1
|
Sari ÜS, Eroglu M, Büyükşerbetçi G, Tokucoglu F, Sahin N. Positive effect of self-exercise following Botulinum toxin injection on the permanence of the recovery among the patients with HFS and BFS: A clinical trial. Medicine (Baltimore) 2024; 103:e38215. [PMID: 38875371 PMCID: PMC11175951 DOI: 10.1097/md.0000000000038215] [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: 10/23/2023] [Revised: 01/11/2024] [Accepted: 04/22/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Botulinum toxin (BoNT) injection serves as the primary modality for addressing hemifacial spasm (HFS) and blepharospasm (BFS), which are prevalent movement disorders affecting the craniofacial region. However, even though the short-term effectiveness of the botulinum injection may reach over 80%, the long-term effectiveness is still a debatable point Herein, we aim to investigate whether facial self-exercise following the BoNT injection can extend the time period of effectiveness. METHODS In this study, 51 volunteers who received Onabotilinumtoxin A (BoNTA) treatment for the diagnosis of HFS or BFS, were randomized into 2 groups. A detailed instruction about the self-exercise was given by an experienced physician to the subjects in Group 1. Volunteers were asked to repeat the exercise program afterward and continue to each movement for 5 seconds, to repeat each movement 10 times with a 10-second break, every day, 3 times a week for 1 week. hemifacial spasm grating scale (HSGS) and Jankovic scales were used to assess the efficacy of the treatment. RESULTS Both groups are similar to each other based on demographic features and the severity of the diseases. According to HSGS and Jankovic scales, at the end of the first month, there was no significant difference between the groups. At the end of the third month, the improvement achieved in the first month remained the same in each parameter in Group 1. On the other hand, in Group 2, most of the values returned to the baseline. CONCLUSION Facial self-exercise following the botulinum toxin application may extend the period of effectiveness of botulinum toxin treatment the subjects with HFS and BFS.
Collapse
Affiliation(s)
- Ümmü Serpil Sari
- Balikesir University Faculty of Medicine Neurology Department, Balikesir, Turkey
| | - Mehmet Eroglu
- Mersin Medical Park Hospital Physical Therapy and Rehabilitation Clinic, Mersin, Turkey
| | | | - Figen Tokucoglu
- Balikesir University Faculty of Medicine Neurology Department, Balikesir, Turkey
| | - Nilay Sahin
- Balikesir University Faculty of Medicine Physical Therapy and Rehabilitation Department, Balikesir, Turkey
| |
Collapse
|
2
|
Targino da Costa MGES, Maranhão-Filho PDA, Santos IC, Luiz RR. Post-parotidectomy facial nerve rehabilitation outcomes: Comparison between benign and malignant neoplasms. NeuroRehabilitation 2024; 54:259-273. [PMID: 38306064 DOI: 10.3233/nre-230220] [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: 02/03/2024]
Abstract
BACKGROUND Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients. OBJECTIVE To assess rehabilitation outcomes concerning patients with post-parotidectomy facial nerve dysfunction, comparing benign versus malignant neoplasms. METHODS Prospective study enrolling adults who underwent parotidectomy with facial nerve sparing between 2016 and 2020. The Modified Sunnybrook System (mS-FGS) was used for facial assessments. Physiotherapy began on the first post-operative day with a tailored program of facial exercises based on Neuromuscular Retraining, to be performed at home 3 times/day. From the first outpatient consultation, Proprioceptive Neuromuscular Facilitation was added to the treatment of cases with moderate or severe facial dysfunctions. RESULTS Benign and malignant groups had a statistically significant improvement in mS-FGS (p < 0.001 and p = 0.005, respectively). There was no significant difference between groups regarding treatment duration or number of physiotherapy sessions performed. The history of previous parotidectomy resulted in more severe initial dysfunctions and worse outcome. Age over 60 years and initially more severe dysfunctions impacted the outcome. CONCLUSION Patients with benign and malignant parotid neoplasms had significant and equivalent improvement in postoperative facial dysfunction following an early tailored physiotherapy program, with no significant difference in the final facial score, treatment duration, or number of sessions required.
Collapse
Affiliation(s)
| | - Péricles de Andrade Maranhão-Filho
- Department of Neurology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Izabella Costa Santos
- Department of Head and Neck Surgery, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- Institute for Studies in Public Health (IESC), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Alharbi R, Kashoo FZ, Ahmed M, Alqahtani M, Aloyuni S, Alzhrani M, Alanazi AD, Sidiq M, Alharbi BH, Nambi G. Effect of neural mobilisation in Bell's palsy: A randomised controlled trial. Hong Kong Physiother J 2023; 43:93-103. [PMID: 37583924 PMCID: PMC10423671 DOI: 10.1142/s1013702523500063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/17/2023] [Indexed: 03/12/2023] Open
Abstract
Background Neural mobilisation technique is effective in spinal nerve rehabilitation. However, no study has reported the effect of facial nerve mobilisation in acute Bell's palsy. Objectives The objective of our study was to evaluate the effect of facial neural mobilisation over conventional therapy in improving facial symmetry in patients with acute Bell's palsy. Methods A randomised controlled trial was conducted in the physical therapy department for 62 patients with acute Bell's palsy. The intervention included 10 days of drug therapy including 3 weeks of conventional therapy to the experimental and the control group. However, the experimental group received additional nerve mobilisation technique aimed at mobilising the facial nerve at the origin of external auditory meatus. All participants were assessed at baseline and after three weeks using the Sunnybrook facial grading system (SBS) and Kinovea Movement Analysis Software (KMAS). Results For primary outcome, analysis of covariance with baseline data as covariate showed a significant difference between groups for the post-test mean scores of SBS after 3 weeks (between-group difference, 9.2 [95% CI, 5.1-13.3], p = 0 . 001 . Importantly, the effect size calculated by partial η 2 for neural mobilisation was 0.258 (small effect size). For secondary outcomes, independent sample t-test showed a significant difference between groups for the scores on KMAS after 3 weeks for zygomatic muscle (between-group difference, - 27 . 2 [95% CI, - 31 to - 22 . 6 ], p = 0 . 001 ), frontalis muscle - 16 . 7 [95% CI, - 9 . 9 to - 23 . 4 ], p = 0 . 001 , and orbicularis oris muscle - 15 . 0 [95% CI, - 11 . 1 to - 18 . 8 ], p = 0 . 001 . Conclusion Facial neural mobilisation is likely to be an effective adjunctive intervention in addition to conventional therapy in improving facial symmetry in acute Bell's palsy.
Collapse
Affiliation(s)
- Raed Alharbi
- Department of Public Health, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmed
- Department of Nursing, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Saleh Aloyuni
- Department of Public Health, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Ahmad Dhahawi Alanazi
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Mohammad Sidiq
- Department of Physiotherapy, Medical and Allied Health Sciences Galgotias University, Greater Noida, Uttar Pradesh, 203201, India
| | - Bander Hamud Alharbi
- Director of Medical Records Department King Khalid Hospital Majmaah, Saudi Arabia
| | - Gopal Nambi
- Department of Health and Rehabilitation Sciences College of Applied Medical Sciences Prince Sattam Bin Abdulaziz University, Al kharj, Saudi Arabia
| |
Collapse
|
4
|
Fuad M, Goh BS, Lokman FL, Mohamad Yunus MR. Blue Parotid Unveiled: A Rare Case of Traumatic Hemorrhagic Parotid Lymphangioma in an Eight-Year-Old Boy. Cureus 2023; 15:e46415. [PMID: 37927667 PMCID: PMC10621628 DOI: 10.7759/cureus.46415] [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: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Parotid lymphangioma is a benign lymphatic malformation commonly observed in infancy or early childhood. It often grows insidiously and presents as a painless, soft fluctuant mass. We report a case of an eight-year-old boy who was diagnosed from another center with right parotid lymphangioma of one-year duration. He presented with right painful preauricular swelling and trismus for nine days after a recent history of blunt trauma to the preauricular caused an acute expansion of the swelling and subsequently, the patient developed ipsilateral facial nerve palsy. Examination showed right preauricular swelling measuring about 6 x 6 cm that extended posteriorly until the mastoid region, superiorly until the zygoma, and inferiorly until the angle of the mandible, pushing the ear lobule anteromedially. There was bluish discoloration of the overlying skin. The swelling was warm and tender on palpation. Multiple shotty lymph nodes were palpable at the posterior triangle. Aspiration of the swelling revealed blood content, but it reaccumulated after a few hours. A magnetic resonance imaging (MRI) of the neck showed a lesion confined within the parotid gland. There was a presence of air-fluid level with dependent layers of hyperintense on the T1-weighted image (T1WI) and T2-weighted image (T2WI) with clumps of isointensity on T1WI, which are hypointense on T2WI, which is suggestive of acute-late subacute blood product. A diagnosis of lymphatic malformation complicated with hemorrhage was made. Hence, the patient underwent surgery for the evacuation of blood clot and right superficial parotidectomy. Histopathological examination of the intraoperative tissue biopsy revealed evidence of venolymphatic malformation of the parotid gland. Postoperatively, he was discharged home after three days. The facial nerve function recovered from House and Brackmann grade II to grade I three weeks after the surgery.
Collapse
Affiliation(s)
- Muizzuddin Fuad
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Bee See Goh
- Otorhinolaryngology/Pediatrics Otorhinolaryngology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Farah Liana Lokman
- Otolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Mohd Razif Mohamad Yunus
- Otorhinolaryngology - Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| |
Collapse
|
5
|
Application of anatomy unit resection surgery for lateral basicranial surgical approach in oral squamous carcinoma. BMC Oral Health 2023; 23:9. [PMID: 36611157 PMCID: PMC9826594 DOI: 10.1186/s12903-023-02708-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The basicranial region lacks definite boundaries and includes various anatomical units. We developed a novel concept of the posterior oral anatomical complex (POAC) to identify these anatomical units in the basicranial region. OSCC with POAC involvement is termed posterior oral squamous cell carcinoma (POSCC) with poor prognosis. The principal aim of this study was to evaluate the effect of anatomy unit resection surgery (AUSR) on patients with POSCC. METHODS A total of 120 POSCC patients who underwent radical surgical treatment were recruited for this study. These POSCC patients were treated with conventional surgery or AUSR. According to the extent of primary tumor resection in the AUSR group, the lateral basicranial surgical approach can be subdivided into four types: face-lateral approach I, face-lateral approach II, face-median approach or face-median and face-lateral combined approach. Facial nerve function was evaluated according to the House-Brackmann Facial Nerve Grading System. RESULTS The overall survival rate was 62.5% and 37.5% in the AURS group and conventional group (hazard ratio: 0.59; p < 0.0001), respectively. The disease-free survival rate was 62.5% and 34.3% in the AURS group and conventional group (hazard ratio: 0.43; p = 0.0008), respectively. The local disease control rate in the AURS group (71.4%) was significantly better than that in the conventional group (34.4%) in present study (p < 0.0001). Compared to the conventional group, all the patients undergoing AURS were classified as T4 stage and presented with more lymph node metastasis (71.4%). A total of 20 patients (face-lateral approach I and face-lateral combined approach) were temporarily disconnected from the temporofacial branch of the facial nerve. Fifteen patients exhibited slight paresis, and five patients presented with moderate or severe paresis. The survival rate of zygomatic arch disconnection was 94.6% (54 of 56 patients). CONCLUSION This lateral basicranial surgical approach based on AUSR improves the survival rate and enhances the local control rate while also preserving a good prognosis without damaging the nerve and zygomatic bone. This surgical approach based on AUSR provides a novel and effective surgical treatment to address POSCC with better prognosis, especially for patients without metastatic lymph nodes.
Collapse
|
6
|
Martineau S, Rahal A, Piette E, Moubayed S, Marcotte K. The "Mirror Effect Plus Protocol" for acute Bell's palsy: A randomized controlled trial with 1-year follow-up. Clin Rehabil 2022; 36:1292-1304. [PMID: 35722671 PMCID: PMC9420890 DOI: 10.1177/02692155221107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the effects of the "Mirror Effect Plus Protocol" (MEPP) on global facial function in acute and severe Bell's Palsy. DESIGN Single blind and randomized controlled trial to compare the effects of basic counseling (control group) versus MEPP (experimental group) over one year. SETTING Outpatient clinic following referrals from Emergency or Otorhinolaryngology Departments. SUBJECTS 40 patients (n = 20 per group) with moderately severe to total palsy who received standard medication were recruited within 14 days of onset. Baseline characteristics were comparable between the groups. INTERVENTIONS The experimental group received the MEPP program (motor imagery + manipulations + facial mirror therapy) while the control group received basic counseling. Both groups met the clinician monthly until 6 months and at one-year post-onset for assessments. OUTCOME MEASURES Facial symmetry, synkinesis, and quality of life were measured using standardized scales. Perceived speech intelligibility was rated before and after therapy by naïve judges. RESULTS Descriptive statistics demonstrated improvements in favor of the MEPP for each measured variable. Significant differences were found for one facial symmetry score (House-Brackmann 2.0 mean (SD) = 7.40 (3.15) for controls versus 5.1 (1.44) for MEPP), for synkinesis measures (p = 0.008) and for quality-of-life ratings (mean (SD) score = 83.17% (17.383) for controls versus 98.36% (3.608) for MEPP (p = 0.002)). No group difference was found for perceived speech intelligibility. CONCLUSION The MEPP demonstrates promising long-term results when started during the acute phase of moderately severe to total Bell's Palsy.
Collapse
Affiliation(s)
- Sarah Martineau
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Centre de recherche du Centre intégré Universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Département d'oto-rhino-laryngologie, Centre Intégré Universitaire de Santé et Services Sociaux de l'Est-de-l'Île de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Akram Rahal
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Département d'oto-rhino-laryngologie, Centre Intégré Universitaire de Santé et Services Sociaux de l'Est-de-l'Île de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Eric Piette
- Centre de recherche du Centre intégré Universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Département de médecine d’urgence, Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Sami Moubayed
- Centre de recherche du Centre intégré Universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Département d’oto-rhino-laryngologie, Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Karine Marcotte
- Centre de recherche du Centre intégré Universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Département d'oto-rhino-laryngologie, Centre Intégré Universitaire de Santé et Services Sociaux de l'Est-de-l'Île de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| |
Collapse
|
7
|
Boschetti CE, Vitagliano R, Staglianò S, Pollice A, Giudice GL, Apice C, Santagata M, Tartaro G, Colella G. Development of an application for mobile phones (App) capable to predict the improvement of the degree House Brackmann scale in patients suffering from iatrogenic facial palsy. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
8
|
Kabat Rehabilitation in Facial Nerve Palsy after Parotid Gland Tumor Surgery: A Case-Control Study. Diagnostics (Basel) 2022; 12:diagnostics12030565. [PMID: 35328118 PMCID: PMC8947506 DOI: 10.3390/diagnostics12030565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023] Open
Abstract
Temporary facial nerve palsy after parotid tumor surgery ranges from 14 to 65%, depending on surgery, tumor type, and subsite. The study aimed to evaluate the role of Kabat physical rehabilitation in the outcomes of patients affected by severe facial nerve palsy following parotid gland surgery. The results and clinical data of two groups, Kabat and non-Kabat (control), were statistically compared. Descriptive statistics, the multiple linear regression model, difference in difference approach, and the generalized linear model were used. F-Test, Chi-square test, McFadden R-squared, and adjusted R-squared were used to assess the significance. The results showed that the House–Brackmann (HB) stage of patients who had physiotherapy performed were lower than the control group. The decrease of HB staging in the Kabat group at 3 months was −0.71 on average, thus the probability of having a high HB stage decreased by about 13% using Kabat therapy. The results are statistically significant, and indicated that when the Kabat rehabilitation protocol is performed, mainly in the cases of a high-grade HB score, the patients showed a better and faster improvement in postoperative facial nerve palsy.
Collapse
|
9
|
Ning Y, Wang W, Cai Y, Zhou Y, Jiang J, Zeng D, Sun R, Wang X, Zheng W, He T, Shui C, Liu W, Zhang Y, Chen X, Li C. The application of venous nerve conduit trap in the immediate repair and reconstruction of facial nerve in parotid gland tumor: an attempt of a new technique. Eur Arch Otorhinolaryngol 2021; 278:4967-4976. [PMID: 33948682 DOI: 10.1007/s00405-021-06732-6] [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: 12/18/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To introduce the application of venous nerve conduit in the immediate repair and reconstruction of facial nerve in parotid gland tumor. METHODS Three patients with parotid gland tumor in Sichuan Provincial Cancer Hospital were reviewed. All patients were found that the tumor encased and invaded the facial nerve which was difficult to be separated during the operation when all patients were treated with facial nerve repair and reconstruction with the venous nerve conduit trapping technique. RESULTS After 1-year follow-up, all patients recovered well in facial nerve function. CONCLUSION The venous nerve conduit trapping technique is an effective attempt in the immediate repair and reconstruction of facial nerve in parotid gland tumor, but it needs to be further confirmed by multiple studies.
Collapse
Affiliation(s)
- Yudong Ning
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Wei Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Jian Jiang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Xu Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Wanghu Zheng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Tianqi He
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Chunyan Shui
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Wei Liu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Yuyao Zhang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Xiaolei Chen
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology, Chengdu, China. .,Department of Head and Neck Surgery, Sichuan Cancer Hospital, No.55, 4th Section of Southern Renmin Road, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
10
|
Martineau S, Rahal A, Piette É, Chouinard AM, Marcotte K. The Mirror Effect Plus Protocol for acute Bell's palsy: a randomised and longitudinal study on facial rehabilitation. Acta Otolaryngol 2021; 141:203-208. [PMID: 33215948 DOI: 10.1080/00016489.2020.1842905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Small but interesting evidences suggest that facial rehabilitation for acute Bell Palsy (BP) could improve facial outcomes in patients who benefited from optimal medication, but whose symptoms are still severe two weeks after BP's onset. AIMS This study aimed to provide preliminary evidence of the long-term effects of a new facial retraining based on motor imagery and mirror therapy, the Mirror Effect Plus Protocol (MEPP). MATERIAL AND METHODS Twenty BP patients received the standard medication for acute BP and were then randomly allocated to the treatment (MEPP) or control group, if their palsy was still at least moderate-to-severe at 14 days post onset. Three blind independent assessors graded the patients' evolution until 6 months after onset. RESULTS Significant differences between the groups were not found for any measured variable; however, a trend toward better recovery was found in the treatment group for every measured variable. This trend grew bigger for patients with severe or total BP. CONCLUSIONS This study suggests a promising effect of the MEPP on acute severe to total BP but requires further investigation with a larger number of participants. SIGNIFICANCE Facial rehabilitation should be considered as an adjunct to medication for acute and most severe degrees of BP.
Collapse
Affiliation(s)
- Sarah Martineau
- Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
- Centre de recherche du Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- École d’orthophonie et d’audiologie, Université de Montréal, Montréal, QC, Canada
| | - Akram Rahal
- Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Éric Piette
- Centre de recherche du Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- Département de médecine d’urgence, Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | - Anne-Marie Chouinard
- Centre de recherche du Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- École d’orthophonie et d’audiologie, Université de Montréal, Montréal, QC, Canada
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
- École d’orthophonie et d’audiologie, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
11
|
Wamkpah NS, Jeanpierre L, Lieu JEC, Del Toro D, Simon LE, Chi JJ. Physical Therapy for Iatrogenic Facial Paralysis: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2020; 146:1065-1072. [PMID: 32970128 DOI: 10.1001/jamaoto.2020.3049] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the expectation of facial function recovery. A potential treatment is physical therapy (PT). Objective To investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP. Evidence Review Patients with noniatrogenic FP, facial reanimation surgery, and invasive adjunctive treatments (acupuncture or botulinum toxin injection) were excluded. A systematic review was conducted for records discussing iatrogenic FP and PT; a search for these records was performed using Ovid MEDLINE (1946-2019), Embase (1947-2019), Scopus (1823-2019), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform (2004-2019), and ClinicalTrials.gov (1997-2019). The references of all the included articles were also assessed for eligible studies. All human participant, English-language study designs with at least 2 cases were included. Quality assessment was performed using the Methodological Index for Non-randomized Studies (MINORS) and the revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. All search strategies were completed on May 16, 2019, and again on October 1, 2019. Findings Fifteen studies (7 of which were retrospective cohort studies) and 313 patients with iatrogenic FP were included in the systematic review. Most iatrogenic FP (166 patients [53%]) was associated with parotidectomy; traditional PT (ie, facial massage) was the most common intervention (196 patients [63%]). The use of various facial grading systems and inconsistent reporting of outcomes prevented direct comparison of PT types. Conclusions and Relevance Because of heterogeneity in reported outcomes of facial nerve recovery, definitive conclusions were unable to be made regarding the association between PT and outcomes of iatrogenic FP. Physical therapy probably has benefit and is associated with no harm in patients with iatrogenic FP.
Collapse
Affiliation(s)
- Nneoma S Wamkpah
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Latoya Jeanpierre
- graduate of Wayne State University School of Medicine, Detroit, Michigan
| | - Judith E C Lieu
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Drew Del Toro
- currently a medical student at Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Laura E Simon
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John J Chi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| |
Collapse
|
12
|
Costa MGESTD, Maranhão-Filho PDA, Santos IC, Luiz RR, Vincent MB. Parotidectomy-related facial nerve lesions: proposal for a modified Sunnybrook Facial Grading System. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:460-469. [PMID: 31365637 DOI: 10.1590/0004-282x20190074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. METHODS We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. RESULTS The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. CONCLUSION The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.
Collapse
Affiliation(s)
| | | | - Izabella Costa Santos
- Instituto Nacional de Câncer, Serviço de Cirurgia de Cabeça e Pescoço, Rio de Janeiro RJ, Brasil
| | - Ronir Raggio Luiz
- Universidade Federal do Rio de Janeiro, Instituto de Estudos de Saúde Pública, Rio de Janeiro RJ, Brasil
| | | |
Collapse
|
13
|
Blandford AD, Ansari W, Young JM, Maley B, Plesec TP, Hwang CJ, Perry JD. Deoxycholic Acid and the Marginal Mandibular Nerve: A Cadaver Study. Aesthetic Plast Surg 2018; 42:1394-1398. [PMID: 29869228 DOI: 10.1007/s00266-018-1164-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/22/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND One of the rare but serious complications observed with deoxycholic acid administration is damage to the marginal mandibular nerve. In this study, we evaluated if deoxycholic acid directly induces histologic damage to fresh cadaveric marginal mandibular nerve. METHODS A segment of marginal mandibular nerve was harvested from 12 hemifaces of 6 fresh cadavers. The nerve specimen was exposed to either 0.9% sterile saline for 24 h, deoxycholic acid (10 mg/ml) for 20 min, or deoxycholic acid (10 mg/ml) for 24 h. The nerve specimens were then fixed in glutaraldehyde for a minimum of 24 h. Toluidine blue stained sections were evaluated for stain intensity using light microscopy and color deconvolution image analysis. Supraplatysmal fat was harvested as a positive control and exposed to the same treatments as the marginal mandibular nerve specimens, then evaluated using transmission electron microscopy. RESULTS Toluidine blue staining was less in the marginal mandibular nerve exposed to deoxycholic acid when compared to saline. The specimen exposed to deoxycholic acid for 24 h showed less toluidine blue staining than that of the nerve exposed to deoxycholic acid for 20 min. Transmission electron microscopy of submental fat exposed to deoxycholic acid revealed disruption of adipocyte cell membrane integrity and loss of cellular organelles when compared to specimens only exposed to saline. CONCLUSIONS Deoxycholic acid (10 mg/ml) damages the marginal mandibular nerve myelin sheath in fresh human cadaver specimens. Direct deoxycholic acid neurotoxicity may cause marginal mandibular nerve injury clinically. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Alexander D Blandford
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA.
| | - Waseem Ansari
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA
| | - Jason M Young
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA
| | - Bruce Maley
- Department of Anatomy and Neuroscience, University of Kentucky, Lexington, KY, USA
| | - Thomas P Plesec
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine J Hwang
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA
| | - Julian D Perry
- Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i-13, Cleveland, OH, 44195, USA
| |
Collapse
|
14
|
Infante-Cossio P, Gonzalez-Cardero E, Garcia-Perla-Garcia A, Montes-Latorre E, Gutierrez-Perez JL, Prats-Golczer VE. Complications after superficial parotidectomy for pleomorphic adenoma. Med Oral Patol Oral Cir Bucal 2018; 23:e485-e492. [PMID: 29924764 PMCID: PMC6051677 DOI: 10.4317/medoral.22386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022] Open
Abstract
Background The significance of complications after superficial parotidectomy remains unclear, since prospective studies are lacking. The aim of this study was to evaluate facial nerve dysfunction and other postoperative complications after superficial parotidectomy for pleomorphic adenoma of the superficial lobe and to identify the associated risk factors. Material and Methods Prospective and descriptive clinical study on 79 patients undergoing formal superficial parotidectomy with the modified facelift incision, dissection of the facial nerve and reconstruction with the superficial musculoaponeurotic system flap. Function of the facial nerve using the House-Brackmann scale and the intra- and postoperative complications were recorded at 1 week and 1, 3, 6 and 12 months. A descriptive, inferential and binary logistic regression analysis were performed for the variables facial nerve dysfunction, tumor size and location, clinical presentation and duration of surgery. Results 77.2% of the patients presented facial paresis at 1 week, with the marginal-mandibular branch being the most commonly affected (64.5%). 94.9% recovered the facial function at 6 months and 100% at 12 months. A statistically significant relationship was found between the appearance of facial paresis and tumor location in the superior lateral area of the superficial lobe, size >2 cm and prolonged operative time. None of the remaining variables showed significant differences at any study timepoint. At 12 months, 57% of patients had recovered tactile sensitivity in the earlobe. The clinical occurrence of Frey’s syndrome was 11.4%. Conclusions Despite the high incidence of postoperative facial paresis at 1 week, its magnitude was low and the recovery time was short. Tumor location in the parotid superficial lobe upper area, size and prolonged operative time are risk factors that can worsen facial paresis at different study timepoints. The knowledge of these complications is relevant for patient´s counseling and to achieve better long-term outcomes. Key words:Superficial parotidectomy, pleomorphic adenoma, parotid gland, facial nerve paralysis, postoperative complications.
Collapse
Affiliation(s)
- P Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Av. Manuel Siurot, 41013-Seville, Spain,
| | | | | | | | | | | |
Collapse
|