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Ballmaier J, Hölzer S, Geitner M, Kuttenreich AM, Erfurth C, Guntinas-Lichius O, Volk GF. [Telemedicine for patients with facial palsy : Current developments and options in otorhinolaryngologic treatment]. HNO 2024:10.1007/s00106-024-01449-4. [PMID: 38530382 DOI: 10.1007/s00106-024-01449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
Digitalization is also becoming increasingly important in medicine. The COVID-19 pandemic has further accelerated this process and politicians are trying to create a framework for successful knowledge transfer and better digital medical care. This article describes the role of telemedicine in the treatment of patients suffering from facial nerve palsy. Facial nerve palsy has a wide range of effects, from limitations in facial mobility to psychological sequelae. While many of the acute, idiopathic facial nerve palsies improve after a few weeks, around a third of those affected develop synkinesis, involuntary movements that have lifelong functional and psychological consequences. Treatment includes various modalities, from medication and surgery to movement training. Telemedicine offers innovative solutions in cases of regional underuse, but also in the treatment of chronic facial nerve palsies. The article defines the term "telemedicine" in the current context and presents different types of application. A detailed analysis of the application scenarios of telemedicine in facial nerve palsy patients shows that despite a lack of evidence, many potentially useful concepts exist.
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Affiliation(s)
- Jonas Ballmaier
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland
| | - Sabrina Hölzer
- Fachbereich Wirtschaftsingenieurswesen, Ernst-Abbe-Hochschule Jena, Jena, Deutschland
| | - Maren Geitner
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland
| | - Anna-Maria Kuttenreich
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland
| | - Christian Erfurth
- Fachbereich Wirtschaftsingenieurswesen, Ernst-Abbe-Hochschule Jena, Jena, Deutschland
| | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland
| | - Gerd Fabian Volk
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Jena, Deutschland.
- Fazialis-Nerv-Zentrums Jena, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Institut für Phoniatrie und Pädaudiologie, Universitätsklinikum Jena, Haus A, Am Klinikum 1, 07747, Jena, Deutschland.
- Zentrum für Seltene Erkrankungen Jena, Universitätsklinik Jena, Jena, Deutschland.
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Chen Y, Liu Y, Huang Q, Luo J, Wu H, Wang Y, Wu L, Li X, Bi X. Facial nerve function training in patients with peripheral facial paralysis: an expert consensus. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2023; 41:613-621. [PMID: 38597024 PMCID: PMC10722454 DOI: 10.7518/hxkq.2023.2023200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/22/2023] [Indexed: 04/11/2024]
Abstract
Facial nerve training can prevent facial expression muscle atrophy and promote the recovery of facial para-lysis in patients with peripheral facial paralysis. However, there is still a lack of specific and unified technical standards for facial nerve training, which results in a variety of clinical training methods and uneven levels. In order to standardize the application of facial nerve function training technology for nursing staff, the study convened relevant domestic experts, based on evidence-based combination with the disease characteristics of peripheral facial paralysis and expert clinical experience, conducted in-depth interviews with experts, expert correspondence and expert meetings, and finally formulated the expert consensus on facial nerve function training in patients with peripheral facial paralysis. Overall, suggestions for standardizing the timing, training methods, evaluation methods, health education and other aspects were provided for clinical reference.
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Affiliation(s)
- Yunmei Chen
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yan Liu
- Dept. of Maxillofacial Surgery, Stomatology Center, Shenzhen People's Hospital, Shenzhen 518020, China
| | - Qiuyu Huang
- Dept. of Oral and Maxillofacial Surgery, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
| | - Jiang Luo
- Dept. of Nursing, Xiangya Stomatological Hospital, Central South University, Changsha 410000, China
| | - Hongmei Wu
- Dept. of Nursing, Stomatological College of Nanjing Medical University, Nanjing 210029, China
| | - Yehua Wang
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ling Wu
- Dept. of Oral and Maxillofacial Trauma and Temporomandibular Joint Surgery, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Xiu'e Li
- Dept. of Nursing, Hospital of Stomatology, Peking University, Beijing 100081, China
| | - Xiaoqin Bi
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Nursing, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Arnold D, Thielker J, Klingner CM, Guntinas-Lichius O, Volk GF. Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1205154. [PMID: 37908489 PMCID: PMC10613664 DOI: 10.3389/fresc.2023.1205154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023]
Abstract
Introduction Although many different treatments were developed for facial palsy, only a few therapeutic options are available for facial synkinesis. Electrical stimulation of specific muscles via implants could be useful in restoring facial symmetry in synkinetic patients. A challenge in developing stimulation devices is finding the right stimulation location, type, and amplitude. This work assesses the ability to selectively stimulate the zygomaticus muscle (ZYG) in patients with oral-ocular synkinesis to elicit a visually detectable response of the ipsilateral corner of the mouth (COM), without causing a reaction of the orbicularis oculi muscle (OOM). We aimed to assess how close to the COM the stimulation should be delivered in order to be selective. Methods A total of 10 patients (eight females, two males) were enrolled. Facial function was graded according to the Sunnybrook facial grading system. Needle EMG was used to test the activities of the muscles, during volitional and "unintended" movements, and the degree of synkinesis of the ZYG and OOM. Two ball electrodes connected to an external stimulator were placed on the paretic ZYG, as close as possible to the COM. Results Independent of the waveform with which the stimulation was presented, a selective ZYG response was observed within 4.5 cm of the horizontal plane and 3 cm of the vertical plane of the COM. When the distance between the electrodes was kept to ≤2 cm, the amplitude necessary to trigger a response ranged between 3 and 6 mA when the stimulation was delivered with triangular pulses and between 2.5 and 3.5 mA for rectangular pulses. The required amplitude did not seem to be dependent on the applied phase duration (PD), as long as the PD was ≥5 ms. Conclusion Our results show that selective stimulation of the ZYG presenting synkinetic ZYG-OOM reinnervation can be achieved using a broad PD range (25-1,000 ms) and an average amplitude ≤6 mA, which may be further decreased to 3.5 mA if the stimulation is delivered via rectangular rather than triangular waves. The most comfortable and effective results were observed with PDs between 50 and 250 ms, suggesting that this range should be selected in future studies. Clinical Trial Registration [https://drks.de/search/de/trial/DRKS00019992], identifier (DRKS00019992).
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Affiliation(s)
- Dirk Arnold
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Carsten M. Klingner
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
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Tikhtman R, Hsieh TY. Minimization of facial synkinesis. Curr Opin Otolaryngol Head Neck Surg 2023; 31:293-299. [PMID: 37610981 DOI: 10.1097/moo.0000000000000920] [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: 08/25/2023]
Abstract
PURPOSE OF REVIEW To summarize the treatment options available for the management of postparalytic facial synkinesis which include facial rehabilitation, chemodenervation, and a spectrum of surgical interventions. RECENT FINDINGS Facial rehabilitation and botulinum toxin chemodenervation represent the foundation of facial synkinesis management, with specific treatment paradigms directed by individual patient needs. Evolving surgical approaches range from isolated selective myectomies or neurectomies to combination approaches which may incorporate various types of nerve transfer with gracilis free muscle transplantation. SUMMARY Postparalytic facial synkinesis bears significant patient morbidity due to aesthetic and functional implications. Management strategies must balance patient goals with treatment risks and typically progress stepwise from the least to most invasive interventions. Emerging techniques reveal a convergence in approaches to facial reanimation and synkinesis mitigation.
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Affiliation(s)
- Raisa Tikhtman
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Guntinas-Lichius O, Prengel J, Cohen O, Mäkitie AA, Vander Poorten V, Ronen O, Shaha A, Ferlito A. Pathogenesis, diagnosis and therapy of facial synkinesis: A systematic review and clinical practice recommendations by the international head and neck scientific group. Front Neurol 2022; 13:1019554. [PMID: 36438936 PMCID: PMC9682287 DOI: 10.3389/fneur.2022.1019554] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Post-paralytic facial synkinesis after facial nerve injury produces functional disabilities and mimetic deficits, but also cosmetic and non-motor psychosocial impairments for the patients. These patients typically have a high and continuous high motivation for rehabilitation. The aim is to inform the affected patients and their therapeutic professionals (otorhinolaryngologist - head and neck surgeons; oral-maxillofacial surgeons, plastic and reconstructive surgeons, neurosurgeons, neurologists, and mime therapists be it speech and language therapy- or physiotherapy-based) and to provide practical recommendations for diagnostics and a stepwise systematic treatment approach of facial synkinesis. Methods In the first phase, a systematic literature search on the topic in PubMed and ScienceDirect starting in 2008 resulted in 132 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostic tests and treatment options. In the second phase, one consensus article circulated among the membership of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations. Results Diagnostics should include a standardized assessment of the degree of synkinesis using validated clinician-graded instruments and synkinesis-specific patient-reported outcome measures. Treatments for facial synkinesis include facial training mainly based on facial biofeedback retraining, chemodenervation with botulinum toxin, selective neurectomy, myectomy, and any combination treatment of these options. Conclusion A basic understanding of the pathomechanisms of synkinesis is essential to understand the treatment strategies. A standardized assessment of the synkinetic symptoms and the individual synkinesis pattern is needed. The first-line treatment is facial training, followed by botulinum toxin. Surgery is reserved for individual cases with unsatisfactory first-line treatment.
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Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial Nerve Center, Jena University Hospital, Jena, Germany,Multidisciplinary Salivary Gland Society, Geneva, Switzerland,*Correspondence: Orlando Guntinas-Lichius
| | - Jonas Prengel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial Nerve Center, Jena University Hospital, Jena, Germany
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Affiliated With Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Vincent Vander Poorten
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium,Otorhinolaryngology, Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Affiliated With Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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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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