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Naguib LE, Abdel Azim GS, Elazab SA, Mohamed HS. Ultrasonography as diagnostic and prognostic tool and Therapeutic role of repetitive peripheral magnetic stimulation in acute idiopathic facial nerve palsy. J Ultrasound 2024:10.1007/s40477-024-00927-3. [PMID: 38910221 DOI: 10.1007/s40477-024-00927-3] [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: 03/05/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE Repetitive Peripheral Magnetic Stimulation [rPMS] is a non-invasive tool that has a potential therapeutic role in many musculoskeletal disorders. We aimed to demonstrate the therapeutic efficacy of high frequency [rPMS] in acute Idiopathic Facial Nerve Palsy [IFP]. And to study the role of neuromuscular ultrasonography in acute idiopathic facial palsy. METHODS Forty patients, aged above 18 years, diagnosed with unilateral acute [within 7 days of onset] idiopathic facial palsy were enrolled and randomly divided into intervention group [20 patients] and control group. Both groups underwent clinical examination, assessment of facial nerve disability by House-Brackmann grading [HBG] score and Facial Disability Index [FDI] score, ultrasonography of facial nerve of both normal and affected sides at baseline and after 6 weeks, medical treatment and routine rehabilitation therapy. The intervention group were subjected to 10 sessions of high frequency r PMS [5/week for 2 successive weeks] on the affected side. RESULTS Both [HBG] and [FDI] showed more significant improvement in the intervention group in comparison to the control group after 6 weeks follow up. Ultrasonographic measures of facial nerve in the affected side were significantly larger than non-affected side at baseline. However, those measures significantly decreased after 6 weeks follow up. Surprisingly, the intervention group showed more significant decrease in facial nerve dimeter at proximal portion [without sheath] in comparison to control group. CONCLUSION high frequency r PMS have an adjuvant role in treatment of acute idiopathic facial palsy. Also, ultrasonography has beneficial role in evaluation and prognosis of [IFP].
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Affiliation(s)
- Laila Elmously Naguib
- Neurology Department, Faculty of Medicine-for Girls, Al-Azhar University, Cairo, Egypt
| | - Ghada Saed Abdel Azim
- Neurology Department, Faculty of Medicine-for Girls, Al-Azhar University, Cairo, Egypt.
| | - Seham Abdallah Elazab
- Rheumatology and Rehabilitation Department, Faculty of Medicine-for Girls, Al-Azhar University, Cairo, Egypt
| | - Hadeir Said Mohamed
- Neurology Department, Faculty of Medicine-for Girls, Al-Azhar University, Cairo, Egypt
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Santiago S, Joshua AM, Nayak A, Misri Z, Pai S, Pai R, Mithra P, Prabhakar AJ, Palaniswamy V. Effectiveness of novel facial stretching with structured exercise versus conventional exercise for Bell's palsy: a single-blinded randomized clinical trial. Sci Rep 2024; 14:13266. [PMID: 38858464 PMCID: PMC11164989 DOI: 10.1038/s41598-024-64046-z] [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: 05/31/2023] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
The purpose of the study was to assess the effects of a novel technique involving facial stretching of the unaffected side along with a structured exercise for the affected side on facial symmetry and facial functions as compared to conventional exercise. A hospital-based parallel-group randomized trial was completed among patients with acute Bell's palsy in Mangalore, India. Participants were randomized to receive facial stretching and a structured exercise program (experimental group) or the conventional exercise regimen (conventional group). Primary outcomes were facial symmetry and voluntary movement; assessed by the Sunnybrook Facial Grading System (SFGS). Both regimens were given for 3 weeks, with baseline, 10th day, and 20th day assessments. Out of 31 participants screened, 24 were eligible and 12 participants each were assigned to experimental and conventional groups. Change scores revealed greater improvement in the SFGS score (p = 0.002) for the experimental group participants. Facial stretching and structured exercise program exhibited promising results in enhancing facial symmetry and function in acute Bell's palsy when compared to conventional exercise regimen.
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Affiliation(s)
- Stephanie Santiago
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Abraham M Joshua
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Akshatha Nayak
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Zulkifli Misri
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Shivananda Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Rohit Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ashish John Prabhakar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Vijayakumar Palaniswamy
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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3
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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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Ross BC, Tomblinson CM. Beyond the AJR: Routine MRI May Provide Utility in Identifying Secondary Causes in Adult Patients With Suspected Bell Palsy at Initial Presentation. AJR Am J Roentgenol 2024; 222:e2329811. [PMID: 37377361 DOI: 10.2214/ajr.23.29811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Affiliation(s)
- Brent C Ross
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1121 21st Ave S, CCC-1118 MCN, Nashville, TN 37232-2675
| | - Courtney M Tomblinson
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1121 21st Ave S, CCC-1118 MCN, Nashville, TN 37232-2675
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Rajangam J, Lakshmanan AP, Rao KU, Jayashree D, Radhakrishnan R, Roshitha B, Sivanandy P, Sravani MJ, Pravalika KH. Bell Palsy: Facts and Current Research Perspectives. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:203-214. [PMID: 36959147 DOI: 10.2174/1871527322666230321120618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Abstract
Bell palsy is a non-progressive neurological condition characterized by the acute onset of ipsilateral seventh cranial nerve paralysis. People who suffer from this type of facial paralysis develop a droop on one side of their face, or sometimes both. This condition is distinguished by a sudden onset of facial paralysis accompanied by clinical features such as mild fever, postauricular pain, dysgeusia, hyperacusis, facial changes, and drooling or dry eyes. Epidemiological evidence suggests that 15 to 23 people per 100,000 are affected each year, with a recurrence rate of 12%. It could be caused by ischaemic compression of the seventh cranial nerve, which could be caused by viral inflammation. Pregnant women, people with diabetes, and people with respiratory infections are more likely to have facial paralysis than the general population. Immune, viral, and ischemic pathways are all thought to play a role in the development of Bell paralysis, but the exact cause is unknown. However, there is evidence that Bell's hereditary proclivity to cause paralysis is a public health issue that has a greater impact on patients and their families. Delay or untreated Bell paralysis may contribute to an increased risk of facial impairment, as well as a negative impact on the patient's quality of life. For management, antiviral agents such as acyclovir and valacyclovir, and steroid treatment are recommended. Thus, early diagnosis accompanied by treatment of the uncertain etiology of the disorder is crucial. This paper reviews mechanistic approaches, and emerging medical perspectives on recent developments that encounter Bell palsy disorder.
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Affiliation(s)
- Jayaraman Rajangam
- AMITY Institute of Pharmacy, AMITY University, Lucknow, Uttar Pradesh, 226028, India
| | | | - K Umamaheswara Rao
- Department of Pharmacology, Sri Venkateswara Institute of Medical Sciences, Sri Padmavati Mahila Visvavidyalayam, Tirupati, Andhra Pradesh, 517507, India
| | - D Jayashree
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, P.O Box 505055, Dubai, UAE
| | - B Roshitha
- Sri Venkateswara Institute of Cancer Care and Advanced Research, Tirupati, Andhra Pradesh, 517507, India
| | - Palanisamy Sivanandy
- School of Pharmacy, International Medical University, No 126, Jalan Jalil Perkasa 19, Bukit Jalil 57000 Kuala Lumpur, Malaysia
| | - M Jyothi Sravani
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - K Hanna Pravalika
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
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Hu Z, Muller B, Slone JS, Inaba H. Cough, Neck Pain, and Right Facial Paralysis in a 14-year-old with Autism. Pediatr Rev 2024; 45:47-51. [PMID: 38161159 DOI: 10.1542/pir.2022-005512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Zhongbo Hu
- Hospitalist Medicine Program, Department of Oncology
| | | | - Jeremy S Slone
- Hospitalist Medicine Program, Department of Oncology
- Global Pediatric Medicine
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
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Morales-Puebla JM, Fernández-Fournier M, Plana-Blanco A, Lassaletta L. Variations in the treatment of acute peripheral facial paralysis. A nationwide survey. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:31-39. [PMID: 37722655 DOI: 10.1016/j.otoeng.2023.09.001] [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: 03/21/2023] [Accepted: 05/09/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Acute peripheral facial paralysis may be diagnosed and treated by different specialists. OBJECTIVE The aim of this study was to explore the variability in the treatment of Bell's palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties. METHODS An anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP). RESULTS 1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002). CONCLUSION There is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.
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Affiliation(s)
- José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Otology Commission of the Spanish Society of Otolaryngology and Head and Neck Surgery, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, Madrid, Spain; Autonomous University of Madrid, School of Medicine, Madrid, Spain.
| | - Mireya Fernández-Fournier
- Neurology Department, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Neuroepidemiology Coordinator of the Spanish Society of Neurology, Spain
| | - Antoni Plana-Blanco
- Primary Care Center of Balàfia-Pardinyes-Secà de St. Pere, Lleida, Spain; Neurology Coordinator of the Spanish Society of Family and Community Medicine, Spain; University of Lleida, School of Medicine, Lleida, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain; Otology Commission of the Spanish Society of Otolaryngology and Head and Neck Surgery, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, Madrid, Spain; Autonomous University of Madrid, School of Medicine, Madrid, Spain
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DeBord K, Ding P, Harrington M, Duggal R, Genther DJ, Ciolek PJ, Byrne PJ. Clinical application of physical therapy in facial paralysis treatment: A review. J Plast Reconstr Aesthet Surg 2023; 87:217-223. [PMID: 37918298 DOI: 10.1016/j.bjps.2023.10.076] [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: 06/27/2023] [Revised: 09/14/2023] [Accepted: 10/07/2023] [Indexed: 11/04/2023]
Abstract
This review aims to summarize recent studies regarding the specific modalities of physical therapy as a form of treatment for patients with facial paralysis, analyze the different components of physical therapy, and provide healthcare providers with guidance for their best practice in treating patients with facial paralysis. This paper will discuss the mechanism, indications, and impact factors for facial retraining, evaluate the standards for facial retraining, the creation of a treatment plan, and analyze the combined use of facial retraining with botulinum toxin injections and the application of facial retraining in post facial reanimation patients. Other modes of physical therapy, including electrical stimulation, dry needling, and acupuncture, will be addressed. Lastly, the application of new digital technology will be discussed.
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Affiliation(s)
- Katelyn DeBord
- Department of Exercise Science, John Carroll University, University Heights, OH 44118, United States
| | - Peng Ding
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
| | | | - Radhika Duggal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Dane J Genther
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Peter J Ciolek
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Patrick J Byrne
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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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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Kishimoto‐Urata M, Urata S, Nishijima H, Baba S, Fujimaki Y, Kondo K, Yamasoba T. Predicting synkinesis caused by Bell's palsy or Ramsay Hunt syndrome using machine learning-based logistic regression. Laryngoscope Investig Otolaryngol 2023; 8:1189-1195. [PMID: 37899861 PMCID: PMC10601547 DOI: 10.1002/lio2.1145] [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: 04/16/2023] [Revised: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 10/31/2023] Open
Abstract
Objective To investigate whether machine learning (ML)-based algorithms, namely logistic regression (LR), random forest (RF), k-nearest neighbor (k-NN), and gradient-boosting decision tree (GBDT), utilizing early post-onset parameters can predict facial synkinesis resulting from Bell's palsy or Ramsay Hunt syndrome more accurately than the conventional statistics-based LR. Methods This retrospective study included 362 patients who presented to a facial palsy outpatient clinic. Median follow-up of synkinesis-positive and -negative patients was 388 (range, 177-1922) and 198 (range, 190-3021) days, respectively. Electrophysiological examinations were performed, and the rate of synkinesis in Bell's palsy and Ramsay Hunt syndrome was evaluated. Sensitivity and specificity were assessed using statistics-based LR; and electroneurography (ENoG) value, the difference in the nerve excitability test (NET), and scores of the subjective Yanagihara scaling system were evaluated using early post-onset parameters with ML-based LR, RF, k-NN, and GBDT. Results Synkinesis rate in Bell's palsy and Ramsay Hunt syndrome was 20.2% (53/262) and 40.0% (40/100), respectively. Sensitivity and specificity obtained with statistics-based LR were 0.796 and 0.806, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.87. AUCs measured using ML-based LR of "ENoG," "difference in NET," "Yanagihara," and all three components ("all") were 0.910, 0.834, 0.711, and 0.901, respectively. Conclusion ML-based LR model shows potential in predicting facial synkinesis probability resulting from Bell's palsy or Ramsay Hunt syndrome and has comparable reliability to the conventional statistics-based LR. Level of Evidence 3.
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Affiliation(s)
- Megumi Kishimoto‐Urata
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shinji Urata
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hironobu Nishijima
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shintaro Baba
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoko Fujimaki
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kenji Kondo
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Graduate School of MedicineThe University of TokyoTokyoJapan
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12
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Qin Y, Liu J, Zhang X, Fan X, Li G, Chang Y, Li L. To explore the pathogenesis of Bell's palsy using diffusion tensor image. Sci Rep 2023; 13:15298. [PMID: 37714930 PMCID: PMC10504306 DOI: 10.1038/s41598-023-42570-8] [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: 06/12/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
To explore the pathogenesis of Bell's palsy using the diffusion tensor image on 3.0 T MR. The healthy people and the patients with Bell's palsy underwent intraparotid facial nerve scanning by using the DTI and T1 structural sequence at 3.0 T MR. The raw DTI data were performed affine transformation and nonlinear registration in the common MNI152_T1 space and resampled to the 0.4 mm3 voxel size. A group of 4 spherical seed regions were placed on the intratemporal facial nerves in the common space, bilaterally and symmetrically. The DTI data in the common space were used to track the intratemporal facial nerve fibers by using TrackVis and its Diffusion Toolkit. Each tractography was used to construct the maximum probability map (MPM) according to the majority rule. The fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were calculated and extracted on the basis of MPM. For healthy people, there was no significant difference in FA, MD, RD and AD of bilateral facial nerves. For patients with Bell's palsy, there was no significant difference in AD, there was significant difference in FA, MD and RD between the affected nerve and the healthy nerve (P < 0.02). This study showed that the myelin sheath injury of the intratemporal facial nerve is the main cause of Bell's palsy. Most neural axons are not damaged. The results may explain the pathogenesis of the Bell's palsy, which is self-limited for most cases.
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Affiliation(s)
- Yi Qin
- Radiology Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
| | - Jihua Liu
- Radiology Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China.
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China.
| | - Xuening Zhang
- Radiology Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, He Xi District, Tianjin, 300211, China
| | - Xiaonong Fan
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
| | - Guiping Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
| | - Yinghui Chang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
| | - Li Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88, ChangLing Road, XiQing District, Tianjin, 300381, China
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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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14
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Sazak Kundi FC, Paksoy ZB. Association of plasma atherogenic index with the severity and prognosis of Bell's palsy. Acta Otolaryngol 2023; 143:730-734. [PMID: 37610308 DOI: 10.1080/00016489.2023.2248205] [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: 07/05/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The plasma atherogenic index (AIP) is used as an indicator of cardiovascular risk. Abnormal lipid levels have been shown to potentially contribute to facial nerve inflammation observed in Bell's palsy. This study sought to investigate the association of AIP with the severity and prognosis of Bell's palsy. MATERIAL AND METHODS AIP is calculated using the equation Log (triglyceride [mg/dL]/high-density lipoprotein cholesterol [mg/dL]). The study was conducted prospectively on 79 patients diagnosed with Bell's palsy. The House-Brackmann (H-B) grade was used to determine the severity of Bell's palsy. RESULTS In total, 79 patients [45 (57%) male and 34 (43% female] with Bell's palsy were included to the study. The mean (SD) age was 54.1 (16.5). In multivariable analyses prediction of unrecovered patients, the Odds Ratio (OR) and Confidence Intervals for NLR was 1.322 (1.021-1.797), p = .032, for PLR was 1.100(1.068-1.250), p = .043, for total cholesterol was 1.038 (1.001-1.076), p = .039, for AIP was 4.250 (2.239-8.226), p = .005. The highest area under curve (0.74) was observed for AIP to predict unrecovered Bell's palsy with 71.4% sensitivity and 62.7% specificity. CONCLUSIONS AND SIGNIFICANCES AIP is associated with advanced-stage facial paralysis at the time of Bell's palsy diagnosis and can be used as a poor prognostic indicator.
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Affiliation(s)
- Fatma Cemre Sazak Kundi
- Department of Otorhinolaryngology, Ankara Yildirim Beyazit University, Ankara, Turkey
- Department of Otorhinolaryngology, Ankara City Hospital, Ankara, Turkey
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15
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Baude M, Guihard M, Gault-Colas C, Bénichou L, Coste A, Méningaud JP, Schmitz D, Natella PA, Audureau E, Gracies JM. Guided Self-rehabilitation Contract vs conventional therapy in chronic peripheral facial paresis: VISAGE, a multicenter randomized controlled trial. BMC Neurol 2023; 23:148. [PMID: 37038105 PMCID: PMC10084642 DOI: 10.1186/s12883-023-03096-8] [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: 08/29/2022] [Accepted: 01/27/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND One year after persistent peripheral facial paresis (PFP), prescriptions of conventional rehabilitation are often downgraded into maintenance rehabilitation or discontinued, the patient entering what is seen as a chronic stage. This therapeutic choice is not consistent with current knowledge about behavior-induced plasticity, which is available all life long and may allow intense sensorimotor rehabilitation to remain effective. This prospective, randomized, multicenter single-blind study in subjects with chronic unilateral PFP evaluates changes in facial motor function with a Guided Self-rehabilitation Contract (GSC) vs. conventional therapy alone, carried out for six months. METHODS Eighty-two adult subjects with chronic unilateral PFP (> 1 year since facial nerve injury) will be included in four tertiary, maxillofacial surgery (2), otolaryngology (1) and rehabilitation (1) centers to be randomized into two rehabilitation groups. In the experimental group, the PM&R specialist will implement the GSC method, which for PFP involves intensive series of motor strengthening performed daily on three facial key muscle groups, i.e. Frontalis, Orbicularis oculi and Zygomatici. The GSC strategy involves: i) prescription of a daily self-rehabilitation program, ii) teaching of the techniques involved in the program, iii) encouragement and guidance of the patient over time, in particular by requesting a quantified diary of the work achieved to be returned by the patient at each visit. In the control group, participants will benefit from community-based conventional therapy only, according to their physician's prescription. The primary outcome measure is the composite score of Sunnybrook Facial Grading System. Secondary outcome measures include clinical and biomechanical facial motor function quantifications (Créteil Scale and 3D facial motion analysis through the Cara system), quality of life (Facial Clinimetric Evaluation and Short-Form 12), aesthetic considerations (FACE-Q scale) and mood representations (Hospital Anxiety and Depression scale). Participants will be evaluated every three months by a blinded investigator, in addition to four phone calls (D30/D60/D120/D150) to monitor compliance and tolerance to treatment. DISCUSSION This study will increase the level of knowledge on the effects of intense facial motor streng- Facial paralysisthening prescribed through a GSC in patients with chronic peripheral facial paresis. TRIAL REGISTRATION ClinicalTrials.gov, NCT04074018 . Registered 29 August 2019. PROTOCOL VERSION Version N°4.0-04/02/2021.
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Affiliation(s)
- Marjolaine Baude
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France.
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France.
| | - Marina Guihard
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France
| | - Caroline Gault-Colas
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
| | - Ludovic Bénichou
- Hôpital Paris Saint-Joseph, Service de Chirurgie Maxillo-Faciale Stomatologie, 75015, Paris, France
| | - André Coste
- Centre Hospitalier Intercommunal Créteil, Service d'ORL, Stomatologie Et Chirurgie Cervico-Faciale, 94000, Créteil, France
| | - Jean-Paul Méningaud
- AP-HP, Service de Chirurgie Plastique, Reconstructrice, Esthétique Et Maxillo-Faciale, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - David Schmitz
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - Pierre-André Natella
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
| | - Etienne Audureau
- AP-HP, Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
- AP-HP, Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, 94000, Créteil, France
- DHU A-TVB, IRMB- EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris Est-Créteil, 94000, Créteil, France
| | - Jean-Michel Gracies
- BIOTN Research Unit 7377, Université Paris-Est Créteil (UPEC), 94000, Créteil, France
- Service de Rééducation Neurolocomotrice, AP-HP, Hôpitaux Universitaires Henri Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
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Savary T, Fieux M, Douplat M, Tournegros R, Daubie S, Pavie D, Denoix L, Pialat JB, Tringali S. Incidence of Underlying Abnormal Findings on Routine Magnetic Resonance Imaging for Bell Palsy. JAMA Netw Open 2023; 6:e239158. [PMID: 37079301 PMCID: PMC10119737 DOI: 10.1001/jamanetworkopen.2023.9158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/24/2023] [Indexed: 04/21/2023] Open
Abstract
Importance There is no consensus on the benefits of routine magnetic resonance imaging (MRI) of the facial nerve in patients with suspected idiopathic peripheral facial palsy (PFP) (ie, Bell palsy [BP]). Objectives To estimate the proportion of adult patients in whom MRI led to correction of an initial clinical diagnosis of BP; to determine the proportion of patients with confirmed BP who had MRI evidence of facial nerve neuritis without secondary lesions; and to identify factors associated with secondary (nonidiopathic) PFP at initial presentation and 1 month later. Design, Setting, and Participants This retrospective multicenter cohort study analyzed the clinical and radiological data of 120 patients initially diagnosed with suspected BP from January 1, 2018, to April 30, 2022, at the emergency department of 3 tertiary referral centers in France. Interventions All patients screened for clinically suspected BP underwent an MRI of the entire facial nerve with a double-blind reading of all images. Main Outcomes and Measures The proportion of patients in whom MRI led to a correction of the initial diagnosis of BP (any condition other than BP, including potentially life-threating conditions) and results of contrast enhancement of the facial nerve were described. Results Among the 120 patients initially diagnosed with suspected BP, 64 (53.3%) were men, and the mean (SD) age was 51 (18) years. Magnetic resonance imaging of the facial nerve led to a correction of the diagnosis in 8 patients (6.7%); among them, potentially life-threatening conditions that required changes in treatment were identified in 3 (37.5%). The MRI confirmed the diagnosis of BP in 112 patients (93.3%), among whom 106 (94.6%) showed evidence of facial nerve neuritis on the affected side (hypersignal on gadolinium-enhanced T1-weighted images). This was the only objective sign confirming the idiopathic nature of PFP. Conclusions and Relevance These preliminary results suggest the added value of the routine use of facial nerve MRI in suspected cases of BP. Multicentered international prospective studies should be organized to confirm these results.
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Affiliation(s)
- Thibault Savary
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Maxime Fieux
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Lyon, France
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Mondor Institute for Biomedical Research (IMRB), Créteil, France
- Centre National de la Recherche Scientifique (CNRS) Equipe Mixte de Recherche 7000, Créteil, France
| | - Marion Douplat
- Université de Lyon, Université Lyon 1, Lyon, France
- Service des Urgences, Hospices Civils of Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Research on Healthcare Performance, Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
- Unité Mixte de Recherche (UMR) Adés 7268, Aix-Marseille University, Etablissement Français du Sang–CNRS, Espace Éthique Méditerranéen, Marseille, France
| | - Romain Tournegros
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Sophie Daubie
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Dylan Pavie
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Luna Denoix
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Jean-Baptiste Pialat
- Université de Lyon, Université Lyon 1, Lyon, France
- Service d’Imagerie Médicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Creatis CNRS UMR 5220, INSERM U1294, Université Lyon 1, Villeurbanne, France
| | - Stephane Tringali
- Service d’ORL, d’Otoneurochirurgie et de Chirurgie Cervico-Faciale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- Université de Lyon, Université Lyon 1, Lyon, France
- UMR 5305, Laboratoire de Biologie Tissulaire et d’Ingénierie Thérapeutique, Institut de Biologie et Chimie des Protéines, CNRS Université Claude Bernard Lyon 1, Lyon, France
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Masouris I, Klein M, Angele B, Groß B, Goswami N, Mashood F, Gesell Salazar M, Schubert S, Pfister HW, Koedel U, Schmidt F. Quantitative proteomic analysis of cerebrospinal fluid from patients with idiopathic facial nerve palsy. Eur J Neurol 2023; 30:1048-1058. [PMID: 36504168 DOI: 10.1111/ene.15663] [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: 10/27/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Idiopathic facial palsy (IFP) accounts for over 60% of peripheral facial palsy (FP) cases. The cause of IFP remains to be determined. Possible etiologies are nerve swelling due to inflammation and/or viral infection. In this study, we applied an integrative mass spectrometry approach to identify possibly altered protein patterns in the cerebrospinal fluid (CSF) of IFP patients. METHODS We obtained CSF samples from 34 patients with FP. In four patients, varicella-zoster virus was the cause (VZV-FP). Among the 30 patients diagnosed with IFP, 17 had normal CSF parameters, five had slightly elevated CSF cell counts and normal or elevated CSF protein, and eight had normal CSF cell counts but elevated CSF protein. Five patients with primary headache served as controls. All samples were tested for viral pathogens by PCR and subjected to liquid chromatography tandem mass spectrometry and bioinformatics analysis and multiplex cytokine/chemokine arrays. RESULTS All CSF samples, except those from VZV-FP patients, were negative for all tested pathogens. The protein composition of CSF samples from IFP patients with normal CSF was comparable to controls. IFP patients with elevated CSF protein showed dysregulated proteins involved in inflammatory pathways, findings which were similar to those in VZV-FP patients. Multiplex analysis revealed similarly elevated cytokine levels in the CSF of IFP patients with elevated CSF protein and VZV-FP. CONCLUSIONS Our study revealed a subgroup of IFP patients with elevated CSF protein that showed upregulated inflammatory pathways, suggesting an inflammatory/infectious cause. However, no evidence for an inflammatory cause was found in IFP patients with normal CSF.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Matthias Klein
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Barbara Angele
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Birgit Groß
- Virology Department, Max-von-Pettenkofer-Institute, Ludwig Maximilian University, Munich, Germany
| | - Neha Goswami
- Proteomics Core, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar
| | - Fathima Mashood
- Proteomics Core, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar
| | - Manuela Gesell Salazar
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Sören Schubert
- Virology Department, Max-von-Pettenkofer-Institute, Ludwig Maximilian University, Munich, Germany
| | - Hans-Walter Pfister
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Uwe Koedel
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Frank Schmidt
- Proteomics Core, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar
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Gupta KK, Balai E, Tang HT, Ahmed AA, Doshi JR. Comparing the Use of High-Dose to Standard-Dose Corticosteroids for the Treatment of Bell's Palsy in Adults-A Systematic Review and Meta-analysis. Otol Neurotol 2023; 44:310-316. [PMID: 36706448 DOI: 10.1097/mao.0000000000003823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Bell's palsy is typically treated with oral corticosteroids (40-60 mg daily). Concomitant antivirals are currently not recommended. The objective of this systematic review and meta-analysis was to examine the effect of high-dose versus standard-dose corticosteroids, without antivirals, in the management of Bell's palsy. DATABASES REVIEWED Embase, MEDLINE, PubMed, CINAHL, Cochrane Library. METHODS A systematic review and meta-analysis was performed according to PRISMA guidelines. Studies comparing high-dose (≥80 mg) or standard-dose (40-60 mg) corticosteroid therapy for Bell's palsy were included. Exclusion criteria were coexisting antiviral treatment, nonoral drug delivery, and facial palsy due to other causes. Risk of bias was assessed using ROBINS-I. A weighted estimate of treatment effects across trials as odds ratios (OR) using a Mantel-Haenzel random-effects model was calculated. RESULTS Three articles were included in the analysis, representing 485 patients. There was a significant decrease in nonrecovery with high-dose, compared with standard-dose, corticosteroids at 6 months follow-up (OR = 0.17, 95% confidence interval = 0.05-0.56, p = 0.004). Overall adverse events were 5.8% (n = 28), all reported in one study in the high-dose group (transient elevated liver enzymes and fecal occult blood). CONCLUSIONS Our analysis shows a favorable effect of high-dose corticosteroid in the treatment of Bell's palsy. It is the first to evaluate this effect without the use of antivirals in keeping with current treatment recommendations. As all included studies had a serious risk of bias, future research should focus on larger trials with more robust methodology. This will allow for more up-to-date and large-scale analyses where more valid conclusions can be drawn that may potentially influence treatment protocols.
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Affiliation(s)
- Keshav Kumar Gupta
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom
| | - Edward Balai
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
| | - Ho Tsun Tang
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom
| | - Abiya Amna Ahmed
- Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, United Kingdom
| | - Jayesh R Doshi
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom
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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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Hattori Y, Lo LJ. Facial palsy after orthognathic surgery: A systematic review. J Craniomaxillofac Surg 2023; 51:52-59. [PMID: 36702655 DOI: 10.1016/j.jcms.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/20/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
It was the aim of the systematic review to evaluate the incidence of facial palsy following orthognathic surgery, and to assess the possible mechanisms of injury, subsequent management, and eventual outcomes. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews. A thorough search of PubMed, Scopus, Cochrane Library, and CINAHL databases up to April 2022 was conducted. In total, 34 articles were selected for this review, including 54 facial palsies in 53 patients. The incidence of facial palsy was estimated to range from 0.04% to 0.77%. Most of the possible etiologies proposed involved intraoperative nerve compression or postoperative edema. Physical therapy and steroid administration were the most frequently employed management approaches. Surgical exploration for the facial nerve was executed in one patient. Forty-three facial palsies (79.6%) attained complete recovery with conservative management, whereas 11 facial palsies (20.4%) continued to show incomplete recovery during the follow-up period. Earlier facial palsy onset (timing after surgery) was related to a higher risk of continuing palsy (p = 0.018). Within the limitations of this review it seems that facial palsy following orthognathic surgery should be treated conservatively whenever appropriate.
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Affiliation(s)
- Yoshitsugu Hattori
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Martineau S, Rivest C, Rahal A, Marcotte K. Development of an open-source and free facial rehabilitation website for severe bell's palsy: a within-subject study on user experience and patient's compliance with the MEPP-website. Disabil Rehabil 2022; 44:8357-8366. [PMID: 34919488 DOI: 10.1080/09638288.2021.2012846] [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: 01/19/2023]
Abstract
PURPOSE An open source and free website called Mirror Effect Plus Protocol (MEPP)-website was developed with features to diminish cognitive load and support motor learning during facial exercises. Assessing patient's perceptions is crucial when developing rehabilitation tools because patients' willingness to use the tools strongly affect engagement in the rehabilitation process. This study compared clinicians' and patients' user experience with the MEPP-website versus a hobby-designed website. MATERIALS AND METHODS Ten patients with acute severe Bell's palsy and five clinicians were enrolled in a within-subject and crossover design. User experience was assessed with the Modular evaluation of Components of User Experience questionnaire. Wilcoxon-Signed-Rank test analysed user experience, and descriptive analyses explored the order effect. Therapeutic compliance was verified for the MEPP-website by an integrated feature. Clinicians' descriptive statistics and subjective observations were also reported. RESULTS Both patients and clinicians demonstrated a preference for the MEPP-website, whether they used it first or second. Despite this preference, compliance with the MEPP-website was reduced, although it tended to be better when used first. CONCLUSIONS MEPP- website during facial rehabilitation improved user experience. Better user experience likely optimizes how patients perform and facilitate their exercises. Factors affecting compliance with facial rehabilitation remain to be addressed.Implications for rehabilitationRecent data suggests that mirror effect therapy combined with drug therapy supports the recovery of severe Bell's Palsy.The specialized Mirror Effect Plus Protocol (MEPP)- website is a clinical computer-based tool developed to promote patients' motor learning and diminish cognitive load during mirror therapy.The MEPP-website increase clinicians' accessibility to a specialized facial rehabilitation tool for mirror therapy.Clinicians using the MEPP-website can also objectively and easily measure compliance to facial therapy with the MEPP-website.
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Affiliation(s)
- Sarah Martineau
- Hôpital Maisonneuve-Rosemont, Montréal, Canada.,Centre de Recherche du Centre Intégré Universitaire de Santé et Services Sociaux du Nord-de-l'île-de-Montréal, Montréal, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Camille Rivest
- Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Akram Rahal
- Hôpital Maisonneuve-Rosemont, Montréal, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Karine Marcotte
- Centre de Recherche du Centre Intégré Universitaire de Santé et Services Sociaux du Nord-de-l'île-de-Montréal, Montréal, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Canada
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22
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Alanazi F, Kashoo FZ, Alduhishy A, Aldaihan M, Ahmad F, Alanazi A. Incidence rate, risk factors, and management of Bell's palsy in the Qurayyat region of Saudi Arabia. PeerJ 2022; 10:e14076. [PMID: 36221264 PMCID: PMC9548320 DOI: 10.7717/peerj.14076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/27/2022] [Indexed: 01/20/2023] Open
Abstract
Background Bell's palsy is an idiopathic facial nerve dysfunction causing temporary paralysis of muscles of facial expression. This study aimed to determine the incidence rate, common risk factors, and preferred treatment by the Saudi patients with Bell's palsy. Method This cross-sectional study was carried out in the Qurayyat region of Saudi Arabia. The retrospective medical records were searched from 2015-2020 of patients diagnosed with Bell's palsy at Qurayyat General Hospital and King Fahad hospital. A 28-item questionnaire was developed by a team of experts and pre-tested among patients with Bell's palsy before being sent to the eligible participants. The data were analyzed using summary statistics, Chi-square test, Fisher exact test and Likelihood ratio test. Results We identified 279 cases of Bell's palsy from the medical records of the hospitals from the years 2015 to 2020, accounting for 46.5 cases per year and an incidence rate of 25.7 per 100,000 per year. Out of 279 patients with Bell's palsy, only 171 returned the questionnaire accounting for a response rate of 61.2%. Out of 171 patients with Bell's palsy, females (n = 147, 86.0%) accounted for the majority of cases. The most affected age group among participants with Bell's palsy was 21-30 years (n = 76, 44.4%). There were 153 (89.5%) cases who reported Bell's palsy for the first time. The majority of the participants experienced right-sided facial paralysis (n = 96, 56.1%). Likelihood ratio test revealed significant relationship between exposure to cold air and common cold with age groups (χ 2(6, N = 171) = 14.92, p = 0.021), χ 2(6, N = 171) = 16.35, pp = 0.012 respectively. The post hoc analyses revealed that participants in the age group of 20-31-years were mostly affected due to exposure to cold air and common cold than the other age groups. The main therapeutic approach preferred was physiotherapy (n = 149, 87.1%), followed by corticosteroids and antivirals medications (n = 61, 35.7%), acupressure (n = 35, 20.5%), traditional Saudi herb medicine (n = 32, 18.7%), cauterization by hot iron rod (n = 23, 13.5%), supplementary therapy (n = 2, 1.2%), facial cosmetic surgery (n = 1, 0.6%) and no treatment (n = 1, 0.6%). The most preferred combined therapy was physiotherapy (87.6%) with corticosteroid and antiviral drugs (35.9%), and acupressure (17.6%). Conclusion The rate of Bell's palsy was approximately 25.7 per 100,000 per year in the Qurayyat region of Saudi Arabia. Exposure to cold air and common cold were the significant risk factors associated with Bell's palsy. Females were predominantly affected by Bell's palsy in the Qurayyat region of Saudi Arabia. Bell's palsy most commonly occurred in the age group 21-30 years. The most favored treatment was physiotherapy following Bell's palsy.
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Affiliation(s)
- Fahad Alanazi
- Department of Physical Therapy and Rehabilitation Sciences, College of Applied Medical Sciences, Jouf University, Al Jouf, Saudi Arabia
| | - Faizan Z. Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Anas Alduhishy
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mishal Aldaihan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
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23
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La paralysie de Bell. CMAJ 2022; 194:E1337. [PMID: 36191939 PMCID: PMC9529575 DOI: 10.1503/cmaj.220267-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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24
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Citron I, Thomson D, Pescarini E, Creasy H, Sorooshian P, Berner JE, Neville C, Kannan RY, Nduka C. Descriptive Study of Facial Motor Cocontractions During Voluntary Facial Movement in a Healthy Population: A New Hypothesis Contributing to Synkinesis. Facial Plast Surg Aesthet Med 2022; 25:244-249. [PMID: 36083281 DOI: 10.1089/fpsam.2022.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Motor overflow refers to involuntary movements that accompany voluntary movements in healthy individuals. This may have a role in synkinesis. Objective: To describe the frequency and magnitude of facial motor overflow in a healthy population. Methodology: Healthy participants performed unilateral facial movements: brow elevation, wink, snarl, and closed smile. Two reviewers analyzed the magnitude of each movement and cocontraction. Patterns of movements are described. Univariate analysis was used to assess the relationship between efficacy of unilateral facial control and the frequency and magnitude of cocontractions. Results: Eighty-nine participants completed the videos. Consensual mirror movements occurred in 96% of participants during unilateral eye closure and 86% during brow elevation. The most common associated movement was ipsilateral eye constriction occurring during snarl (90.1%). Improved unilateral facial control was associated with a decrease in frequency and magnitude of associated movements during brow elevation, wink, and snarl. Conclusion: This study showed stereotyped patterns of motor overflow in facial muscles that resemble those in synkinesis and become more evident as unilateral control of the face decreases.
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Affiliation(s)
- Isabelle Citron
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - David Thomson
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Elena Pescarini
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
- Plastic Surgery Unit, San Bortolo Hospital, Vicenza, Italy
| | - Henrietta Creasy
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Parviz Sorooshian
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | | | - Catriona Neville
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Ruben Y Kannan
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Charles Nduka
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
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25
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Peripheral Repetitive Transcranial Magnetic Stimulation(rTMS) for Idiopathic Facial Nerve Palsy: A Prospective, Randomized Controlled Trial. Neural Plast 2022; 2022:7536783. [PMID: 35875789 PMCID: PMC9300274 DOI: 10.1155/2022/7536783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the clinical efficacy of peripheral repetitive transcranial magnetic stimulation (rTMS) in the treatment of idiopathic facial paralysis, to explore an ideal treatment scheme for idiopathic facial paralysis, and to provide evidence for clinical rehabilitation. Methods 65 patients with idiopathic facial nerve palsy with the first onset were recruited and randomly divided into rTMS group and control group. Both groups received conventional treatment, rTMS group received additional repetitive transcranial magnetic stimulation to the affected side once a day, 5 times a week for 2 weeks. House-Brackmann (HB) grading scale, Sunnybrook facial grading system (SFGS), and modified Portmann scale (MPS) were used to assess facial nerve function before and after treatment, and the time for patients to return to normal facial nerve function and adverse reaction (AR) was also the main observation index. Results After a 2-week intervention, HB, SFGS, and MPS increased in both groups (P < 0.01); the improvement of HB, SFGS, and MPS in rTMS group was significantly higher than that in control group (P < 0.01). The effective improvement rate of the TMS group after 2 weeks was 90.0%, and that of the control group was 53.3%, and the difference was statistically significant (P < 0.01). Conclusions Repetitive transcranial magnetic stimulation is a safe and effective noninvasive method for the treatment of idiopathic facial paralysis, which can significantly accelerate the recovery of facial nerve function and provide a new treatment idea for further improving the prognosis of patients with idiopathic facial paralysis.
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Kehrer A, Ruewe M, Platz Batista da Silva N, Lonic D, Heidekrueger PI, Knoedler S, Jung EM, Prantl L, Knoedler L. Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis—Machine Settings and Technical Aspects for Facial Surgeons. Diagnostics (Basel) 2022; 12:diagnostics12071650. [PMID: 35885554 PMCID: PMC9322000 DOI: 10.3390/diagnostics12071650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/05/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Synkinesis of the facial musculature is a detrimental sequalae in post-paralytic facial palsy (PPFP) patients. Detailed knowledge on the technical requirements and device properties in a high-resolution ultrasound (HRUS) examination is mandatory for a reliable facial muscle assessment in PPFP patients. We therefore aimed to outline the key steps in a HRUS examination and extract an optimized workflow schema. Methods: From December 2020 to April 2021, 20 patients with unilateral synkinesis underwent HRUS. All HRUS examinations were performed by the first author using US devices with linear multifrequency transducers of 4–18 MHz, including a LOGIQ E9 and a LOGIQ S7 XDclear (GE Healthcare; Milwaukee, WI, USA), as well as Philips Affinity 50G (Philips Health Systems; Eindhoven, the Netherlands). Results: Higher-frequency and multifrequency linear probes ≥15 MHz provided superior imaging qualities. The selection of the preset program Small Parts, Breast or Thyroid was linked with a more detailed contrast of the imaging morphology of facial tissue layers. Frequency (Frq) = 15 MHz, Gain (Gn) = 25–35 db, Depth (D) = 1–1.5 cm, and Focus (F) = 0.5 cm enhanced the image quality and assessability. Conclusions: An optimized HRUS examination protocol for quantitative and qualitative facial muscle assessments was proposed.
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Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
- Correspondence: ; Tel.: +49-941-944-6763
| | - Marc Ruewe
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
| | | | - Daniel Lonic
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
| | - Paul Immanuel Heidekrueger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
| | - Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (N.P.B.d.S.); (E.M.J.)
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (M.R.); (D.L.); (P.I.H.); (L.P.); (L.K.)
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Kazemian E, Schaffer HM, Wozniak A, Leonetti JP. Economic Impact of Diagnostic Imaging in the Workup of Uncomplicated Bell's Palsy. Skull Base Surg 2022; 83:323-327. [DOI: 10.1055/s-0040-1722231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/12/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Objective Our primary objective is to identify the costs associated with imaging in the diagnostic workup of uncomplicated Bell's palsy. Our secondary objective is to identify a dollar amount spent on extraneous diagnostic testing on a state and national level.
Design and Setting Retrospective chart analysis was performed at our tertiary care medical center between 2007 and 2018. International Statistical Classification of Diseases-10 code G51.0 was used to identify patients with Bell's palsy seen by the senior author. A total of 163 patients were divided into two groups: those having received imaging and those diagnosed without imaging. The imaging group was then further subdivided by imaging modality: computed tomography (CT) only, magnetic resonance imaging (MRI) only, or both. There was a total of 138 scans in 115 patients. To quantify the amount spent by insurance companies or patients on these scans, net expected pay (NEP) for each modality was used as a representation of cost. The NEP for a CT was $618. The NEP for an MRI was $1,119. The NEP for both scans was $1,737. We extrapolated our results to a state and national level.
Main Outcome Measurements Cost of workup; state and national economic burden.
Results Extrapolating our data, we forecast that in Illinois and in the United States, over $2 million and $53 million, respectively, are spent on unnecessary imaging.
Conclusion By highlighting an unnecessary financial burden, our study provides concrete evidence to support the American Academy of Otolaryngology's recommendation that clinicians should not perform routine imaging studies when diagnosing uncomplicated Bell's palsy.
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Affiliation(s)
- Elycia Kazemian
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Hollie Marie Schaffer
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
| | - Amy Wozniak
- Division of Health Sciences, Loyola University Chicago, Center for Translational Research and Education, Maywood, Illinois, United States
| | - John P. Leonetti
- Department of Otolaryngology, Loyola University Medical Center, Maywood, Illinois, United States
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28
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Wihlidal JG, Bysice A, Rammal A, Yoo J, Matic D, Mendez A. Thematic Analysis of Canadian Patient-Reported Outcomes in Facial Nerve Paralysis: A Combined Interpretive Description and Modified Delphi Approach. Facial Plast Surg Aesthet Med 2022; 24:453-459. [DOI: 10.1089/fpsam.2021.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jacob G.J. Wihlidal
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Andrew Bysice
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Almoaidbellah Rammal
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Otorhinolaryngology—Head and Neck Surgery, King Abdul-Aziz University, Jeddah, Saudi Arabia
- Department of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - John Yoo
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Damir Matic
- Department of Plastic and Reconstructive Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Adrian Mendez
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
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29
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Shi J, Lu D, Chen H, Shu M, Xu Y, Qian J, Ouyang K, Huang H, Luo Z, Wang C, Zhang Y. Efficacy and Safety of Pharmacological and Physical Therapies for Bell's Palsy: A Bayesian Network Meta-Analysis. Front Neurol 2022; 13:868121. [PMID: 35528739 PMCID: PMC9074786 DOI: 10.3389/fneur.2022.868121] [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: 02/02/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The objective was to comprehensively assess the efficacy and safety of all pharmacological and physical treatments (short-term, ≤ 1 month) for patients with acute Bell's palsy. Methods The electronic databases PubMed, Web of Science, Embase, Cochrane Library, and CNKI were searched for the randomized controlled trials comparing two or more regimens in patients with the Bell's palsy to be included in a Bayesian network meta-analysis. Odds ratios and CIs for the primary outcome of the House–Brackmann scale and secondary outcomes of sequelae (synkinesis and crocodile tears) and adverse events were obtained and subgroup analyses of steroids and antivirals were conducted. Results A total of 26 studies representing 3,609 patients having undergone 15 treatments matched our eligibility criteria. For facial recovery, acupuncture plus electrical stimulation, steroid plus antiviral plus Kabat treatment, and steroid plus antiviral plus electrical stimulation were the top three options based on analysis of the treatment ranking (probability = 84, 80, and 77%, respectively). Steroid plus antiviral plus electrical stimulation had the lowest rate of sequelae but were more likely to lead to mild adverse events. Subgroup analysis revealed that methylprednisolone and acyclovir were likely to be the preferred option. Conclusions This network meta-analysis indicated that combined therapies, especially steroid plus antiviral plus Kabat treatment, were associated with a better facial function recovery outcome than single therapy. Other physical therapies, such as acupuncture plus electrical stimulation, may be a good alternative for people with systemic disease or allergies. More high-quality trials of physical regimens are needed in the future. Systematic Review Registration Our registered PROSPERO number is CRD42021275486 and detailed information can be found at https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Jianwei Shi
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Dafeng Lu
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hairong Chen
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Mingzhu Shu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Xu
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaojiao Qian
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ke Ouyang
- Department of Infectious Diseases, Jiangsu People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Huaying Huang
- Department of Infectious Diseases, Jiangsu People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Zhengxiang Luo
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chunhui Wang
- School of Public Health, Nanjing Medical University, Nanjing, China
- Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
- *Correspondence: Chunhui Wang
| | - Yansong Zhang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- Yansong Zhang
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Li M, Ruan J, Zhang H, Wu J, Wang Y, Zhu S. Comparison of therapeutic effects of different acupuncture and moxibustion therapies in the treatment of peripheral facial nerve paralysis: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e28926. [PMID: 35421058 PMCID: PMC9276140 DOI: 10.1097/md.0000000000028926] [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] [Received: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous evidences show that acupuncture and moxibustion therapy has positive effects on peripheral facial nerve paralysis (PFP), but there are many acupuncture treatments based on meridian theory, and there are differences in the efficacy of each program. This study will compare the clinical efficacy of different acupuncture treatments for PFP through mesh meta-analysis. METHODS Randomized controlled trials of acupuncture therapy in the treatment of PFP are going to be retrieved from 8 Science databases including CNKI, Wanfang, VIP and Chinese Biomedical Science, PubMed, Embase, Web of Science and the Cochrane Library from establishment to January 2022. We will use the Cochrane Risk Bias Assessment Tool to assess the quality of the studies and the grading of recommendation assessment, development and evaluation method to assess the strength of the evidence. All data analyses will be performed by Revman5.3, Gemtc 0.14.3, and Stata 14.0. RESULTS This study will evaluate the efficacy of different acupuncture treatments for PFP by evaluating clinical efficacy rate, facial nerve function score, facial disability score scale, facial electromyography, adverse reactions, etc, and further explore the mechanism of action of each therapy. CONCLUSION This study will provide a reliable evidence-based basis for selecting the best acupuncture treatment for PFP. TRIAL REGISTRATION Open science framework registration number: DOI 10.17605/OSF.IO/XQRK9.
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Affiliation(s)
- Ming Li
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - JianGuo Ruan
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - HuaJun Zhang
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - JiuLong Wu
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - YuJuan Wang
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Walsh PS, Gray JM, Ramgopal S, Lipshaw MJ. Risk of malignancy following emergency department Bell's palsy diagnosis in children. Am J Emerg Med 2022; 53:63-67. [PMID: 34992025 DOI: 10.1016/j.ajem.2021.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To quantify the risk of malignancy following the emergency department (ED) diagnosis of Bell's Palsy (BP) using a large retrospective cohort. STUDY DESIGN We performed a cohort study using the Pediatric Health Information System database. We included all children (6 months - 17 years) from 2011 to 2020 with an ED diagnosis of BP. We excluded children with previous neurologic chronic condition or malignancy diagnosed during or prior to the index visit. Our primary outcome was diagnosis of malignancy within 60 days following the index ED visit. We compared clinical characteristics between children with and without new-onset malignancy. RESULTS Of 12,272 encounters for BP, 41 had a new oncologic diagnosis within 60 days (0.33%, 95% confidence interval [CI]: 0.25-0.45%). Median time to oncologic diagnosis was 22 days. Primary CNS malignancy (59%) and leukemia (17.1%) were the most common diagnoses. Younger children had a higher incidence of new oncologic diagnosis compared with older children. Incidences were 0.68% (95% CI 0.36-1.3%), 0.70% (95% CI 0.38-1.3%), 0.26% (95% CI 0.15-0.47%), and 0.21% (95% CI 0.12-0.37%) for children aged <2 years, 2-5 years, 6-11 years, and 12-17 years respectively. CONCLUSIONS We found a small but potentially clinically significant rate of new-onset oncologic diagnosis within 60 days after BP diagnosis in the ED, especially in children younger than 5 years. Further studies of the diagnostic utility of laboratory testing or neuroimaging and the risk of empiric steroids in children with BP are needed.
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Affiliation(s)
- Patrick S Walsh
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America.
| | - James M Gray
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Sriram Ramgopal
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
| | - Matthew J Lipshaw
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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Acute Facial Nerve Palsy in Children: Gold Standard Management. CHILDREN 2022; 9:children9020273. [PMID: 35204994 PMCID: PMC8870855 DOI: 10.3390/children9020273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
Facial nerve palsy (FNP) is a common illness in the paediatric emergency department. Missed or delayed diagnosis can have a serious impact on a patient’s quality of life. The aim of this article is to give a recent overview of this pathology in terms of the causes, diagnosis, red flag symptoms, complementary examinations, treatments and follow-up in the child population. In cases of acquired, acute onset and isolated FNP, Bell’s palsy can be assumed, and no further investigation is required. In any other scenario, complementary examinations are required. Treatment depends on the aetiology. Corticosteroids, in addition to antiviral medication, are recommended to treat Bell’s palsy whenever a viral infection is suspected. However, the lack of randomised control trials in the paediatric population does not allow us to comment on the effectiveness of these treatments. In all cases, treated or not, children have a very good recovery rate. This review emphasises the necessity of randomised control trials concerning this frequent neurological pathology in order to better treat these children.
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Therapie der idiopathischen Fazialisparese („Bell’s palsy“). DGNEUROLOGIE 2022; 5. [PMCID: PMC9554855 DOI: 10.1007/s42451-022-00489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kuchar E, Karlikowska-Skwarnik M, Wawrzuta D. Anti-Inflammatory Therapy of Infections. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8496905 DOI: 10.1016/b978-0-12-818731-9.00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Anti-inflammatory treatment of infections is challenging due to the heterogeneity of etiologic agents and complex immune interactions. Nevertheless, anti-inflammatory medications are commonly used in infections to reduce unpleasant symptoms and to modify host response. They may play a fundamental role in managing infection with over-inflammation by decreasing inflammatory organ damage, e.g., COVID-19. However, by its inherent inhibition of immune functions, they might also contribute to the development of serious bacterial infections. Moreover, reducing a patient's symptoms and signs may provide a false sense of security and delay diagnosing threatening infections.
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Fujiwara T, Iwata S, Hosokawa Y, Mitani S. Intratympanic corticosteroid for Bell's palsy and Ramsay Hunt syndrome: Systematic review and meta-analysis. Auris Nasus Larynx 2021; 49:599-605. [PMID: 34980517 DOI: 10.1016/j.anl.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to reveal the efficacy and safety of intratympanic steroid therapy (ITST) in patients with Bell's palsy and Ramsay Hunt syndrome. METHODS A literature search was conducted in PubMed, Embase, Ichushi-Web, and Cochrane Central Register of Controlled Trials. Published randomized controlled trial and observational studies, which compared the combination of intratympanic corticosteroids with systemic corticosteroid versus systemic corticosteroid for Bell's palsy and Ramsay Hunt syndrome, were included for meta-analysis. The primary outcome was non-recovery at the end of the study follow-up. Data was analyzed using Review Manager software, and pooled odds ratio with 95% CI were calculated. RESULTS Three randomized controlled trial and two cohort studies met the eligible criteria, and 350 individuals included for meta-analysis. The timing of intratympanic corticosteroid was varied from once or twice a week to consecutive 10-days. Patients treated with combination of systemic corticosteroids and intratympanic corticosteroids were likely to achieve recovery of normal facial function (OR = 0.36 [95% CI 0.12-1.14]). The subgroup analysis of the timing revealed that daily ITST reduced non-recovery (OR = 0.14 [95% CI 0.04-0.50). However, non-daily ITST did not reduced non-recovery (OR 0.93 [95% CI 0.37-2.34]). CONCLUSION Intratympanic corticosteroid have a potential to reduce non-recovery in patients with Bell's palsy and Ramsay Hunt syndrome. The methods of intratympanic corticosteroid varied among included studies. Further well-designed randomized controlled trial is needed to confirm the effectiveness and to identify an adequate method of intratympanic corticosteroid in these patients.
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Affiliation(s)
- Takashi Fujiwara
- Department of Public Health Research, Kurashiki Clinical Research Institute. Miwa 1-1-1, Kurashiki City, Okayama Prefecture, 710-8602 Japan; Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan.
| | - Shinji Iwata
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime Prefecture, Japan
| | - Yuki Hosokawa
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime Prefecture, Japan
| | - Sohei Mitani
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime Prefecture, Japan
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Thielker J, Kuttenreich AM, Volk GF, Guntinas-Lichius O. [Diagnostics and Therapy of Idiopathic Facial Palsy (Bell's Palsy)]. Laryngorhinootologie 2021; 100:1004-1018. [PMID: 34826861 DOI: 10.1055/a-1529-3582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this review is to report the knowledge for otolaryngologists on standard of care, latest advances, interesting new findings and controversies about the treatment of Bell's palsy. This review is focusing on the acute phase of the disease. The chronic phase, with incomplete, incorrect or no recovery of the palsy, is described briefly. Treatment with prednisolone alone within 72 hours after onset still is the cornerstone of the treatment. The role of antivirals still is unclear. Since 2009 no new and breakthrough clinical trials with influence on the treatment standards have been performed. A study to clarify the role of prednisolone treatment in children is ongoing. Patient-related outcome measures like the Facial Clinimetric Evaluation Scale and the Facial Disability Index are important tools to assess the subjective severity of the disease and psychosocial impact of Bell's palsy next to the motor deficits. Simplified subjective electronic grading systems like the eFACE and first automated image analysis systems have been introduced. Studies clarifying the role of antivirals for severe cases are urgently needed as well as studies on the role of salvage second line therapy after insufficient response to initial corticosteroid treatment. An international consensus on the outcome measures in diagnostics and follow-up is also needed.
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Affiliation(s)
| | | | | | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Jena, Germany
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Analysis of medical services provided to patients with peripheral facial palsy in Korea: a descriptive, cross-sectional study of the health insurance review and assessment service national patient sample database. BMC Health Serv Res 2021; 21:1178. [PMID: 34715858 PMCID: PMC8555159 DOI: 10.1186/s12913-021-07078-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background This cross-sectional, retrospective, observational study analyzed the demographics of patients with peripheral facial palsy in South Korea and their use of healthcare services. Methods The 2016 Korean Health Insurance Review and Assessment National Patient Sample dataset was used; a total of 4790 patients, diagnosed with facial palsy, who had used healthcare services at least once between January 2016 and December 2016 were included, and data on the use of medical services, hospitalizations, sociodemographic factors, treatments, and medications were analyzed. Results Overall, 326 patients per 100,000 individuals used healthcare services at least once because of peripheral facial palsy in 2016, with higher numbers for women and those aged 50–59 years. The percentage of patients who used Korean traditional medicine (KM), Western medicine (WM), and both KM and WM was 54.4, 23.3, and 22.3%, respectively. Users of both WM and KM had higher per capita medical costs, more visits, and longer treatment durations. Physiotherapy was the most frequent WM treatment (44.4%), and “examinations” was the costliest (24.7%) category. “Procedures” was both the most frequent and costliest KM category (99.9 and 57.3%, respectively). “Continuous intravenous injections” (8.6%) and “superficial heat therapy” (8.3%) were the most frequent WM treatments, while acupuncture accounted for 98% of all KM treatments. Conclusions This study analyzed the demographic characteristics and medical service use of patients with peripheral facial palsy in detail. These results can be used as basic information to improve clinical and policy strategies for the management and treatment of peripheral facial palsy. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07078-9.
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Kim Y, Doo JG, Chon J, Lee JH, Jung J, Lee JM, Kim SH, Yeo SG. Steroids plus antiviral agents are more effective than steroids alone in the treatment of severe Bell's palsy patients over 40 years of age. Int J Immunopathol Pharmacol 2021; 35:20587384211042124. [PMID: 34633253 PMCID: PMC8511921 DOI: 10.1177/20587384211042124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The effectiveness of the combination of steroids and antiviral agents in the
treatment of Bell’s palsy remains unclear. This study evaluated the
therapeutic effect of combination therapy in severe Bell’s palsy patients
and assesses specific conditions under which combination therapy is more
effective than steroids alone. Methods From January 2005 to December 2019, the records of 1710 Bell’s palsy patients
who visited Kyung Hee University Hospital were reviewed retrospectively. Of
these, 335 (19.6%) patients were diagnosed with severe Bell’s palsy, with
162 patients treated with steroids alone and 173 patients treated with
combinations of steroids and antiviral agents. The outcomes of treatment
were assessed using the House–Brackmann (H-B) grade according to age, sex,
hypertension, diabetes, and obesity. Results The favorable recovery rate was significantly higher in severe Bell’s palsy
patients who were treated with combinations of steroids and antiviral agents
than with steroids alone (78.0% vs. 66.7%, p = 0.020).
Subgroup analysis showed that combination therapy resulted in significantly
higher recovery rates than steroids alone in patients aged ≥40 years (77.5%
vs. 64.1%, p = 0.023) and in those without hypertension
(75.8% vs. 63.3%, p = 0.044) and diabetes (79.7% vs. 65.5%,
p = 0.007). Conclusion Combination therapy with steroids and antiviral agents resulted in
significantly higher favorable recovery rates than steroids alone in severe
Bell’s palsy patients. Combination therapy was particularly more effective
than steroids alone in patients aged ≥40 years and in patients without
hypertension and diabetes.
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Affiliation(s)
- Yong Kim
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jeon Gang Doo
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jinmann Chon
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jong Ha Lee
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Junyang Jung
- Department of Anatomy and Neurobiology, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jae Min Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Sang Hoon Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
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Elkin ME, Zhu X. Community and topic modeling for infectious disease clinical trial recommendation. ACTA ACUST UNITED AC 2021; 10:47. [PMID: 34254037 PMCID: PMC8262767 DOI: 10.1007/s13721-021-00321-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
Clinical trials are crucial for the advancement of treatment and knowledge within the medical community. Although the ClinicalTrials.gov initiative has resulted in a rich source of information for clinical trial research, only a handful of analytic studies have been carried out to understand this valuable data source. Analysis of this database provides insight for emerging trends of clinical research. In this study, we propose to use network analysis to understand infectious disease clinical trial research. Our goal is to understand two important issues related to the clinical trials: (1) the concentrations and characteristics of infectious disease clinical trial research, and (2) recommendation of clinical trials to a sponsor (or an investigator). The first issue helps summarize clinical trial research related to a particular disease(s), and the second issue helps match clinical trial sponsors and investigators for information recommendation. By using 4228 clinical trials as the test bed, our study investigates 4864 sponsors and 1879 research areas characterized by Medical Subject Heading (MeSH) keywords. We use a network to characterize infectious disease clinical trials, and design a new community-topic-based link prediction approach to predict sponsors’ interests. Our design relies on network modeling of both clinical trial sponsors and keywords. For sponsors, we extract communities with each community consisting of sponsors with coherent interests. For keywords, we extract topics with each topic containing semantic consistent keywords. The communities and topics are combined for accurate clinical trial recommendation. This transformative study concludes that using network analysis can tremendously help the understanding of clinical trial research for effective summarization, characterization, and prediction.
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Affiliation(s)
- Magdalyn E Elkin
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431 USA
| | - Xingquan Zhu
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431 USA
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CS-VIBE accelerates cranial nerve MR imaging for the diagnosis of facial neuritis: comparison of the diagnostic performance of post-contrast MPRAGE and CS-VIBE. Eur Radiol 2021; 32:223-233. [PMID: 34156555 DOI: 10.1007/s00330-021-08102-6] [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] [Received: 12/17/2020] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to compare the diagnostic performance of post-contrast 3D compressed sensing volume-interpolated breath-hold examination (CS-VIBE) and 3D T1 magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) in detecting facial neuritis. MATERIALS AND METHODS Between February 2019 and September 2019, 60 patients (30 facial palsy patients and 30 controls) who underwent contrast-enhanced cranial nerve MRI with both conventional MPRAGE and CS-VIBE (scan time: 6 min 8 s vs. 2 min 48 s) were included in this retrospective study. All images were independently reviewed by three radiologists for the presence of facial neuritis. In patients with facial palsy, signal-to-noise ratio (SNR) of the pons, enhancement degree and contrast-to-noise ratio (CNRnerve-CSF) of the facial nerve were measured. The overall image quality, artifacts, and facial nerve discrimination were analyzed. The sensitivity and specificity of both sequences were calculated with the clinical diagnosis as a reference. RESULTS CS-VIBE had comparable performance in the detection of facial neuritis to that of MPRAGE (sensitivity and specificity, 97.8% and 99.4% vs. 100.0% and 99.4% in pooled analysis; 97.8% and 98.9% vs. 100.0% and 98.9% in patents with facial palsy, p value > 0.05 for all). CS-VIBE showed significantly lower SNR (p value < 0.001 for all), but significantly higher CNRnerve-CSF (p value < 0.05 for all) than MPRAGE. CS-VIBE also performed better in the overall image quality, artifacts, and facial nerve discrimination than MPRAGE (p value < 0.001 for all). CONCLUSION CS-VIBE achieved comparable diagnostic performance for facial neuritis compared to the conventional MPRAGE, with the scan time being half of that of MPRAGE. KEY POINTS • Post-contrast 3D CS-VIBE MRI is a reliable method for the diagnosis of facial neuritis. • CS-VIBE reduces the scan time of cranial nerve MRI by more than half compared to conventional T1-weighted image. • CS-VIBE had better performance in contrast-to-noise ratio and favorable image quality compared with conventional T1-weighted image.
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Watson NA, Siddiqui Z, Miller BJ, Karagama Y, Gibbins N. Non-aesthetic uses of botulinum toxin in the head and neck. Eur Arch Otorhinolaryngol 2021; 278:4147-4154. [PMID: 33738565 DOI: 10.1007/s00405-021-06750-4] [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] [Received: 12/18/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of botulinum toxin in the specialty of aesthetic surgery in the head and neck is well known. However, it has also been used for other conditions affecting the head and neck, and in recent years its use, as well as the number of relevant applications, has expanded enormously. REVIEW This article presents a summary of the current range of uses in the laryngeal, pharyngeal, cervical, oromandibular and facial muscles and salivary glands. We highlight particular conditions focusing on dystonia (laryngeal, craniocervical, oromandibular and cervical), multiple system atrophy, migraines, facial nerve palsy, post-laryngectomy, cricopharyngeal dysphagia, Zenker's diverticulum, retrograde cricopharyngeal dysfunction disorder, sialorrhea and gustatory sweating (Frey's syndrome). CONCLUSION This article should aid the ear, nose and throat surgeon garner knowledge about the range of uses for botulinum toxin in the head and neck.
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Affiliation(s)
- Natalie Anne Watson
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Zohaib Siddiqui
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
| | - Benjamin John Miller
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Yakubu Karagama
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Gibbins
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE13 6LH, UK
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Peng CH, Chen JL, Liao MF, Hsu JL, Hsu HC, Ro LS. Reappraisal of the Prognostic Factors of Outcome and Recovery Time in Patients with Idiopathic Bell's Palsy: A Retrospective Single-Center Analysis. J Pers Med 2021; 11:jpm11030171. [PMID: 33801402 PMCID: PMC7998821 DOI: 10.3390/jpm11030171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022] Open
Abstract
Study Objectives: This retrospective study investigated prognostic factors and recovery time in patients with Bell’s palsy after different doses and durations of oral glucocorticoid treatments. Subjects and Methods: A total of 396 patients initially diagnosed with Bell’s palsy that had visited the Department of Neurology of Chang Gung Memorial Hospital, Taoyuan, a tertiary referral medical center in Taiwan, between January 2014 and December 2018 were included. Medical records, facial electroneurography (fENoG), and blink reflex (BR) tests were reviewed and analyzed. A favorable outcome was defined as patients who improved to grade ≤ II, and an unfavorable outcome was defined as patients who improved to grade ≥ III in 6 months according to the House–Brackmann (HB) grading system. Results: The rate of favorable outcomes was 89.4% (354 of 396 patients) at the 6-month follow-up. A favorable outcome (HB less than grade II) was associated with a delayed BR (odds ratio, OR, 5.38; 95% CI, 1.82 to 15.90) and fENoG values (the lesion side/the healthy side) over 33% (OR, 6.67; 95% CI, 3.02 to 14.71). The recovery time was significantly shorter for those with a delayed BR than for those with an absent BR and shorter for those with good fENoG values (>33%) than for those with poor values (≤33%). However, treatment without or with different doses and durations of oral glucocorticoid did not influence the final outcome or recovery time in this study. Conclusions: The fENoG and BR tests were significant and highly valuable examinations for predicting the final outcome. Moreover, age younger than 60 years, a delayed BR, and fENoG values > 33% were associated with shorter recovery times.
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Affiliation(s)
- Chi-Hao Peng
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.P.); (J.-L.C.)
| | - Jiun-Liang Chen
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-H.P.); (J.-L.C.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ming-Feng Liao
- Department of Neurology, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (M.-F.L.); (J.-L.H.)
| | - Jung-Lung Hsu
- Department of Neurology, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (M.-F.L.); (J.-L.H.)
| | - Hui-Ching Hsu
- Department of Traditional Chinese Medicine, Division of Chinese Acupuncture and Traumatology, Chang Gung Memorial Hospital, Taipei 105, Taiwan;
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital, Taipei 105, Taiwan; (M.-F.L.); (J.-L.H.)
- Correspondence: ; Tel.: +886-3-3281200-8351
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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.
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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
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Arnold D, Thielker J, Klingner CM, Puls WC, Misikire W, Guntinas-Lichius O, Volk GF. Selective Surface Electrostimulation of the Denervated Zygomaticus Muscle. Diagnostics (Basel) 2021; 11:diagnostics11020188. [PMID: 33525522 PMCID: PMC7912406 DOI: 10.3390/diagnostics11020188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/05/2023] Open
Abstract
This article describes a first attempt to generate a standardized and safe selective surface electrostimulation (SES) protocol, including detailed instructions on electrode placement and stimulation parameter choice to obtain a selective stimulation of the denervated zygomaticus muscle (ZYG), without unwanted simultaneous activation of other ipsilateral or contralateral facial muscles. Methods: Single pulse stimulation with biphasic triangular and rectangular waveforms and pulse widths (PW) of 1000, 500, 250, 100, 50, 25, 15, 10, 5, 2, 1 ms, at increasing amplitudes between 0.1 and 20 mA was performed. Stimulations delivered in trains were assessed at a PW of 50 ms only. The stimulation was considered successful exclusively if it drew the ipsilateral corner of the mouth upwards and outwards, without the simultaneous activation of other ipsilateral or contralateral facial muscles. I/t curves, accommodation quotient, rheobase, and chronaxie were regularly assessed over 1-year follow-up. Results: 5 facial paralysis patients were assessed. Selective ZYG response in absence of discomfort and unselective contraction of other facial muscle was reproducibly obtained for all the assessed patients. The most effective results with single pulses were observed with PW ≥ 50 ms. The required amplitude was remarkably lower (≤5 mA vs. up to 15 mA) in freshly diagnosed (≤3 months) than in long-term facial paralysis patients (>5 years). Triangular was more effective than rectangular waveform, mostly because of the lower discomfort threshold of the latter. Delivery of trains of stimulation showed similar results to the single pulse setting, though lower amplitudes were necessary to achieve the selective ZYG response. Initial reinnervation signs could be detected effectively by needle-electromyography (n-EMG). Conclusion: It is possible to define stimulation parameters able to elicit an effective selective stimulation of a specific facial muscle, in our case, of the ZYG, without causing discomfort to the patient and without causing unwanted unspecific reactions of other ipsilateral and/or contralateral facial muscles. We observed that the SES success is strongly conditioned by the correct electrode placement, which ideally should exclusively interest the area of the target muscles and its immediate proximity.
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Affiliation(s)
- Dirk Arnold
- Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany; (D.A.); (J.T.); (C.M.K.); (W.C.P.); (W.M.); (O.G.-L.)
- Institute of Zoology and Evolutionary Research, Friedrich-Schiller-University Jena, 07743 Jena, Germany
| | - Jovanna Thielker
- Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany; (D.A.); (J.T.); (C.M.K.); (W.C.P.); (W.M.); (O.G.-L.)
- Department of Otorhinolaryngology, Jena University Hospital, 07740 Jena, Germany
| | - Carsten M. Klingner
- Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany; (D.A.); (J.T.); (C.M.K.); (W.C.P.); (W.M.); (O.G.-L.)
- Department of Neurology, Jena University Hospital, 07740 Jena, Germany
| | - Wiebke Caren Puls
- Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany; (D.A.); (J.T.); (C.M.K.); (W.C.P.); (W.M.); (O.G.-L.)
- Department of Otorhinolaryngology, Jena University Hospital, 07740 Jena, Germany
| | - Wengelawit Misikire
- Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany; (D.A.); (J.T.); (C.M.K.); (W.C.P.); (W.M.); (O.G.-L.)
- Department of Otorhinolaryngology, Jena University Hospital, 07740 Jena, Germany
| | - Orlando Guntinas-Lichius
- Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany; (D.A.); (J.T.); (C.M.K.); (W.C.P.); (W.M.); (O.G.-L.)
- Department of Otorhinolaryngology, Jena University Hospital, 07740 Jena, Germany
| | - Gerd Fabian Volk
- Facial-Nerve-Center Jena, Jena University Hospital, 07740 Jena, Germany; (D.A.); (J.T.); (C.M.K.); (W.C.P.); (W.M.); (O.G.-L.)
- Department of Otorhinolaryngology, Jena University Hospital, 07740 Jena, Germany
- Correspondence:
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Luu NN, Chorath KT, May BR, Bhuiyan N, Moreira AG, Rajasekaran K. Clinical practice guidelines in idiopathic facial paralysis: systematic review using the appraisal of guidelines for research and evaluation (AGREE II) instrument. J Neurol 2021; 268:1847-1856. [PMID: 33389026 DOI: 10.1007/s00415-020-10345-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022]
Abstract
Bell's palsy, or idiopathic facial paralysis, is a peripheral facial palsy of unknown cause that presents as sudden, unilateral weakness of the muscles of the face. Prompt treatment of Bell's palsy is critical in order for patients to achieve complete recovery of facial function. Delays in diagnosis and management can result in permanent facial defects. A number of clinical practice guidelines (CPG) exist to guide clinical decision-making in patients presenting with idiopathic facial paralysis. However, to date, there has been no comprehensive review of the methodological rigor and quality of these CPGs. Thus, the objective of the authors is to appraise the existing CPGs to ensure safe and effective practices. A total of eight guidelines met the inclusion criteria and were appraised. Only two CPGs achieved an overall rating of 'High', having five or more quality domains scoring > 60%. Across the CPGs, the domains of rigor of development, stakeholder involvement, and applicability has the lowest overall scores with 48.1%, 43.9%, and 43.1%, respectively. Based on the AGREE II instrument, the methodological rigor and quality of CPGs for Bell's palsy is low to average. In particular, future guidelines for Bell's palsy should look to the quality domains of rigor of development, stakeholder involvement, and applicability as the greatest opportunities for improvement.
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Affiliation(s)
- Neil N Luu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Kevin T Chorath
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Brandon R May
- University of Texas Health Science Center-San Antonio, Texas, USA
| | - Nuvid Bhuiyan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Alvaro G Moreira
- University of Texas Health Science Center-San Antonio, Texas, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Zhang Q, Zhu C, Liu J. Kinesitherapy for idiopathic facial palsy: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23902. [PMID: 33350789 PMCID: PMC7769292 DOI: 10.1097/md.0000000000023902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Idiopathic facial nerve palsy (Bells palsy) is the most common acute mono-neuropathy which lack of effective treatments. Kinesitherapy as an alternative therapeutic approach was widely used in clinical. But the effects on Bells palsy outcome are still debated. METHODS The aim of this study is to systematically review the therapeutic efficacy of kinesitherapy for Bells palsy. Database including PubMed, EMBASE, Cochrane Library, Chinese Biomedical database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical database (VIP) and WangFang database will be searched to collect randomized controlled trails (RCTs) on kinesitherapy for Bells palsy from inception to Nov 2020. The therapeutic effects based on recovery rate, House-Brackmann (H-B) facial classification system, Sunny brook face grading system and adverse events after the treatment will be marked as the primary outcomes. RevMan V.5.3 software will be used to calculate the data synthesis as well as to perform meta-analysis if the results are appropriate. RESULTS The literature will provide a high-quality synthesis of current evidence of kinesitherapy for Bells palsy from various comprehensive assessment, including the recovery rate, H-B facial classification, Sunny brook face scores, adverse events rate, Facial disability index (FDI), residual symptoms 6 months after onset, incomplete recovery rate after 1 year. CONCLUSION The systematic review will provide up-to-date evidence to assess kinesitherapy for Bells palsy. PROSPERO REGISTRATION NUMBER PROSPERO CRD42020215109.
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Affiliation(s)
| | - Chan Zhu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Jing Liu
- Sichuan Bayi Rehabilitation Center, Sichuan Provincial Rehabilitation Hospital, Chengdu, Sichuan Province, PR China
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Pacheco A, Rutler O, Valenzuela I, Feldman D, Eskin B, Allegra JR. Positive Tests for Lyme Disease and Emergency Department Visits for Bell's Palsy Patients. J Emerg Med 2020; 59:820-827. [PMID: 32978030 DOI: 10.1016/j.jemermed.2020.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Etiologies for Bell's palsy include herpes viruses and Lyme disease, with highest incidence in the colder and warmer months, respectively. In New Jersey, a Lyme-endemic area, the months with the most Lyme disease (80% of cases) are May through October ("Lyme months"). OBJECTIVE Our aim was to determine whether positive tests for Lyme disease and visits are greater in the Lyme months than the rest of the year for patients with Bell's palsy in New Jersey emergency departments (EDs). METHODS We conducted a retrospective chart review from two New Jersey suburban EDs with consecutive patients from February 1, 2013 to January 31, 2018.We identified patients having Bell's palsy using the emergency physician diagnosis. We tabulated positive Lyme tests and visits for Bell's palsy by month of year. We calculated the ratio of positive tests and visits between the Lyme months and the rest of the year along with 95% confidence intervals (CIs). RESULTS There were 442 visits for Bell's palsy, 359 (81%) of these patients were tested for Lyme disease and 57 (16%) of the tests were positive. The Lyme months had 7.1 (95% CI 3.5-14.4) times more positive tests and 1.3 (95% CI 1.1-1.4) times more Bell's palsy visits than the rest of the year. Both measures peaked in July. CONCLUSIONS In a Lyme-endemic area, positive Lyme tests and ED visits for Bell's palsy are greatest in the Lyme months, peaking in July. This finding can help guide testing and treatment for patients in the ED with Bell's palsy during various months of the year.
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Affiliation(s)
| | | | | | | | - Barnet Eskin
- Morristown Medical Center, Morristown, New Jersey
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Volokitin M, Sheikh A, Patel S, Milani S, Banihashem M. Treating Bell’s Palsy With Osteopathic Manipulative Medicine: A Case Report. Cureus 2020; 12:e11092. [PMID: 33240690 PMCID: PMC7681752 DOI: 10.7759/cureus.11092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bell's palsy (BP) occurs when the facial nerve (CN VII) is swollen, inflamed, or compressed, resulting in facial weakness or paralysis; etiology is unknown. BP patients often succumb to a decreased quality of life due to the inability to make facial expressions, increased sensitivity to auditory stimuli, and dysregulation in tear and saliva production. Despite conventional examination and therapy options, the syndrome is majorly regarded as idiopathic and left unresolved for many patients. In this case of a patient with BP, treatment with osteopathic manipulative treatment (OMT) which focused on restoring a normal structure-function relationship resolved the patient’s symptoms. The osteopathic manipulative procedures utilized findings from an osteopathic structural exam and addressed those somatic dysfunctions with OMT. The authors report that the patient's symptoms improved after the application of OMT and without the use of pharmaceuticals. The results of the case study suggest that treating BP with OMT can rapidly improve symptoms and can be used without or concurrently with other treatment modalities, if applicable. Patient’s consent for this case report was obtained in written and verbal form.
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Fieux M, Daubie S, Pialat JB, Tringali S. Petrous Apex Cholesterol Granuloma Revealed by Facial Palsy. Ann Neurol 2020; 89:414-415. [PMID: 33015882 DOI: 10.1002/ana.25924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Maxime Fieux
- Department of ENT Surgery, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Sophie Daubie
- Department of Medical Imaging, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Jean-Baptiste Pialat
- Department of Medical Imaging, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Stephane Tringali
- Department of ENT Surgery, Lyon Sud University Hospital, Claude Bernard Lyon 1 University, Lyon, France
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Szczepura A, Holliday N, Neville C, Johnson K, Khan AJK, Oxford SW, Nduka C. Raising the Digital Profile of Facial Palsy: National Surveys of Patients' and Clinicians' Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology. J Med Internet Res 2020; 22:e20406. [PMID: 32763890 PMCID: PMC7573702 DOI: 10.2196/20406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Facial nerve palsy leaves people unable to move muscles on the affected side of their face. Challenges exist in patients accessing facial neuromuscular retraining (NMR), a therapy used to strengthen muscle and improve nerve function. Access to therapy could potentially be improved through the use of digital technology. However, there is limited research available on patients' and clinicians' views about the potential benefits of such telerehabilitation based on their lived experiences of treatment pathways. OBJECTIVE This study aims to gather information about facial palsy treatment pathways in the United Kingdom, barriers to accessing NMR, factors influencing patient adherence, measures used to monitor recovery, and the potential value of emerging wearable digital technology. METHODS Separate surveys of patients with facial palsy and facial therapy specialists were conducted. Questionnaires explored treatment pathways and views on telerehabilitation, were co-designed with users, and followed a similar format to enable cross-referencing of responses. A follow-up survey of national specialists investigated methods used to monitor recovery in greater detail. Analysis of quantitative data was conducted allowing for data distribution. Open-text responses were analyzed using thematic content analysis. RESULTS A total of 216 patients with facial palsy and 25 specialist therapists completed the national surveys. Significant variations were observed in individual treatment pathways. Patients reported an average of 3.27 (SD 1.60) different treatments provided by various specialists, but multidisciplinary team reviews were rare. For patients diagnosed most recently, there was evidence of more rapid initial prescribing of corticosteroids (prednisolone) and earlier referral for NMR therapy. Barriers to NMR referral included difficulties accessing funding, shortage of specialist therapists, and limited awareness of NMR among general practitioners. Patients traveled long distances to reach an NMR specialist center; 9% (8/93) of adults reported traveling ≥115 miles. The thematic content analysis demonstrates positive attitudes to the introduction of digital technology, with similar incentives and barriers identified by both patients and clinicians. The follow-up survey of 28 specialists uncovered variations in the measures currently used to monitor recovery and no agreed definitions of a clinically significant change for any of these. The main barriers to NMR adherence identified by patients and therapists could all be addressed by using suitable real-time digital technology. CONCLUSIONS The study findings provide valuable information on facial palsy treatment pathways and views on the future introduction of digital technology. Possible ways in which emerging sensor-based digital technology can improve rehabilitation and provide more rigorous evidence on effectiveness are described. It is suggested that one legacy of the COVID-19 pandemic will be lower organizational barriers to this introduction of digital technology to assist NMR delivery, especially if cost-effectiveness can be demonstrated.
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Affiliation(s)
- Ala Szczepura
- Faculty Health & Life Sciences, Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Nikki Holliday
- Health & Life Sciences, Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
| | - Karen Johnson
- Facial Palsy UK (Charity), Peterborough, United Kingdom
| | - Amir Jahan Khan Khan
- Department of Economics,, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Samuel W Oxford
- Exercise & Life Sciences, Faculty Health & Life Sciences, Centre for Sport, Coventry University, Coventry, United Kingdom
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
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