity and thickness of facial muscles, blood flow parameters of the facial artery, the serum inflammatory level, safety evaluation, and adverse events. Preliminary exploration of its mechanism of action occurs through inflammation and immune response. The difference between groups will be assessed using repeated measure analysis of covariance (ANCOVA) and trend chi-square. Discussion The trial will evaluate the efficacy and facial nerve edema of acupuncture for Bell's palsy patients in the acute phase and preliminarily explore its possible mechanism. The results thus may provide evidence for clinical application. Clinical trial registration https://www.chictr.org.cn/bin/project/edit?pid=133211, identifier ChiCTR2100050815.
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Affiliation(s)
- Zhidan Wang
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Jie Zhang
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Zhen Zhang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Yue Liu
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Shuang Ren
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Hao Sun
- Department of Clinical Epidemiology, The First Hospital of China Medical University, Shenyang, China
| | - Di Meng
- Department of Geratology, The First Hospital of China Medical University, Shenyang, China
| | - Ruoshi Liu
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Yang Zhang
- Department of Traditional Chinese Medicine, The First Hospital of China Medical University, Shenyang, China
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Abdelrehim AB, Kananeh S, Landau D. The Vital Role of Clinical Examination in Unmasking Bell's Palsy: Beyond Pattern Recognition. Cureus 2024; 16:e55311. [PMID: 38559504 PMCID: PMC10981794 DOI: 10.7759/cureus.55311] [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] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
While multiple sclerosis (MS) commonly manifests with optic nerve involvement, it can also masquerade as diverse cranial nerve (CN) palsies. We present the case of a young male initially diagnosed with Bell's palsy based on unilateral facial nerve paralysis. Despite the presence of typical clinical features, the patient's evaluation took an unexpected turn. Subsequent brain MRI revealed demyelinating lesions, ultimately confirming the diagnosis of MS. This case underscores the importance of maintaining vigilance in diagnosing atypical presentations of MS, illustrating how meticulous evaluation and neuroimaging play pivotal roles in uncovering underlying pathologies when conventional diagnoses such as Bell's palsy raise uncertainties.
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Affiliation(s)
| | - Salman Kananeh
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Daniel Landau
- Neurology, Capital Health Regional Medical Center, Trenton, USA
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Jeong J, Chung JH, Ryu S, Lee JD, Kim J, Lee HY, Song CI, Cho YS, Lee SA, Jun B. Monthly Variation in Bell's Palsy Based on Population Data of Korea. Audiol Neurootol 2024; 29:290-296. [PMID: 38402865 PMCID: PMC11309058 DOI: 10.1159/000536365] [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: 08/06/2023] [Accepted: 01/09/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Several studies have reported that the number of patients with Bell's palsy varied significantly by month and season. However, few studies have reported the monthly variation in Bell's palsy based on the whole population. We investigated the monthly variation in Bell's palsy in Korea during a long-term period based on whole population data. METHODS This retrospective study used the data of the National Health Insurance Service of Korea, which included the entire Korean population from 2008 to 2020. The monthly incidence of Bell's palsy per 100,000 was evaluated in total and according to sex, age, and residence. RESULTS The total average monthly incidence differed significantly by month, with the highest observed in January (9.1 per 100,000) and the lowest in June (7.7 per 100,000) (p < 0.001). The average monthly incidence according to sex, age, and residence also varied significantly by month, with most of the highest values noted in January and the lowest in June. CONCLUSION There was significant monthly variation in the incidence of Bell's palsy, with the highest in January during the winter and the lowest in June during the summer, based on whole population data over a long-term period in Korea.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jae Ho Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, South Korea
| | - Soorack Ryu
- Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, South Korea
| | - Jong Dae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Ho Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Chan Il Song
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se A Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Beomcho Jun
- Department of Otorhinolaryngology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
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13
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Venditto CM, Grotting JC, Auersvald A, Johnson DJ, Labbé D, Hodgkinson D, Barrera A, Warren RJ, Botti G, Von Laeken N, Bald M. Complete Hemifacial Paralysis Post-facelift: Making Sense of a Plastic Surgeon's Worst Nightmare. Aesthet Surg J 2024; 44:256-264. [PMID: 37897668 DOI: 10.1093/asj/sjad337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Postrhytidectomy hemifacial paralysis is a frightening clinical condition affecting the proximal facial nerve and most often associated with Bell's palsy. Associated symptoms are common and include auditory, salivary, vestibular, and gustatory complaints. OBJECTIVES The aim of the study was to provide increased awareness of postrhytidectomy hemifacial paralysis secondary to Bell's palsy in the plastic surgery community. METHODS Following a roundtable discussion with the senior author's (J.C.G.) plastic surgery colleagues located all over the world, 8 surgeons reported having had firsthand experience with hemifacial paralysis in patients following facelift. Descriptions of their cases, including preoperative, intraoperative, and postoperative courses were collected and reported. RESULTS A total of 10 cases of postrhytidectomy hemifacial paralysis were analyzed based on results of a clinical questionnaire. Eight of the 10 cases involved all facial nerve branches, with 2 cases sparing the marginal mandibular branch. The vast majority of cases were referred to a neurologist and steroids initiated. Two patients were returned to the operating room for exploration. Associated symptoms reported included pain in the ear, hearing loss, ocular symptoms such as tearing or dryness, vestibular symptoms such as vertigo, changes in taste, and in 1 patient an electric-shock type sensation to the face. CONCLUSIONS Hemifacial paralysis associated with Bell's palsy following rhytidectomy is a rare but known clinical entity that should be included in the preoperative informed consent process before facelift. Current management trends are neurology referral and steroid initiation. LEVEL OF EVIDENCE: 4
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14
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Nocini R, Soloperto D, Arietti V, De Cecco F, Fulco G, Monzani D, Marchioni D, Sacchetto L. Subtotal Petrosectomy: Pictorial Review of Clinical Indications and Surgical Approach. Indian J Otolaryngol Head Neck Surg 2024; 76:224-236. [PMID: 38440666 PMCID: PMC10909040 DOI: 10.1007/s12070-023-04131-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 03/06/2024] Open
Abstract
Subtotal petrosectomy (STP) is characterized by obliteration of the middle ear and occlusion of the external auditory canal. The advent of the endoscope has allowed a reduction in morbidity for some conditions such as cholesteatoma and other middle ear disorders, but STP still plays an important role. A retrospective review of medical records and videos of patients who had undergone STP was performed. Perioperative data and images were collected from various clinical cases who had undergone subtotal petrosectomy at our tertiary referral university hospital in Verona. We confronted our experience with a review of the literature to present the main indications for this type of procedure. STP allows a variety of diseases to be managed effectively as it offers the possibility of a definitive healing with radical clearance of temporal bone. Moreover, it can be safely combined with other procedures with a very low complication rate. Although the endoscope represents a revolution in ear surgery, STP, when indicated, is nowadays a surgical option that should be included in the otosurgeon's portfolio.
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Affiliation(s)
- Riccardo Nocini
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Davide Soloperto
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Valerio Arietti
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Francesca De Cecco
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Gianfranco Fulco
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Daniele Monzani
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
| | - Daniele Marchioni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Luca Sacchetto
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
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15
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Shiozaki T, Kaneko F, Murakami D, Kono M, Hotomi M. Contrast-Enhanced MRI Is Useful for Prognostic Prediction on Idiopathic Bilateral Simultaneous Facial Nerve Palsy: A Case Report and Literature Review. Cureus 2024; 16:e54719. [PMID: 38524057 PMCID: PMC10960733 DOI: 10.7759/cureus.54719] [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] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Idiopathic bilateral facial nerve palsy is a rare condition and presents a diagnostic and prognostic challenge. Specifically, when bilateral nerves are damaged, it is difficult to predict the prognosis. We showcase the usefulness of contrast-enhanced magnetic resonance imaging (MRI) by providing information about localization and severity of degeneration of facial nerve. A 70-year-old Japanese man presented with bilateral simultaneous facial nerve palsy of House-Brackmann Grade VI on both sides. Contrast-enhanced MRI revealed bilateral intensity enhancement of intratemporal facial nerves. The signal intensity was higher on the left side than on the right side. Facial nerve decompression was performed on the left side. The left facial nerve palsy was finally improved eight months after the onset, while the right side was improved just under two months after the onset. Contrast-enhanced MRI for facial nerve palsy can provide valuable information for the evaluation of damaged facial nerves. In our patient's case, it was useful as a prognostic predictor of bilateral facial nerve palsy.
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Affiliation(s)
- Takato Shiozaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, JPN
| | - Fumie Kaneko
- Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, JPN
| | - Daichi Murakami
- Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, JPN
| | - Masamitsu Kono
- Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, JPN
| | - Muneki Hotomi
- Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, JPN
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16
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Wu D, Lan X, Litscher G, Zhao YL, Wu YQ, Dai RJ, Cao K, Wang Y, Chen LQ. Laser acupuncture and photobiomodulation therapy in Bell's palsy with a duration of greater than 8 weeks: a randomized controlled trial. Lasers Med Sci 2024; 39:29. [PMID: 38216803 PMCID: PMC10787006 DOI: 10.1007/s10103-023-03970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
To investigate the efficacy of laser acupuncture and photobiomodulation therapy in alleviating symptoms among patients diagnosed with Bell's palsy with duration of greater than 8 weeks. The randomized controlled trial has been performed from May 2021 to April 2023. Patients were eligible who had Bell's palsy with duration of greater than 8 weeks on out-patient Department of Otorhinolaryngology in Beijing Tongren Hospital. The laser acupuncture group received class IV laser treatment for 3 times per weeks, a total of 72 times. The control group received the same treatment procedure except the laser parameter. The primary outcome measures comprised House-Brackmann facial nerve grading system and electroneurography. Secondary outcome measures comprised Sunnybrook facial grading system, electromyography, and the blink reflex. A total of 84 participants were included (42 control group, 42 laser acupuncture group). After treatment, House-Brackmann facial nerve grading system (OR, 0.11; 95% CI, 0.04-0.30; P < 0.001), and the pathologic numbers of electroneuronography were statistically different between the laser acupuncture group and control group, including orbicularis oculi (OR,0.08; 95% CI, 0.02-0.21; P < 0.001), Frontalis muscle (OR,0.14; 95% CI, 0.05-0.39; P < 0.001), Orbicularis oris (OR,0.13; 95% CI, 0.04-0.36; P < 0.001), Ala nasi muscle (OR,0.06; 95% CI, 0.02-0.18; P < 0.001). In secondary outcomes, Sunnybrook facial grading system, has significant difference between the two groups (20.26; 95% CI, 14.69 to 25.83; P < 0.01). Latency by ENoG, include orbicularis oculi (-0.61; 95% CI, -0.43 to -0.09; P < 0.001), frontalis muscle (-0.12; 95% CI, -0.21 to -0.03; P < 0.01), orbicularis oris (-0.28; 95% CI, -0.41 to -0.16; P < 0.001), and ala nasi muscle (-0.26; 95% CI, -0.38 to -0.16; P < 0.001). All amplitudes of MUAPs and durations by electromyography (EMG) showed statistically significant differences compared with the control group after treatment. For the frontalis muscle, the amplitude of MUAPs was -64.23 (95% CI, -80.89 to -47.56; P < 0.001) and duration was -1.18 (95% CI, -1.49 to -0.87; P < 0.001). For orbicularis oris, amplitude of MUAPs was -29.82 (95% CI, -55.03 to -4.62; P = 0.02) and duration was -0.57 (95% CI, -0.94 to -0.20; P < 0.001). For depressor angulli oris, amplitude of MUAPs was -47.06 (95% CI, -62.15 to -31.97; P < 0.001) and duration was -2.21 (95% CI, -2.69 to -1.72; P < 0.001). Blink reflex, including R1 (OR, 0.03; 95% CI, 0.01-0.16; P < .001), R2 (OR, 0.04; 95% CI, 0.004-0.29; P < .001), and R2 latency differences (OR, 0.15; 95% CI, 0.05-0.51; P < .001), have significant difference between the two groups, respectively. The findings suggest that laser acupuncture relieve symptoms for patients with Bell's palsy with a duration of greater than 8 weeks.Trial registration: ClinicalTrials.gov Identifier: NCT05846217.
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Affiliation(s)
- Dong Wu
- Department of Traditional Chinese Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xin Lan
- Jococo Inc, Los Angeles, CA, USA
| | - Gerhard Litscher
- President of the International Society for Medical Laser Applications (ISLA transcontinental; since 2012), German Vice President of the German-Chinese Research Foundation (DCFG) for TCM (since 2014), Vice Chairperson, World Federation of Chinese Medicine Societies, Committee of Card. Rehab. (2023-2028), Honorary President of the European Federation of Acupuncture and Moxibustion Societies (2023), Honorary Professor of China Beijing International Acupuncture Training Center, China Academy of Chinese Medical Sciences (2023), Former Head of two Research Units at Medical University of Graz, 8036, Graz, Austria
| | - Yan-Ling Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun-Qing Wu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru-Jun Dai
- TED Healthcare Technology Ltd (Beijing), Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Institute of Acupuncture-Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lu-Quan Chen
- Department of Traditional Chinese Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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17
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Akulov MA, Orlova OR, Shimansky VN, Tanyashin SV, Poshataev VK, Zakharov VO. [Five-year follow-up after neurosurgery complicated by facial neuropathy]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:50-55. [PMID: 39169581 DOI: 10.17116/neiro20248804150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND Botulinum toxin A (BTA) injections are effective for facial neuropathy. However, there is insufficient number of studies devoted to long-term management of these patients. OBJECTIVE To evaluate the effectiveness and safety of BTA therapy in patients with facial neuropathy after neurosurgical interventions. MATERIAL AND METHODS The study included 86 patients with facial neuropathy after surgical treatment of posterior cranial fossa and cerebellopontine angle tumors. All ones were divided into 2 groups: group I (main) - 57 patients with BTA prescribed early after facial nerve injury, group II (control) - 29 people undergoing exercise therapy, as well as special exercises and acupressure of painful muscle cords. The Sunnybrook Facial Grading Scale (SFGS) was used to assess facial symmetry and synkinesis, the Facial Disability Index (FDI scale) - to assess the quality of life. Overall duration of the study was 5 years (control points: 6 months, 1, 2, 3 and 5 years). RESULTS The SFGS scores after 1, 2, 3 and 5 years were significantly better in the main group (resting symmetry p<0.01, voluntary movement symmetry p<0.01, synkinesis p<0.01, general condition of facial muscles p<0.01). Scores of physical and social functioning were significantly higher in the main group after 1 (p<0.01), 2 (p<0.01), 3 (p<0.01) and 5 years (p<0.01) after surgery. There was no need to change BTA dosage over 5 years. Thus, this form of BTA may be the most effective for synkinesis of facial muscles. CONCLUSION Correction of synkinesis caused by facial neuropathy requires long-term follow-up and long-term treatment. BTA is effective and may be recommended for long-term treatment of these patients.
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Affiliation(s)
- M A Akulov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - O R Orlova
- Sechenov First Moscow State Medical University, Moscow, Russia
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18
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Loyo Li M, Cameron MH, Volk GF. Does electrical stimulation still have a place in the treatment armamentarium for Bell's palsy? Expert Rev Neurother 2024; 24:1-3. [PMID: 38105767 DOI: 10.1080/14737175.2023.2295426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Myriam Loyo Li
- Facial Nerve Center, Department of Otolaryngology- Head and Neck Surgery, Oregon Health & Science University, Oregon, USA
| | - Michelle H Cameron
- Department of Neurology, Oregon Health & Science University, MS Center of Excellence-West, VA Portland Health Care System, Portland, OR, USA
| | - Gerd Fabian Volk
- Facial-Nerve-Center, Department of Otorhinolaryngology, Head and Neck Surgery, Center of Rare Diseases, Jena University Hospital, Jena, Germany
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19
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Hijioka T, Aoki Y, Moteki H, Mizushiro N. Bell’s palsy with abnormal findings in the ipsilateral parotid gland. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2023. [DOI: 10.1080/23772484.2023.2176858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
| | - Yoshihiro Aoki
- Department of Pediatrics, Aizawa Hospital, Matsumoto, Japan
- Coordination Office for Emergency Medicine and International Response, Acute and Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideaki Moteki
- Department of Otorhinolaryngology, Aizawa Hospital, Matsumoto, Japan
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20
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Altowayan RM, Alruwaysan SA, Alraddadi S, Alanazi MA, Alharbi S, Alobaid NM, Aldakhil LM, Almohaimeed AF, Alhomaid TA. Knowledge and Awareness Regarding Bell's Palsy in the Al-Qassim Region, Saudi Arabia. Cureus 2023; 15:e51327. [PMID: 38288216 PMCID: PMC10823306 DOI: 10.7759/cureus.51327] [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] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction: Bell's palsy, characterized by acute onset unilateral facial weakness, is caused by the paralysis of the seventh cranial nerve, which controls the muscles of the face. This condition can result in functional disabilities, and early detection and management are crucial for quick recovery. Awareness was found to be one of the factors associated with early detection and interventions. Therefore, this study aimed to assess the awareness of the population of Al-Qassim, Saudi Arabia, regarding Bell's palsy. METHODS We conducted a cross-sectional study on 1,198 participants in Al-Qassim, Saudi Arabia, between May and July 2023. We used a self-administered online questionnaire inquiring about knowledge and awareness of Bell's palsy. We performed descriptive and correlation analyses, and a p-value of less than 0.05 indicated a statistical significance. RESULTS The mean (± SD) knowledge score was 7.02 ± 2.03 out of a total of 13 points. Almost a third of participants (n=353, 29.5%) expressed uncertainty about the causes of Bell's palsy, with 346 (28.9%) and 107 (8.9%) attributing it to idiopathic factors and viral infections, respectively. Most participants (n=520, 43.4%) believed both genders were equally affected, while 563 (46.9%) correctly identified cranial nerve 7 as the affected nerve. Treatment awareness varied, with 629 (58.2%) acknowledging physiotherapy and (n=777, 64.9%) acknowledging traditional medicine. Interestingly, only 111 (9.3%) thought that Bell's palsy was permanent, most participants (n=1023, 85.4%) recognized Bell's palsy as treatable, and 1,105 (92.2%) correctly perceived it as non-contagious. There were significant correlations between awareness and age (p<0.001), gender (p<0.001), marital status (p<0.001), occupation (p<0.001), information source (p<0.001), nationality (p=0.009), and education levels (p<0.031). Addressing these gaps and demographic nuances through targeted educational campaigns is crucial for enhancing overall awareness of Bell's palsy. CONCLUSION These findings indicate suboptimal awareness among participants in general, poor knowledge about causes and clinical manifestation, and a relatively better awareness of treatments. We recommend further studies exploring awareness and associated factors.
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Affiliation(s)
- Ruba M Altowayan
- Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | - Samar A Alruwaysan
- Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | - Seba Alraddadi
- Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | | | - Seham Alharbi
- Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | - Njood M Alobaid
- Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | - Lama M Aldakhil
- Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | - Abdulaziz F Almohaimeed
- Department of Public Health, Department of Medicine and Surgery, King Fahad Specialist Hospital, Buraydah, SAU
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21
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Kim S, Kang M, Park JS, Seok HY. Risk and characteristics of Bell's palsy in adults as an adverse event following COVID-19 vaccination: a retrospective study. Acta Neurol Belg 2023; 123:2185-2193. [PMID: 36781626 PMCID: PMC9924857 DOI: 10.1007/s13760-023-02204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Although an association between COVID-19 vaccination and Bell's palsy (BP) has been reported, a clear causal relationship has not been elucidated. We investigated the risk and clinical characteristics of BP after COVID-19 vaccination. METHODS This retrospective chart review evaluated the association between COVID-19 vaccination and BP by comparing the number of patients diagnosed with BP during the pre-COVID-19 vaccination period (March 2018-February 2021) and the COVID-19 mass vaccination period (March 2021-February 2022). We then compared vaccine-related (time between vaccination and BP onset < 42 days) and -unrelated (time interval ≥ 42 days or non-vaccination) clinical characteristics in newly diagnosed patients with BP. RESULTS BP occurred more during the COVID-19 vaccination period than in the previous three pre-vaccination years. Thirteen patients developed BP within 42 days of vaccination. All patients, except one, developed BP after mRNA-based vaccination, with most cases (9/13, 69.2%) occurring after the second or third dose. Thirteen patients with vaccine-related BP were younger (age 43.92 ± 13.14 vs. 54.32 ± 16.01 years; p = 0.033) and more frequently experienced taste changes (58.8% vs. 10.9%; p = 0.002) than 52 patients with vaccine-unrelated BP. Patients with vaccine-related BP had a greater likelihood of good and faster (p = 0.042) facial nerve function recovery than those with vaccine-unrelated BP (100% vs. 78%). CONCLUSION COVID-19 vaccines, especially mRNA-based vaccines, may be associated with BP cases with distinctive clinical characteristics, which occur more frequently in young individuals, are frequently accompanied by taste changes, and have fast and good recovery.
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Affiliation(s)
- Sohyeon Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Minsung Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-Ro, Buk-Gu, Daegu, 41404, Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-Ro, Buk-Gu, Daegu, 41404, Korea.
| | - Hung Youl Seok
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.
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22
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Patel DJ, Chaudhari K, Shrivastava D, Dave A. Bell's Palsy Unmasked: A Compelling Case Study of Facial Nerve Palsy During Pregnancy. Cureus 2023; 15:e51369. [PMID: 38292948 PMCID: PMC10825380 DOI: 10.7759/cureus.51369] [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: 11/14/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Facial paralysis occurs more frequently in pregnant individuals, affecting them two to four times more often than those who are not pregnant, making it the most frequent unilateral cranial nerve pathology in pregnancy. This case report describes a 29-year-old primigravida's presentation, examination, and treatment of left-sided (unilateral) facial nerve palsy during 32 weeks of gestation. Concerns regarding possible underlying reasons were raised when the patient suddenly developed left-side facial weakness. We examined her history, clinical assessment, and diagnosis methods, which included laboratory and neuro-imaging tests. The difficulties of managing this illness during pregnancy are explored, taking into account the well-being of the developing fetus and mother. There are several causes for facial nerve palsy during pregnancy, including idiopathic causes, vascular problems, and viral infections. Here, we emphasize the value of a multidisciplinary approach comprising obstetricians, neurologists, and other medical professionals to guarantee the best possible care. The paper also underscores the necessity for prompt diagnosis and suitable interventions to reduce problems and foster a successful outcome. This case report adds to the limited literature on facial nerve palsy in pregnancy by highlighting individualized medical care and teamwork in addressing this uncommon but serious condition.
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Affiliation(s)
- Dharmesh J Patel
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepti Shrivastava
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Apoorva Dave
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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23
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Di Pietro A, Cameron M, Campana V, Leyes L, Zalazar Cinat JAI, Lochala C, Johnson CZ, Hilldebrand A, Loyo M. Efficacy of adding selective electrical muscle stimulation to usual physical therapy for Bell's palsy: immediate and six-month outcomes. Eur J Transl Myol 2023; 33:11630. [PMID: 37877154 PMCID: PMC10811644 DOI: 10.4081/ejtm.2023.11630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/26/2023] Open
Abstract
Bell's palsy is the most common cause of facial paralysis, affecting one in every 60 people in their lifetime. Transcutaneously applied selective electrical muscle stimulation could potentially accelerate recovery from Bell's palsy but this intervention remains controversial. Studies have shown benefit, but concerns for lack of efficacy and potential for worsening synkinesis remain. We performed a prospective controlled trial comparing outcomes at initial recovery and six months later with selective electrical muscle stimulation and usual physical therapy versus usual physical therapy alone in adults with acute Bell's palsy. Outcomes were facial function assessed with the House Brackman and eFACE scales. Outcomes were evaluated at discharge and six months after discharge. Discharge occurred when participants were judged to be fully recovered by their treating therapist and supervisor. 38 adults participated in the study. Participants in the electrical stimulation group achieved maximal recovery twice as fast as the control group (2.5 weeks versus 5.2 weeks) with no significant differences in facial function or synkinesis between groups at any time point. This study is the first human trial of electrical stimulation in Bell's palsy to follow patients 6 months from recovery and supports that selective electrical muscle stimulation accelerates recovery and does not increase synkinesis.
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Affiliation(s)
| | - Michelle Cameron
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; VA Portland Health Care System.
| | - Vilma Campana
- Department of Biomedical Physics, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba.
| | - Laura Leyes
- Department of Kinesiology and Physical Therapy, Universidad Nacional del Nordeste, Corrientes.
| | | | - Carly Lochala
- Department of Rehabilitation, Oregon Health & Science University, Portland, OR, USA; Division of Biokinesiology & Physical Therapy, University of Southern California.
| | - Christopher Z Johnson
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
| | - Andrea Hilldebrand
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA; Portland State University School of Public Health, Portland, OR.
| | - Myriam Loyo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
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Jones H, Hintze J, Slattery F, Gendre A. Bell's palsy in pregnancy: A scoping review of risk factors, treatment and outcomes. Laryngoscope Investig Otolaryngol 2023; 8:1376-1383. [PMID: 37899862 PMCID: PMC10601580 DOI: 10.1002/lio2.1136] [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: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023] Open
Abstract
Objective There are limited studies reporting on Bell's palsy and pregnancy. Our study aimed to evaluate risk factors, current treatment options and facial function outcomes in women who developed Bell's palsy in pregnancy. To our knowledge this is the first review analyzing these factors. Data sources/review methods A search of PubMed/MEDLINE, Embase, Web of Sciences and Scopus was carried out. Studies describing risk factors, treatment and/or facial function outcomes of Bell's palsy in pregnancy were included. PRISMA-Scr guidelines were followed. Results The search yielded 392 abstracts, of which 15 studies were included for analysis. It was not possible to perform a meta-analysis due to small numbers and quality of studies. There were 559 patients included from the 15 studies. The third trimester was the most common time for Bell's palsy to occur (n = 364, 65%). Pre-eclampsia was the most common co-morbidity reported. The most common treatment was corticosteroids and the majority of patients had a complete recovery of their palsy (58%, n = 192). Conclusion This analysis has evaluated all available data concerning risk factors, treatment and facial function outcomes of BP in pregnancy. The third trimester is the most common time for Bell's palsy to occur in pregnancy. There is currently a lack of high quality evidence into this condition in pregnancy. Level of evidence 1.
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Affiliation(s)
- Holly Jones
- Department of Otolaryngology, Head and Neck SurgeryBeaumont HospitalDublinIreland
- Royal College of Surgeons in IrelandDublinIreland
| | - Justin Hintze
- Department of Otolaryngology, Head and Neck SurgeryBeaumont HospitalDublinIreland
- Royal College of Surgeons in IrelandDublinIreland
| | - Fionn Slattery
- Department of Otolaryngology, Head and Neck SurgeryBeaumont HospitalDublinIreland
- Royal College of Surgeons in IrelandDublinIreland
| | - Adrien Gendre
- Department of Otolaryngology, Head and Neck SurgeryBeaumont HospitalDublinIreland
- Royal College of Surgeons in IrelandDublinIreland
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Dreschnack PA, Belshaku I. Treatment of idiopathic facial paralysis (Bell's Palsy) and secondary facial paralysis with extracellular vesicles: a pilot safety study. BMC Neurol 2023; 23:342. [PMID: 37770834 PMCID: PMC10536754 DOI: 10.1186/s12883-023-03400-6] [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: 08/24/2022] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Paralysis of the facial nerve (CN VII) is one of the most debilitating issues that any patient can encounter. Bell's palsy is the most commonly seen mononeuropathy. Although usually self-limited, symptomatology can persist for decades in persistent cases. The non-surgical alternative therapies discussed in this study are successful without reconstruction and are regenerative. OBJECTIVE AND DESIGN We sought to determine a safe new treatment could be developed to restore facial nerve function using extracellular vesicles (EVs) in patients who have been unable to return to normal under a variety of conditions. We performed a pilot safety study of 7 patients with idiopathic and secondary facial paralysis to determine if any functional restoration was possible. Each patient had symptomology for varying periods of time, with diverse House-Brackmann scores. They were all treated with the same protocol of extracellular vesicles (EVs) over a 4-week period of time and were evaluated both before and after treatment. CASE PRESENTATIONS All patients in this study received treatment by their private physicians prior to entering the study. A record review was completed, with independent physical examinations. House-Brackmann scores and Facial Disability Indices were obtained prior to, and after completing the study. EVs were injected into the area of the main trunk of the facial nerve on the affected side, and an intravenous drip of EVs on visits during weeks 1, 2, and 4. CONCLUSIONS All seven patients enrolled in the study improved with this treatment protocol. After the second week of treatment, we saw a progression of independent motion of the affected eyelid, brow motion, and commissure. Although all patients began at different House-Brackman starting points, almost all ended at the same endpoint on the scale over the same period of time - four weeks. No adverse effects were encountered. Clearly, the duration of the treatment protocol needs to be longer than one month. The pathomechanism is still unknown. But it appears that the mechanism is reversible. At last, these patients can have hope. TRIAL REGISTRATION The Institute of Regenerative and Cellular Medicine IRB approval number: IRCM-2021-304.
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Lee LN, McCarty JC, Gadkaree SK, Ford OA, Occhiogrosso J, Yau J, Hadlock TA, Derakhshan A. Effect of Filler Therapy on Psychosocial Distress in Facial Paralysis: Patients with Major Asymmetry Derive Greater Benefit. Facial Plast Surg Aesthet Med 2023; 25:415-419. [PMID: 36459105 DOI: 10.1089/fpsam.2022.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Facial filler is an effective nonsurgical treatment option for improving facial symmetry in patients with facial paralysis (FP). Objective: To compare the effects of filler among patients with FP that is self-perceived as major or minor asymmetry, by measuring psychosocial distress. Methods: In this prospective cohort study of patients with FP undergoing filler at a tertiary academic center, patients were classified as having minor or major self-perceived asymmetry using a visual analog scale (VAS). FACE-Q Appearance-Related Psychosocial Distress was administered before and after filler. Descriptive statistics and a random-effects generalized linear model assessed the relationship between perceived facial asymmetry and change in psychosocial distress. Results: A total of 28 patients participated. Twenty-five (89%) patients were female with median age of 54 (interquartile range [IQR]: 49-66). Median VAS score was 2 (IQR: 1-3.5, 0 = completely asymmetric, 10 = no asymmetry). Psychosocial distress improved in all patients after filler. In multivariable modeling, patients with major asymmetry experienced 2.45 (confidence interval: 0.46-4.44, p = 0.016) points more improvement in psychosocial distress than patients with minor asymmetry. Age, gender, and FP duration were not associated with change in psychosocial distress. Conclusion: Facial filler treatment was seen to improve psychosocial distress in patients with FP, especially by those with more self-perceived deficit.
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Affiliation(s)
- Linda N Lee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Justin C McCarty
- Division of Plastic Surgery, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shekhar K Gadkaree
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Olivia Abbate Ford
- Division of Plastic Surgery, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jessica Occhiogrosso
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jenny Yau
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Adeeb Derakhshan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Zhang T, Gan Y, Bai Y, Hao W, Zeng Z, Wu F, Li X. Influence of cold-stimulated adipocyte supernatant on the expression of adhesion-related molecules in Schwann cell line. Biochem Biophys Rep 2023; 35:101523. [PMID: 37529013 PMCID: PMC10388730 DOI: 10.1016/j.bbrep.2023.101523] [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: 05/17/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
Bell's palsy is the most common form of facial nerve palsy. This study aimed to explore the pathogenesis of Bell's palsy by investigating the effect of cold-stimulated adipocyte supernatant on adhesion molecule expression in Schwann cell line. Schwann cells were cultured in regular or adipocyte-conditioned medium and analyzed using RNA sequencing. The mRNA expression of Schwann cell adhesion molecules melanoma cell adhesion molecule (MCAM), protocadherin 9 (PCDH9), and intercellular cell adhesion molecule 1 (ICAM1) was determined using real-time reverse-transcription polymerase chain reaction. Differentially expressed genes were identified, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were conducted. Compared with Schwann cells in 37 °C, the expression of MCAM, PCDH9, and ICAM1 was downregulated in Schwann cells treated with cold-stimulated adipocyte supernatant compared with Schwann cells in 37 °C. Adipocytes subjected to cold exposure may weaken the adhesion capacity of Schwann cells and disrupt the local homeostasis of Schwann cell-axon interactions by affecting the expression of MCAM, PCDH9, and ICAM1, ultimately leading to the development of demyelinating lesions.
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Affiliation(s)
- Tiefeng Zhang
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, 030001, China
| | - Yaxin Gan
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, 030001, China
| | - Yulan Bai
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, 030001, China
| | - Weijiang Hao
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, 030001, China
| | - Ziqi Zeng
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, 030001, China
| | - Feng Wu
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, 030001, China
| | - Xianqi Li
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi, 030001, China
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Matsumoto Dental University, Shiojiri, 399-0781, Japan
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Wu D, Zhao YL, Sun JY, Dai RJ, Cao K, Qu RK, Wang Y, Wu YQ. A Nonrandomized Trial of the Effects of Near-Infrared Photobiomodulation Therapy on Bell's Palsy with a Duration of Greater Than 8 Weeks. Photobiomodul Photomed Laser Surg 2023; 41:490-500. [PMID: 37738368 DOI: 10.1089/photob.2023.0056] [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] [Indexed: 09/24/2023] Open
Abstract
Objective: To determine whether photobiomodulation therapy (PBMT) by class IV Multiwave Locked System laser treatment as an adjunctive therapy could relieve symptoms in patients with Bell's palsy with a duration of greater than 8 weeks. Materials and methods: This nonrandomized controlled trial was conducted from January 2020 to December 2022. Patients were eligible if they had Bell's palsy with a duration of greater than 8 weeks at the out-patient department of otorhinolaryngology in Beijing Tongren Hospital. The control group consisted of patients recruited between January 1, 2020, and December 31, 2020. The PBMT group consisted of patients recruited between January 1, 2021, and December 31, 2022. In this study, the PBM used has a wavelength of 808 and 905 nm, 1.2 W power (808 nm is 1 W, 905 nm is 200 mW), continuous mode emission (808 nm) and pulsed mode emission (905 nm), 8.35 J/cm2 dosimetry, administered 3 times per week, 72 times of total treatment. The primary outcome measures included the House-Brackmann facial nerve grading system, the Sunnybrook facial grading system, and the Facial Clinimetric Evaluation Scale (FaCE). Secondary outcome measures comprised electroneurography, electromyography, and the blink reflex. Results: A total of 54 participants were included (27 in the control group and 27 in the photobiomodulation group). After 6 months, the House-Brackmann grading system [risk difference, -0.59, confidence interval (95% CI), -0.81 to -0.38, relative risk, 0.27, 95% CI, 0.13-0.56, p < 0.001], Sunnybrook facial grading system (21.14, 95% CI, 11.71-30.58; p < 0.001), and FaCE (-0.20, 95% CI, 0.41-0.02; p = 0.07) had significant difference between the two groups. Latency of ala nasi muscle (10.92, 95% CI, 5.58-16.27; p < 0.001) was not statistically significant after treatment compared with the control group; however, most of the electrophysiological examinations have significant difference between the two groups, respectively. Conclusions: The results of this study suggest that PBMT may relieve symptoms for patients with Bell's palsy with a duration of greater than 8 weeks. Trial Registration: ClinicalTrials.gov Identifier: NCT05585333.
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Affiliation(s)
- Dong Wu
- Department of Traditional Chinese Medicine and Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yan-Ling Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing-Yi Sun
- Department of Oncology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ru-Jun Dai
- TED Healthcare Technology Ltd (Beijing), Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong-Kun Qu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Institute of Acupuncture-Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yun-Qing Wu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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McCoul ED, Megwalu UC, Joe S, Gray R, O'Brien DC, Ference EH, Lee VS, Patel PS, Figueroa-Morales MA, Shin JJ, Brenner MJ. Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngol Head Neck Surg 2023; 168:643-657. [PMID: 35349383 DOI: 10.1177/01945998221087664] [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: 11/30/2021] [Accepted: 02/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
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Affiliation(s)
- Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Stephanie Joe
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Raluca Gray
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel C O'Brien
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Prayag S Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Marco A Figueroa-Morales
- Department of Otolaryngology-Head and Neck Surgery, Mexican Social Security Institute, Mexico City, Mexico
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Yoshida A, Tsuzuki N, Kanzaki S. Association Between Multiple Sclerosis and the Symptoms of Vertigo and Facial Nerve Palsy. EAR, NOSE & THROAT JOURNAL 2023:1455613221148310. [PMID: 36899449 DOI: 10.1177/01455613221148310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Patients with vertigo and facial nerve palsy as initial symptoms are rarely diagnosed with multiple sclerosis. A 43-year-old woman presented to our department with symptoms of vertigo and right facial nerve palsy (Yanagihara 16-point system [total score, 40] or House- Brackmann grade IV [obvious facial weakness]). On the day of the visit, she presented with right eye abduction, left eye adduction, and complaints of diplopia. Based on magnetic resonance imaging findings, she was diagnosed with clinically isolated syndrome, which is an early manifestation of multiple sclerosis. She was treated with intravenous methylprednisolone. Otolaryngologists often suspect Hunt's syndrome in patients who present with facial nerve palsy combined with vertigo. However, herein, we report our experience with an extremely rare case of a patient with atypical nystagmus symptoms, eye movement disorder, and diplopia secondary to facial palsy and vertigo, who presented with a clinical course different from that of Hunt's syndrome.
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Affiliation(s)
- Alyssa Yoshida
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyoshi Tsuzuki
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Sho Kanzaki
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Takemura K, Yamanaka T, Hayashida M, Kizawa R, Yamaguchi T, Tanabe Y, Sakaguchi K, Suyama K, Urakami S, Miura Y. Bell's palsy during rechallenge of immune checkpoint inhibitor. IJU Case Rep 2023; 6:144-146. [PMID: 36875003 PMCID: PMC9978074 DOI: 10.1002/iju5.12572] [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: 06/04/2022] [Accepted: 12/18/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction The peripheral nervous system is one of the target organs of immune-related adverse events. Peripheral facial nerve palsy, also called Bell's palsy, which is induced by immune checkpoint inhibitors, is quite rare, and its clinical features are not well known. Case presentation A man with renal cell carcinoma who received rechallenging immune checkpoint inhibitor therapy developed unilateral facial palsy and was diagnosed with Bell's palsy. He did not have any severe immune-related adverse events during his previous immune checkpoint inhibitor treatment. Corticosteroid therapy was immediately initiated, and his facial palsy symptoms promptly improved. Conclusion Physicians should be aware that Bell's palsy can occur as an immune-related adverse event. Additionally, careful observation is necessary during rechallenge with immune checkpoint inhibitors, even in patients who did not have previous immune-related adverse events.
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Affiliation(s)
- Kohji Takemura
- Department of Medical Oncology Toranomon Hospital Tokyo Japan
| | - Taro Yamanaka
- Department of Medical Oncology Toranomon Hospital Tokyo Japan
| | | | - Rika Kizawa
- Department of Medical Oncology Toranomon Hospital Tokyo Japan
| | | | - Yuko Tanabe
- Department of Medical Oncology Toranomon Hospital Tokyo Japan
| | | | - Koichi Suyama
- Department of Medical Oncology Toranomon Hospital Tokyo Japan
| | | | - Yuji Miura
- Department of Medical Oncology Toranomon Hospital Tokyo Japan
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Varelas AN, Dickstein L, Eytan DF. Episodic Facial Paresis-An Isolated Presenting Symptom of Multiple Sclerosis. JAMA Otolaryngol Head Neck Surg 2023; 149:374-375. [PMID: 36757719 DOI: 10.1001/jamaoto.2022.4662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This case report describes a case of a man in his 30s who presented with episodic right lower facial paresis for 10 days and was diagnosede with an episodic, transient pattern of unilateral facial palsy associated with relapsing remitting multiple sclerosis.
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Affiliation(s)
- Antonios N Varelas
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York
| | - Leah Dickstein
- Department of Neurology, New York University Grossman School of Medicine, New York
| | - Danielle F Eytan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York
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Efficacy of High-Dose Corticosteroid Therapy in Acute Stage Severe Facial Palsy in Children. Otol Neurotol 2023; 44:e103-e107. [PMID: 36449668 DOI: 10.1097/mao.0000000000003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To evaluate the efficacy of high-dose corticosteroid for severe acute facial paralysis in children. METHODS The present study enrolled 10 pediatric patients with House-Brackmann (H-B) Grade VI facial paralysis who received prednisolone (PSL) 3 to 4 mg/kg/d for 2 to 3 days followed by a 10-day taper (the child high-dose group). Eight pediatric patients who received PSL 0.5 to 1 mg/kg/d were enrolled in a child low-dose group, and nine adult patients (25-64 yr) who received a high-dose PSL 200 mg equivalent for 2 to 3 days followed by a 10-day taper were enrolled in an adult high-dose group. On the initial and follow-up visits, facial movements were evaluated using the H-B grading system. The degree of oral-ocular synkinesis was evaluated by the degree of asymmetry in eye-opening width during mouth movements. The synkinesis index was defined as a percentage of the interpalpebral space width ([normal side - affected side]/normal side). RESULTS The child high-dose group achieved a significantly better H-B score than the child low-dose group ( p < 0.01). The synkinesis index was significantly lower in the child high-dose group than in the child low-dose group or the adult high-dose group ( p < 0.05). CONCLUSION Children receiving PSL 3 to 4 mg/kg/d achieved better recovery and less synkinesis than those treated with low-dose PSL (0.5-1 mg/kg/d).
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King J, Virani FR, Thomas R, Squires L. Spontaneous Bilateral Facial Paralysis Secondary to Metastatic Breast Cancer. EAR, NOSE & THROAT JOURNAL 2023; 102:NP56-NP59. [PMID: 33491485 DOI: 10.1177/0145561320982693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Sudden onset, bilateral facial paralysis is a rare clinical entity, representing less than 2% of all diagnoses of facial nerve paralysis. The differential for these patients is necessarily broad and includes numerous etiologies. Metastatic breast carcinoma to the bilateral parotid glands is also exceedingly rare with only 2 reported case reports noted in the literature, neither of which demonstrated facial nerve paralysis. Here, we report the only known occurrence of a patient presenting with synchronous bilateral facial nerve paralysis secondary to metastatic breast carcinoma to the bilateral parotid glands. This exceedingly rare clinical presentation was further confounded by the presence of autoimmune antibodies, highlighting the importance of the diagnostic process and maintaining broad clinical suspicion.
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Affiliation(s)
- Jackson King
- Elson S. Floyd College of Medicine at Washington State University, Spokane, WA, USA
| | - Farrukh R Virani
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, CA, USA
| | - Ryan Thomas
- Department of Pathology and Laboratory Services, University of California, Davis, Medical Center, Sacramento, CA, USA
| | - Lane Squires
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, CA, USA.,Veterans Affairs Northern California Healthcare System, Sacramento, CA, USA
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Inagaki A, Takahashi M, Murakami S. Frequency-dependent hearing outcomes with or without preservation of intact ossicular articulations. Laryngoscope Investig Otolaryngol 2023; 8:185-191. [PMID: 36846434 PMCID: PMC9948566 DOI: 10.1002/lio2.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/27/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022] Open
Abstract
Objective To determine the frequency-specific benefits of ossicular chain preservation compared to performing disarticulations and reconstructions in transmastoid facial nerve decompression surgery in patients with an intact ossicular chain. Methods A retrospective chart review (January 2007 and June 2018) of patients undergoing transmastoid facial nerve decompression on the intact middle ear for severe facial palsy at a tertiary referral center. Surgery was performed with ossicular chain disarticulation on an as-needed basis using either ossicular chain preservation (without ossicular disarticulation), incudostapedial separation, or incus disarticulation technique. Hearing outcomes were assessed. Results The 108 patients were included in this study. Among these, 89 patients underwent ossicular chain preservation, 5 underwent incudostapedial separation and 14 underwent incus repositioning. The proportion of patients with a change in the 4-frequency air conduction pure-tone average of less than 10 dB was 91%, 60%, and 50%, respectively, for the three surgical techniques; these were significantly different (Fisher's exact test, p < .001). Frequency-specific analysis showed that air conduction was significantly better following the ossicular chain preservation technique compared with the incus repositioning technique at stimulation frequencies lower than 250 Hz and higher than 2000 Hz, and compared with the incudostapedial separation technique at 4000 Hz. Analysis of biometric measures determined on CT images suggested that the feasibility of the ossicular chain preservation technique correlates with incus body thickness on coronal CT images. Conclusions Ossicular chain preservation is an effective approach for hearing preservation in transmastoid facial nerve decompression or similar surgical procedures.
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Affiliation(s)
- Akira Inagaki
- Toyohashi Day‐Surgery ClinicToyohashiJapan
- Department of Otolaryngology, Head and Neck SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Mariko Takahashi
- Department of Otolaryngology, Head and Neck SurgeryAichi Gakuin University School of DentistryNagoyaJapan
| | - Shingo Murakami
- Department of Otolaryngology, Head and Neck SurgeryNagoya City University East Medical CenterNagoyaJapan
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Patapnyan E, Ronen O. Parallel reduction in the prevalence of Bell's palsy, idiopathic sudden sensorineural hearing loss and viral infection diseases during the COVID-19 pandemic. J Infect 2023; 86:e8-e9. [PMID: 36064045 PMCID: PMC9439857 DOI: 10.1016/j.jinf.2022.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 02/04/2023]
Affiliation(s)
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Department of Otolaryngology Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel,Correspondence: Ohad Ronen, Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, POB 21, Nahariya 2210001, Israel
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Mohseni Afshar Z, Sharma A, Babazadeh A, Alizadeh-Khatir A, Sio TT, Taghizadeh Moghadam MA, Tavakolli Pirzaman A, Mojadad A, Hosseinzadeh R, Barary M, Ebrahimpour S. A review of the potential neurological adverse events of COVID-19 vaccines. Acta Neurol Belg 2023; 123:9-44. [PMID: 36385246 PMCID: PMC9668235 DOI: 10.1007/s13760-022-02137-2] [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: 03/17/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
Despite the advantages of getting access to the coronavirus disease 2019 (COVID-19) vaccines, their potential ability to induce severe adverse events (AEs) has been a significant concern. Neurological complications are significant among the various adverse events following immunization (AEFI) due to their likely durability and debilitating sequelae. Neurological AEs following COVID-19 vaccination can either exacerbate or induce new-onset neuro-immunologic diseases, such as myasthenia gravis (MG) and Guillain-Barre syndrome (GBS). The more severe spectrum of AEs post-COVID19 vaccines has included seizures, reactivation of the varicella-zoster virus, strokes, GBS, Bell's palsy, transverse myelitis (TM), and acute disseminated encephalomyelitis (ADEM). Here, we discuss each of these neurological adverse effects separately.
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Affiliation(s)
- Zeinab Mohseni Afshar
- grid.412112.50000 0001 2012 5829Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akanksha Sharma
- grid.417468.80000 0000 8875 6339Department of Neurology, Mayo Clinic, Scottsdale, AZ USA
| | - Arefeh Babazadeh
- grid.411495.c0000 0004 0421 4102Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Alizadeh-Khatir
- grid.411495.c0000 0004 0421 4102Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Terence T. Sio
- grid.417468.80000 0000 8875 6339Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ USA
| | | | - Ali Tavakolli Pirzaman
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Ahmadreza Mojadad
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Rezvan Hosseinzadeh
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Gaber A, Taher MF, Abdel Wahed M, Shalaby NM, Gaber S. Comprehensive assessment of facial paralysis based on facial animation units. PLoS One 2022; 17:e0277297. [PMID: 36516130 PMCID: PMC9750034 DOI: 10.1371/journal.pone.0277297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022] Open
Abstract
Quantitative grading and classification of the severity of facial paralysis (FP) are important for selecting the treatment plan and detecting subtle improvement that cannot be detected clinically. To date, none of the available FP grading systems have gained widespread clinical acceptance. The work presented here describes the development and testing of a system for FP grading and assessment which is part of a comprehensive evaluation system for FP. The system is based on the Kinect v2 hardware and the accompanying software SDK 2.0 in extracting the real time facial landmarks and facial animation units (FAUs). The aim of this paper is to describe the development and testing of the FP assessment phase (first phase) of a larger comprehensive evaluation system of FP. The system includes two phases; FP assessment and FP classification. A dataset of 375 records from 13 unilateral FP patients was compiled for this study. The FP assessment includes three separate modules. One module is the symmetry assessment of both facial sides at rest and while performing five voluntary facial movements. Another module is responsible for recognizing the facial movements. The last module assesses the performance of each facial movement for both sides of the face depending on the involved FAUs. The study validates that the FAUs captured using the Kinect sensor can be processed and used to develop an effective tool for the automatic evaluation of FP. The developed FP grading system provides a detailed quantitative report and has significant advantages over the existing grading scales. It is fast, easy to use, user-independent, low cost, quantitative, and automated and hence it is suitable to be used as a clinical tool.
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Affiliation(s)
- Amira Gaber
- Faculty of Engineering, Systems and Biomedical Engineering Department, Cairo University, Giza, Egypt
| | - Mona F Taher
- Faculty of Engineering, Systems and Biomedical Engineering Department, Cairo University, Giza, Egypt
| | - Manal Abdel Wahed
- Faculty of Engineering, Systems and Biomedical Engineering Department, Cairo University, Giza, Egypt
| | | | - Sarah Gaber
- Faculty of Physical Therapy, Department of Neuromuscular Disorder and Its Surgery, Cairo University, Giza, Egypt
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Wamkpah NS, Kallogjeri D, Snyder-Warwick AK, Buss JL, Durakovic N. Incidence and Management of Facial Paralysis After Skull Base Trauma, an Administrative Database Study. Otol Neurotol 2022; 43:e1180-e1186. [PMID: 36214506 PMCID: PMC9649848 DOI: 10.1097/mao.0000000000003721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Report the incidence of and treatment patterns for facial nerve palsy after skull base fracture. STUDY DESIGN Retrospective cohort study. SETTING IBM MarketScan Commercial Database (2006-2019). PATIENTS Human subjects with skull base fracture, per International Classification of Diseases-9th and 10th Revisions-Clinical Modification diagnosis codes. MAIN OUTCOME MEASURES The primary outcomes were the incidence and median time to facial nerve palsy diagnosis within 30 days of skull base fracture. Secondary outcomes were treatments (corticosteroids, antivirals, facial nerve decompression, botulinum toxin, and facial reanimation), demographics, and rates of hearing loss, vertigo, tympanic membrane rupture, cerebrospinal fluid leak, comorbidities, and loss of consciousness. RESULTS The 30-day incidence of facial nerve palsy after skull base trauma was 1.0% (738 of 72,273 patients). The median (95% confidence interval [CI]) time to diagnosis was 6 (6-7) days, and only 22.9% were diagnosed within 1 day. There were significantly higher rates (risk difference, 95% CI) of hearing loss (26%, 22-29%), tympanic membrane rupture (6.3%, 4.5-8.1%), cerebrospinal fluid leak (6.4%, 4.5-8.3%), comorbidity (14%, 10.4-17.6%), and loss of consciousness (24.3%, 20.7-27.9%). Loss of consciousness was associated with longer median (95% CI) time to facial nerve palsy diagnosis: 10 (9-10) days. Corticosteroids were the most common treatment but only reported for less than one-third of patients. Only eight patients underwent facial nerve decompression. CONCLUSIONS Facial nerve palsy after skull base fracture is associated with higher comorbidity, and the diagnosis is often delayed. Few patients were treated with surgery, and there are inconsistencies in the types and timing of treatments.
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Affiliation(s)
- Nneoma S. Wamkpah
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Dorina Kallogjeri
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Alison K. Snyder-Warwick
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO
| | - Joanna L. Buss
- Institute of Clinical and Translational Sciences, Center for Administrative Data Research, Washington University in St. Louis, St. Louis, MO
| | - Nedim Durakovic
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
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Chiang P, Martins MR. The Anatomical Specificity Between Acupoints and the Facial Nerve: A Cadaveric Study. Med Acupunct 2022; 34:391-399. [PMID: 36644430 PMCID: PMC9805865 DOI: 10.1089/acu.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective This research was conducted to increase precision of point location and standardize acupoint targets in relation to the facial nerve (CN VII). Materials and Methods A literature review, cadaver dissection, and electrostimulation of the CN VII were performed, focusing on the anatomical locations of the acupoints along the facial-nerve trajectory. The results were contrasted against established acupoint locations described in the 4th edition of Chinese Acupuncture and Moxibustion. Results Triple Energizer (TE)-17 targets the facial nerve at its cranial exit; Qian Zheng at the facial nerve trunk; Tai Yang at the frontotemporal branch; Gallbladder (GB)-3 at the zygomatic branch; Small Intestine (SI)-18 at the buccal branch; Stomach (ST)-5 at the marginal mandibular branch; SI-17 at the cervical branch; TE-18 at the posterior auricular branch; TE-19 at the posterior auricular nerve; TE-20 at the superior auricular nerve; and TE-22 at the anterior auricular nerve. Conclusions This study demonstrated the specificity with which acupuncture points are located in relation to the facial nerve. Standardization of facial acupuncture points to distinct branches of the facial nerve will facilitate reproducible research designs and interpractitioner reproducibility.
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Affiliation(s)
- Poney Chiang
- River Clinic Integrative Medicine, Markham, Ontario, Canada
- Faculty of Health, Department of Health Science, School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
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Kar M, Altıntaş M. Seasonal Distribution of Bell's Palsy. Indian J Otolaryngol Head Neck Surg 2022; 74:4065-4068. [PMID: 36742807 PMCID: PMC9895622 DOI: 10.1007/s12070-021-02796-2] [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: 06/19/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023] Open
Abstract
Bell's palsy (BP) is the most frequently diagnosed acute partial or complete paralysis of the facial nerve which has an unclear etiology and mostly affects one side of the face. Adverse weather conditions are considered to increase the likelihood of developing BP. The retrospective study included 199 BP patients aged 2-82 years that presented to the Ear, Nose, and Throat (ENT) clinics at Kumluca State Hospital and Serik State Hospital, Antalya, Turkey and received treatment between January 2017 and December 2020. The 199 patients comprised 106 (53.3%) men and 93 (46.7%) women with a mean age of 42.23 ± 12.99 years. The highest incidence of BP was observed in winter (December-February) (35%), followed by fall (23%), summer (22%), and spring (20%) (p < 0.05). Accordingly, the incidence of BP was significantly higher in November, December, January and February compared to other months of the year (p < 0.05). The results indicated that BP shows seasonal variation and its peak incidence is in winter (December-February). Further studies are needed to explain the reasons for seasonal differences in BP. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02796-2.
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Affiliation(s)
- Murat Kar
- Ear Nose and Throat Clinic, Kumluca State Hospital, Posta Kodu: 07350 Antalya, Turkey
| | - Mustafa Altıntaş
- Ear Nose and Throat Clinic, Serik State Hospital, Antalya, Turkey
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Schepens EJA, Blijleven EE, Boek WM, Boesveldt S, Stokroos RJ, Stegeman I, Kamalski DMA. Prednisolone does not improve olfactory function after COVID-19: a randomized, double-blind, placebo-controlled trial. BMC Med 2022; 20:445. [PMID: 36384737 PMCID: PMC9667850 DOI: 10.1186/s12916-022-02625-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prednisolone has been suggested as a treatment for olfactory disorders after COVID-19, but evidence is scarce. Hence, we aimed to determine the efficacy of a short oral prednisolone treatment on patients with persistent olfactory disorders after COVID-19. METHODS We performed a randomized, double-blind, placebo-controlled, single-centered trial in the Netherlands. Patients were included if they were > 18 years old and if they had persistent (> 4 weeks) olfactory disorders within 12 weeks after a confirmed COVID-19 test. The treatment group received oral prednisolone 40 mg once daily for 10 days and the placebo group received matching placebo. In addition, all patients performed olfactory training. The primary outcome was the objective olfactory function on Sniffin' Sticks Test (SST) 12 weeks after the start of treatment, measured in Threshold-Discrimination-Identification (TDI) score. Secondary outcomes were objective gustatory function assessed by the Taste Strip Test (TST) and subjective self-reported outcomes on questionnaires about olfactory, gustatory and trigeminal function, quality of life, and nasal symptoms. The CONSORT 2010 guideline was performed. RESULTS Between November 2021 and February 2022, we included 115 eligible patients, randomly assigned to the treatment (n = 58) or placebo group (n = 57). No difference in olfactory function between groups was obtained after 12 weeks. Median TDI score on SST was 26.8 (IQR 23.6-29.3) in the placebo group and 28.8 (IQR 24.0-30.9) in the prednisolone group, with a median difference of 2.0 (95% CI 0.75 to 1.5). There was similar improvement on olfactory function in both groups after 12 weeks. Furthermore, on secondary outcomes, we obtained no differences between groups. CONCLUSIONS This trial shows that prednisolone does not improve olfactory function after COVID-19. Therefore, we recommend not prescribing prednisolone for patients with persistent olfactory disorders after COVID-19. TRIAL REGISTRATION This trial is registered on the ISRCTN registry with trial ID ISRCTN70794078.
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Affiliation(s)
- Emma J A Schepens
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Esther E Blijleven
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilbert M Boek
- Department of Otorhinolaryngology- Head and Neck Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Sanne Boesveldt
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Digna M A Kamalski
- Department of Otorhinolaryngology- Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Bose S, Anjankar A. Incidence of Facial Nerve Palsy in Pregnancy. Cureus 2022; 14:e31426. [DOI: 10.7759/cureus.31426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022] Open
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Khan AJ, Szczepura A, Palmer S, Bark C, Neville C, Thomson D, Martin H, Nduka C. Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil 2022; 36:1424-1449. [PMID: 35787015 PMCID: PMC9510940 DOI: 10.1177/02692155221110727] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published between 01 January 2011 and 30 September 2020. METHODS Predetermined inclusion/exclusion criteria were utilised to shortlist abstracts. Two reviewers independently appraised articles, systematically extracted data and assessed the quality of individual studies and reviews (using GRADE and AMSTAR-2, respectively). Thematic analysis used for evidence synthesis; no quantitative meta-analysis conducted. The review was registered with PROSPERO (CRD42017073067). RESULTS Seven new randomised controlled trials, nine observational studies, and three quasi-experimental or pilot studies were identified (n = 854 participants). 75% utilised validated measures to record changes in facial function and/or patient-rated outcomes. High-quality trials (4/7) all reported positive impacts; as did observational studies rated as high/moderate quality (3/9). The benefit of therapy at different time points post-onset and for cases of varying clinical severity is discussed. Differences in study design prevented data pooling to strengthen estimates of therapy effects. Six new review articles identified were all rated critically low quality. CONCLUSION The findings of this targeted review reinforce those of the earlier more general Cochrane review. New research studies strengthen previous conclusions about the benefits of facial exercise therapy early in recovery and add to evidence of the value in chronic cases. Further standardisation of study design/outcome measures and evaluation of cost-effectiveness are recommended.
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Affiliation(s)
- Amir J Khan
- Department of Economics, Institute of Business
Administration, Karachi, Pakistan
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Ala Szczepura
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Shea Palmer
- Centre for Healthcare Research, Coventry University, Coventry, UK
- Centre for Care Excellence, Coventry University & University
Hospital Coventry & Warwickshire, Coventry, UK
| | - Chris Bark
- Lanchester Library, Coventry University, Coventry, UK
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - David Thomson
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - Helen Martin
- St Helens and Knowsley Teaching Hospitals
NHS Trust, Liverpool, UK
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
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Lovin BD, Sweeney AD, Chapel AC, Alfonso K, Govil N, Liu YCC. Effects of Age on Delayed Facial Palsy After Otologic Surgery: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2022; 131:1092-1101. [PMID: 34706584 DOI: 10.1177/00034894211053966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To report 4 cases of delayed facial palsy (DFP) after pediatric middle ear (ME) surgery and systematically review and analyze the associated literature to evaluate the effects of age on DFP etiology, management, and prognosis. METHODS Systematic review of PubMed, Cochrane Library, and Embase for articles related to DFP after cochlear implantation (CI) was performed. These articles were assessed for level of evidence, methodological limitations, and number of cases. Meta-analysis was performed to assess the effects of age on DFP incidence. Furthermore, a comprehensive list of all pediatric DFP cases after otologic surgery was assembled through a multi-institutional retrospective review and systematic review of the literature. RESULTS Twenty-nine articles fit the criteria for inclusion in the meta-analysis. The incidence of DFP after CI was 0.23% and 1.01% for pediatric and adult cases, respectively. This difference was statistically significant (P < .001, odds ratio 4.36). Twenty-three cases, adding to the 4 presented herein, were suitable for a comprehensive list. The mean age was 6.9 years. Average postoperative day of paresis onset was 5.4, with an average maximum House-Brackmann grade of 3.5. All patients obtained full facial recovery after an average of 23.5 days. CONCLUSIONS The systematic review demonstrates that DFP after pediatric CI is rare and occurs at a significantly lower rate than in adults, further supporting the viral reactivation hypothesis of DFP. The prognosis for pediatric DFP after otologic surgery is excellent, with a high rate of full recovery in a short time frame. However, steroid administration can be considered. LEVEL OF EVIDENCE IIa.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Kristan Alfonso
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nandini Govil
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yi-Chun Carol Liu
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA
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Chen WQ, Li Q. Electroacupuncture combined with Qianzhengsan decoction for the treatment of peripheral facial paralysis: A retrospective study. Medicine (Baltimore) 2022; 101:e30740. [PMID: 36123862 PMCID: PMC9478275 DOI: 10.1097/md.0000000000030740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study retrospectively explored the effectiveness of electroacupuncture (EA) combined with Qianzhengsan decoction (QZSD) for the treatment of peripheral facial paralysis (PFP). This retrospective study included patients with PFP admitted to a single hospital between July 2018 and June 2020. Ninety patients were included and divided into treatment (n = 45) and control (n = 45) groups. All the patients in both groups received oral prednisone tablets and mecobalamin. In addition, patients in the treatment group received EA and QZSD. The outcomes were the overall response rate, facial nerve function, facial nerve electromyography, and adverse events. All outcome data were analyzed before and after treatment. Patients in the treatment group achieved better outcomes than those in the control group in improving overall response rate (P = .04), facial nerve function (P < .01), and facial nerve electromyography (P < .01). Patients in both groups reported adverse events. The results of this study showed that patients with PFP and QZSD received better outcomes than those who did not. Further studies are required to confirm these results.
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Affiliation(s)
- Wei-Qiang Chen
- Third Ward of Neurology Department, Xingyuan Hospital of Yulin/4th Hospital of Yulin, Yulin, China
| | - Qiang Li
- First Ward of Neurology Department, Xingyuan Hospital of Yulin/4th Hospital of Yulin, Yulin, China
- *Correspondence: Qiang Li, First Ward of Neurology Department, Xingyuan Hospital of Yulin/4th Hospital of Yulin, No. 33, West Renmin Road, Yuyang District, Yulin, Shaanxi 719000, China (e-mail: )
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Magnetic resonance imaging findings of delayed facial palsy after dental procedures suggest viral reactivation as pathogenesis: a retrospective study. Acta Neurol Belg 2022:10.1007/s13760-022-01957-6. [DOI: 10.1007/s13760-022-01957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/15/2022] [Indexed: 11/01/2022]
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Yang LS, Zhou DF, Zheng SZ, Zhao BM, Li HG, Chen QQ, Zhong Y, Yang HZ, Zhang K, Tang CZ. Early intervention with acupuncture improves the outcome of patients with Bell's palsy: A propensity score-matching analysis. Front Neurol 2022; 13:943453. [PMID: 36188388 PMCID: PMC9517937 DOI: 10.3389/fneur.2022.943453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Although acupuncture is widely used as a complementary therapy in the treatment of Bell's palsy (BP) when to initiate acupuncture is still controversial. This study aims to determine the efficacy of the early intervention by acupuncture on BP. Methods We retrospectively gathered clinical data from the Third Affiliated Hospital of SUN-YAT SEN University between 2016 and 2021. We selected newly diagnosed patients with BP who were diagnosed by registered neurologists or acupuncturists formally. The qualified patients were divided into two groups according to whether or not initial acupuncture treatment was given within 7 days from the onset of palsy. Cohorts were balanced using 1:1 propensity score matching (PSM). Cox proportional hazards modeling and Kaplan–Meier analysis were applied to determine the differences between the two groups. The outcome included time to complete recovery of facial function, the rate of complete recovery, and the occurrence of sequelae in 24 weeks. Results A total of 345 patients were eligible for this study and were divided into the manual acupuncture/electroacupuncture (MA/EA) group (n = 76) and the EA group (n = 125). In the propensity score-matched cohort, the time to complete recovery was significantly shorter in the MA/EA group compared with the patients in the EA group (hazard ratio 1.505, 95% CI 1.028–2.404, p <0.05). The MA/EA group had a higher rate of favorable outcomes at 12 weeks than the EA group (93.4 vs. 80.3%, p = 0.032), and the occurrence of sequelae at 24 weeks showed a greater reducing trend in the MA/EA group than the EA group (6.6 vs. 16.4%, p = 0.088). Conclusion Acupuncture intervention at the acute stage of BP could shorten the time to recovery and improve the outcome. Clinical trial registration http://www.chictr.org.cn, identifier ChiCTR 2200058060.
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Affiliation(s)
- Lian-Sheng Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dan-Feng Zhou
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shu-Zhen Zheng
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bai-Ming Zhao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huo-Gui Li
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qi-Qing Chen
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yun Zhong
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hong-Zhi Yang
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kun Zhang
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Kun Zhang
| | - Chun-Zhi Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- Chun-Zhi Tang
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Nguyen CT, Taw MB. Acupuncture and the Otolaryngology-Head & Neck Surgery Patient. Otolaryngol Clin North Am 2022; 55:1087-1099. [PMID: 36088161 DOI: 10.1016/j.otc.2022.06.011] [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] [Indexed: 11/17/2022]
Abstract
The use of acupuncture among US adults was estimated at nearly 40% in 2012. A study from the United Kingdom in 2010 found 60% of otolaryngologic patients had used a form of complementary or integrative medicine, with greater than a third in the last year alone. Acupuncture, a therapeutic modality of traditional Chinese medicine, has been used for millennia in Asian countries. Within otolaryngology, acupuncture has been used for a variety of conditions encompassing otology, laryngology, rhinology, and pediatrics. Herein, we review the current literature on the applications of acupuncture for a range of ENT disorders.
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Affiliation(s)
- Chau T Nguyen
- Division of Otolaryngology-Head & Neck Surgery, Ventura County Medical Center, 300 Hillmont Avenue, Suite 401, Ventura, CA 93003, USA.
| | - Malcolm B Taw
- UCLA Center for East-West Medicine, 1250 La Venta Drive, Suite 101A, Westlake Village, CA 91361, USA
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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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