Kabat Rehabilitation in Facial Nerve Palsy after Parotid Gland Tumor Surgery: A Case-Control Study

The Effects of Telerehabilitation-Based Exercise Therapy on Motor and Non-Motor Clinical Outcomes in Adults With Facial Palsy: A Randomized Controlled Trial

Recent case reports have emphasized the essential clinical contribution of telerehabilitation in the treatment of facial palsy. However, no randomized controlled trial has yet demonstrated the effects of telerehabilitation-based facial exercise therapy. Thus, we aimed to investigate the effectiveness of video exercise-based telerehabilitation on motor and non-motor clinical outcomes in adults with facial palsy. We conducted a randomized controlled trial with 40 peripheral facial palsy patients. Those in the experimental group (EG) received four weeks of telerehabilitation-based video exercises and routine care. Those in the control group (CG) received only routine care. All participants were evaluated with the Facial Disability Index (FDI), the Facial Clinimetric Evaluation Scale (FaCE), Short Form-12 (SF-12), the Hospital Anxiety and Depression Scale (HADS), the House-Brackmann Scale (H-B) and the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ), both before and after the interventions. Both groups demonstrated a significant improvement in FDI, FaCE, and SF-12 PCS scores (p < .05). In addition, there was a significant improvement only in EG on the SF-12 MCS score (p < .05), and there was a significant gain only in CG on the HADS-Depression score (p < .05). While these results provide a further contribution to our understanding of telerehabilitation benefits in mental health variables related to quality of life for facial palsy patients, we found no EG and CG differences on the physical components of treatment.

Comparative analysis of free SMAS fold flap and ADM in facial depression after parotidectomy

BACKGROUND

This study aimed to analyze the effects of anterior descending mandible (ADM) and free superior mesenteric artery (SMAS) folding flaps on post-parotidectomy facial depression.

METHODS

This retrospective study examined the effects of sex, age, surgical sample size, method, duration, and blood loss on postoperative complications in 65 patients.

RESULTS

No significant differences involving sex, age, or sample size for surgical resection were observed between the two groups. The incidence of Frey syndrome (P = 0.175) and the locations of facial nerve injuries and tumors were not significantly different between the two groups. However, a statistically significant difference was observed in postoperative facial depression between the groups (P = 0.045, P < 0.05). No significant difference was found between facial nerve injury and Frey's sign in subgroup analysis of facial depression deformities. Within the facial depression group, tumor locations were significantly different (P = 0.021, P < 0.05). In the cases of facial depression after partial parotid resection, no significant difference was observed between ADM implantation and SMAS flap placement. A significant difference was noted between the ADM implantation and SMAS flap groups in the total parotidectomy group (P = 0.046 and P < 0.05, respectively).

CONCLUSION

Women are more likely to experience facial depression after parotid surgery. Facial depression is most likely to occur after parotid resection if the tumor is located in the deep lobes of the parotid gland. The use of SMAS flaps can prevent facial depression, and both ADM and SMAS flaps can prevent Frey's syndrome. Partial parotid resection reduces the risk of facial nerve injury and facial depression.

Extracapsular Dissection Versus Traditional Parotid Surgery: A Comprehensive Review of Techniques and Outcomes

Parotid tumours, encompassing both benign and malignant forms, present significant challenges in surgical management. Traditional parotid surgery, including various forms of parotidectomy, has long been the standard approach, aiming for complete tumour removal while addressing potential complications such as facial nerve injury. However, extracapsular dissection (ECD) has emerged as an alternative technique, focusing on excising the tumour along with a thin layer of surrounding tissue, which may offer benefits in preserving healthy glandular tissue and reducing postoperative complications. This review comprehensively compares ECD and traditional parotid surgery techniques, evaluating their efficacy, outcomes, and associated complications. We analyse clinical studies and evidence to assess differences in tumour recurrence rates, facial nerve function preservation, and overall patient recovery. Additionally, the review explores the indications for each surgical approach, considering tumour characteristics and patient-specific factors. The findings suggest that while ECD may offer advantages in terms of reduced postoperative complications and improved preservation of glandular tissue, traditional parotidectomy remains a robust method for managing complex cases. This review aims to inform clinical decision-making by presenting a detailed comparison of both techniques, ultimately guiding surgeons in selecting the most appropriate approach for individual patients.

The professional interactions between speech language therapist and dentist

Aim: This study investigates the collaborative efforts between speech language therapists and dentists to address the challenges faced by patients with concurrent dental and speech issues. It underscores the importance of understanding the complex interactions within the craniofacial system and its implications for both oral health and communication abilities. Methods: A questionnaire-based research was conducted involving speech language therapists and dentists, using Google Forms as the medium of data collection. This study was disseminated through professional networks, where practitioners provided information on their demographics, practices of collaboration, and the perceived advantages of such interdisciplinary work. All ethical standards were adhered to, ensuring the confidentiality and informed consent of the participants. Results: The findings indicate that dentists, often see first patient visits beyond recommended ages primarily for existing conditions, deviating from preventive norms. About half communicate monthly with speech language therapists, revealing gaps in early care and collaboration. Speech language therapists focus on language disorders and orofacial myofunctional disorders (SMOF), with 37% collaborating frequently with dentists. This interaction highlights the potential for enhanced patient outcomes through interdisciplinary cooperation. Despite these challenges, both groups acknowledged the benefits of their collaborative efforts. Conclusions: The partnership between speech language therapists and dentists represents a vital area of healthcare, aimed at tackling the complex issues of oral health and communication through a multidisciplinary approach. Although obstacles in collaboration were identified, the positive outcomes observed from such partnerships emphasize the importance of developing a unified framework to improve integrated healthcare delivery in the future.

Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis

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).

Special Issue: Evidence-Based Diagnosis and Management of Facial Nerve Disorders

Although there has been a rapid increase in the number of new publications and studies in relation to the diagnostics, impacts and rehabilitation methods of facial nerve disorders, a general structure in evidence-based medicine is still difficult to establish [...].

Safety and Aesthetics of Autologous Dermis-Fat Graft after Parotidectomy: A Multidisciplinary Retrospective Study

(1) Background: In surgical procedures for maxillofacial tumours, it is challenging to preserve functional and cosmetic properties in the affected patients. The use of fat grafting is considered as a valuable alternative to overcome postoperative aesthetic asymmetry problems. (2) Methods: In this study, we enrolled thirty patients with parotid gland tumours in which a partial or complete parotidectomy was performed with positioning in the parotid bed of autologous dermis-fat grafts. We evaluated the satisfaction rate of the patients and the objective efficacy in solving the deformity by comparing MRI data before and after surgery. (3) Results: Twenty-six patients showed a satisfying cosmetic result with proper facial symmetry between the affected side and the healthy one. Two patients presented mild postsurgical complications such as haematomas, and two patients reported temporary weakness of the facial nerve related to the parotidectomy. (4) Conclusions: Based on the imaging data obtained via MRI before and after surgery, we can assess that the employment of fat grafts in parotidectomy surgical procedures gives good cosmetic results and does not affect the post operative management and follow up of oncologic patients.

Solitary Extrapleural Fibrous Tumor in Salivary Glands: Our Experience-Case Series and Literature Review

(1) Background: Extrapleural solitary fibrous tumors (ESFTs) are rare oncological entities occurring in the head and neck, and even more so in the salivary glands. The clinical presentation and histologic features are usually unspecific, resulting in frequent misclassification. As an unusual tumor, ESTFs have an unpredictable clinical behavior. (2) Methods: We present two clinical cases referred to our Maxillofacial Surgery Unit for the onset of a symptomless mass involving, in one case, the parotid gland, and in the other case, the sublingual gland. (3) Results: Solitary fibrous tumors could be considered as neoplasms with intermediate biological behavior that are not entirely predictable on the basis of morphological features, as these are mostly still unknown. However, a few histologic, immunohistochemical, and imaging features, such as a hypodense signal at the T1 sequence in an MRI, or positivity for CD34, bcl2, and CD99, and the NAB2-STATS6 fusion gene, could be useful for an early differential diagnosis of ESTFs. (4) Conclusions: All patients were alive at follow-up with no evidence of disease. Surgical management should always be considered as the first choice for oncological radicality, and clinical behavior should always be defined with the help of the study of radiological and anatomopathological features.

Long-Term Outcomes of Patients with Primary Brain Tumors after Acute Rehabilitation: A Retrospective Analyses of Factors

Although primary brain tumors are relatively rare, they cause significant morbidity and mortality due to the high rates of neurological impairment. The purpose of this study was to examine the physical and functional outcomes of patients with primary brain tumors who had undergone inpatient rehabilitation. This was a retrospective study which recruited 163 patients who had been admitted for inpatient rehabilitation. Rehabilitation outcomes, including the Functional Independence Measure (FIM) and Glasgow Outcome Scale (GOS), were recorded up to 1 year post-discharge. The majority of patients (79.1%) had low-grade (WHO Class I-II) tumors, 35 (21.5%) were diagnosed with GBM and 52 (31.9%) had recurrent brain tumors. Rehabilitation outcomes were sustained, with 125 (76.7%) and 113 (69.3%) patients having a GOS of ≥4 at 6 months and 1 year after discharge, respectively. A GOS of ≥4 at 1 year was negatively associated with high-grade tumors (p < 0.001) and radiotherapy (p = 0.028), and positively associated with a higher discharge FIM motor score (p < 0.001) and the presence of a caregiver after discharge (p = 0.034). Our study demonstrates significant positive functional benefits from 4 weeks of inpatient neuro-oncological rehabilitation for patients with primary brain tumors, as well as the importance of supportive care from caregivers.