Directrices para el diagnóstico y tratamiento de Molares Retenidos / Guidelines for diagnosis and treatment of impacted molars

Los terceros molares son piezas dentarias correspondientes a la dentición permanente y se encuentran por detrás de los segundos molares. Erupcionan entre los 18 y 27 años aproximadamente, tienen variedad de formas, anomalías y disposición diversa. Normalmente se encuentran total o parcialmente retenidos en el hueso maxilar. La retención es muy frecuente y afecta aproximadamente al 75% de la población. La causa principal es por la falta de espacio dentro de la boca. La patología derivada de la retención de un tercer molar puede generar diferentes alteraciones: abscesos, sinusitis, reabsorción de las raíces de los dientes adyacentes, caries del molar retenido y/o del segundo molar, úlceras en la mucosa contigua, podrían generar quistes, ameloblastomas y ulceraciones leucoqueratósicas que pueden degenerar en carcinomas, alteraciones nerviosas o vasomotoras: dolores faciales, trismus, y parálisis facial ipsilateral. Las extracciones profilácticas de terceros molares asintomáticos están justificadas cuando los terceros molares se encuentran bajo prótesis removible que puede estimular su erupción, molares semierupcionados que pueden generar pericoronitis, caries o problemas periodontales; pacientes que van a ser sometidos a radioterapia; cuando el diente incluido interfiera en una cirugía ortognática. Si el molar retenido presenta sintomatología por parte del paciente está aconsejada su extracción quirúrgica.

The third molars are dental pieces corresponding to the permanent dentition and are located behind the second molars. They erupt between the ages of 18 and 27 approximately, have a variety of shapes, anomalies, and diverse dispositions. They are normally fully or partially retained in the maxillary bone. Retention is very frequent and affects approximately 75% of the population. The main cause is due to the lack of space inside the mouth. The pathology derived from the retention of a third molar can generate different alterations: abscesses, sinusitis, resorption of the roots of adjacent teeth, caries of the retained molar and/or second molar, ulcers in the contiguous mucosa, could generate cysts, ameloblastomas and leukokeratotic ulcerations that can degenerate into carcinomas, nervous or vasomotor disorders: facial pain, trismus, and ipsilateral facial paralysis. Prophylactic extractions of asymptomatic third molars are justified when the third molars are under removable prosthesis that can stimulate their eruption, semi-erupted molars that can generate pericoronitis, caries or periodontal problems; patients who are going to undergo radiotherapy; when the included tooth interferes with orthognathic surgery. If the retained molar presents symptoms on the part of the patient, its surgical extraction is recommended.

Parálisis facial periférica bilateral postraumática / Bilateral post-traumatic facial palsy

La parálisis del VII par craneal o nervio facial, es una de las neuropatías más frecuentes. Sin embargo, la bilateral ocurre solo en el 0,3 a 2% de los casos. Se describe el caso de un paciente con parálisis facial periférica bilateral progresiva, secundaria a traumatismo craneoencefálico con fractura de ambos temporales, a quien se le realizó tratamiento médico con esteroides y fisioterapia con mejoría, por lo que se decidió expectar la conducta quirúrgica del nervio facial

Facial nerve palsy is one of the most common neuropathies. However, bilateral occurs only in 0.3 to 2% of cases. The case of a patient with progressive bilateral facial nerve palsy, secondary to cranioencephalic trauma with fracture of both temporal was treated with steroids and physiotherapy with subsequent resolution of symptoms, so it was decided dedicated wait for surgery

Parálisis facial aislada posterior a infección por virus de chikunguña: un nuevo diagnóstico diferencial / Isolated facial palsy after Chikungunya infection: A novel differential diagnosis

En las últimas décadas, se ha incrementado el reporte de manifestaciones neurológicas asociadas con la infección por el virus de chikunguña. Se informa el caso de un adulto joven previamente sano que presentó parálisis facial izquierda aislada después de una infección reciente por el virus de chikunguña en el trópico colombiano. Se describen aspectos importantes de la fisiopatología del virus y su tropismo por el sistema nervioso central y periférico, y se sugiere considerar este virus en el diagnóstico diferencial de la parálisis facial en pacientes con infección confirmada por el virus de chikunguña en regiones tropicales endémicas o en aquellos con antecedente de viajes recientes a dichas regiones.

A significant raise in the reports of neurological manifestations due to Chikungunya virus has been described worldwide. Here, we describe a case report of a previously healthy young adult who developed isolated left facial palsy after a confirmed Chikungunya virus infection in the Colombian tropics. We suggest considering this virus as a differential diagnosis for facial palsy in patients with confirmed Chikungunya virus infection who live in endemic regions or report a history of recent travel to these regions.

Autopercepção da paralisia facial e condições sociodemográficas clínicas de pacientes pós-AVC agudo: uma análise de associação / Self-perception of facial paralysis and sociodemographic-clinical conditions of postacute stroke patients: association analysis / Autopercepción de pacientes agudos faciales y condiciones sociodemográficas-clínicas posteriores post-accidente cerebrovascular en la fase aguda un análisis de asociación de pacientes

Introdução: A Paralisia Facial é uma das sequelas mais comuns em pacientes pós- Acidente Vascular Cerebral, podendo ocasionar uma série de consequências negativas para autopercepção. Objetivos: Avaliar autopercepção dos pacientes quanto à paralisia facial pós-Acidente Vascular Cerebral na fase aguda e verificar se está relacionada às condições sociodemográficas e clínicas. Método: Trata-se de estudo descritivo observacional com 86 pacientes com paralisia facial pós-Acidente Vascular Cerebral. Os critérios de inclusão foram idade acima de 18 anos, escala de Glasgow maior que 13 e compreensão preservada. Dados sócio-demográficos e clínicos foram extraídos do prontuário. A mímica facial foi avaliada com protocolo House & Brackmann (1985) e a autopercepção quanto aos incômodos físicos e psicossociais pelo questionário de auto-avaliação da condição facial. Foram realizadas análises descritiva e de associação com significância estatística de 5%. Resultados: O grau de comprometimento da paralisia facial variou entre moderado a paralisia total. A maioria dos pacientes avaliou a face em repouso como boa, movimento da face como péssima e ruim, sendo os lábios com pior classificação. Os pacientes relataram muito prejuízo nas atividades sociais, muita insatisfação com a face e médio prejuízo da alimentação. A análise de associação revelou que a autopercepção da face em repouso está associada ao sexo e ao comprometimento neurológico. Conclusão: Os pacientes na fase aguda do Acidente Vascular Cerebral possuem autopercepção de que a paralisia facial impacta no movimento dos lábios e atividades psicossociais, sendo pior para as mulheres e naqueles com o nível de comprometimento neurológico moderado e grave.

Introduction: Facial palsy is one of the most common sequelae in post-stroke patients, bringing a series of negative consequences for self-perception. Objective: To evaluate patients' self-perception regarding facial palsy after acute stroke and verify if it is related to sociodemographic and clinical conditions. Method: This is a descriptive observational study with 86 patients with facial paralysis after acute stroke admitted to a public hospital. The inclusion criteria were age over 18 years, Glasgow scale above 13 and preserved understanding. Socio-demographic and clinical data were extracted from the medical records. Facial mimicry was assessed using the House & Brackmann protocol (1985) and self-perception of physical and psychosocial discomfort using the facial condition self-assessment questionnaire. Descriptive and association analyses were performed with statistical significance of 5%. Results: The degree of impairment of facial paralysis varied from moderate to total paralysis. Most patients rated the resting face as good, face movement as very bad and bad, with the lips being the worst rated. The patients reported a lot of damage in social activities, a lot of dissatisfaction with the face and medium impairment on eating. The association analysis revealed that self-perception of the face at rest is associated with sex and neurological impairment. Conclusion: Patients in the acute phase of stroke have a self-perception that facial paralysis impacts on lip movement and psychosocial activities, being worse for women and those with moderate and severe neurological impairment.

Introducción: La parálisis facial es una de las secuelas más comunes en pacientes post-accidente cerebrovascular, que puede causar una serie de consecuencias negativas para la auto-percepción. Objetivos: Evaluar la auto-percepción de los pacientes con respecto a la parálisis facial después del accidente cerebrovascular en la fase aguda y verificar si está relacionada con condiciones sociodemográficas y clínicas. Método: Este es un estudio descriptivo observacional con 86 pacientes con parálisis facial después del accidente cerebrovascular. Los criterios de inclusión tenían una edad superior a los 18 años, glasgow escalaba más de 13 y se conservaba la comprensión. Los datos sociodemográficos y clínicos se extrajeron de los registros médicos. El mimetismo facial fue evaluado usando el protocolo house &brackmann (1985) y la auto-percepción de las molestias físicas y psicosociales explora la autoevaluación de la condición facial. Se realizaron análisis descriptivos y asociativos con una significación estadística del 5%. Resultados: El grado de afectación de la parálisis facial osciló entre la parálisis moderada y total. La mayoría de los pacientes calificaron la cara en reposo como buena, el movimiento facial como malo y malo, siendo los labios los peor valorados. Los pacientes reportaron mucho deterioro en las actividades sociales, mucha insatisfacción con el deterioro facial y medio de los alimentos. El análisis de la asociación reveló que la autopercepción de la cara en reposo se asocia con el sexo y el deterioro neurológico. Conclusión: Los pacientes en la fase aguda del accidente cerebrovascular tienen la autopercepción de que la parálisis facial afecta el movimiento de los labios y las actividades psicosociales, siendo peor para las mujeres y aquellos con el nivel de deterioro neurológico moderado y grave.

Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports

Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.

Anatomical description of the extratemporal facial nerve under high-definition system: a microsurgical study in rats

Purpose: To describe the microsurgical anatomical aspects of the extratemporal facial nerve of Wistar rats under a high-definition video system. Methods: Ten male Wistar rats (12­15 weeks old), without veterinary diseases, weighing 220­280 g, were used in this study. All animals in this study were submitted to the same protocol and by the same surgeon. A 10-mm incision was made below the bony prominence of the right or left ear, and extended towards the angle of the mandible. The dissection was performed and the main branches of the facial nerve were dissected. Results: The main trunk of the facial nerve has a length of 0.88 ± 0.10 mm and a length of 3.81 ± 1.03 mm, measured from its emergence from the stylomastoid foramen to its bifurcation. Seven branches originating from the facial nerve were identified: posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic. Conclusions: The anatomy of the facial nerve is comparable to that of humans, with some variations. The most observed anatomical division was the distribution in posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic branches. There is no statistical difference between the thickness and distance of the structures compared to the contralateral side.

Masseteric-Facial Anastomosis: A Report of Three Cases

Intoduction The pathways of the facial nerve are variable, and knowledge of that is essential. The worst impact caused by facial paralysis is related to quality of life, especially regarding the self-esteem and social acceptance on the part of the patients, leading to social isolation and disruption on their mental health. Case Report A 33-year-old female patient, with a stage-T3 acoustic neurinoma, presented with a moderate dysfunction (grades II to III) according to the House- Brackmann (HB) Facial Nerve Grading System. A 43-year-old male patient, with a stage- T4B trigeminal schwannoma, underwent a resective surgery and presented grade-VI dysfunction according to the HB scale. And a female patient with a stage-T4A acoustic neurinoma presented grade-IV dysfunction according to the HB scale. Discussion We performed a literature review of papers related to surgeries for masseteric-facial nerve anastomosis and compiled the results in table; then, we compared these data with those obtained from our cases. Conclusion The masseteric nerve is the one that shows the best prognosis among all the cranial nerves that could be used, but it is also necessary to perform well the surgical technique to access the facial branch and consequently achieve a better masseteric-facial nerve anastomosis.

Síndrome de Ramsay-Hunt: a propósito de dos casos en que se identificó el genoma del virus de la varicela-zóster en líquido cefalorraquídeo / Ramsay-Hunt syndrome: Report of two cases with identification of the varicella zoster virus genome in cerebrospinal fluid

Resumen | Como los otros herpesvirus alfa, el virus de la varicela-zóster (VZV) permanece en estado de latencia en los ganglios neurales después de la infección primaria (varicela). La reactivación de una infección latente por VZV en los ganglios de la raíz dorsal, produce el herpes zóster. La erupción que este provoca se caracteriza por lesiones cutáneas metaméricas que se acompañan de dolor neurítico y comprometen con mayor frecuencia a ancianos y sujetos inmunocomprometidos, en especial, aquellos infectados con el virus de la inmunodeficiencia humana (HIV). Las complicaciones que se observan en esta población de pacientes incluyen neumonía, hepatitis y compromiso del sistema nervioso central (meningitis y encefalitis). Varios síndromes clínicos se asocian con el herpes zóster de localización craneal, incluida la parálisis facial periférica y el síndrome de Ramsay-Hunt, el cual constituye la segunda causa de parálisis facial periférica y tiene una gran variedad de presentaciones clínicas. La parálisis facial se presenta en 60 a 90 % de los casos de síndrome de Ramsay-Hunt, puede preceder o aparecer después de las lesiones cutáneas y tiene peor pronóstico que la parálisis de Bell. Se describen aquí dos casos de herpes zóster del ganglio geniculado, con parálisis facial periférica que coincidió con la aparición de las lesiones cutáneas vesiculosas en el conducto auditivo externo y el pabellón auricular (síndrome de Ramsay-Hunt multimetamérico). En ambos casos, se identificó el genoma del VZV mediante PCR en el líquido cefalorraquídeo (LCR).

Abstract | Like other alpha-herpesviruses, the varicella-zoster virus (VZV) remains latent in the neural ganglia following the primary varicella infection. The reactivation of the VZV in the dorsal root ganglia results in herpes zoster. Herpes zoster eruption is characterized by localized cutaneous lesions and neuralgic pain mostly in older and immunocompromised persons, especially those living with the human immunodeficiency virus (HIV). The most commonly reported complications include VZV pneumonia, meningitis, encephalitis, and hepatitis. Several neurologic syndromes have been described associated with herpes zoster localized in cranial areas including peripheral nerve palsies and the Ramsay-Hunt syndrome, which has a varied clinical presentation and is the second most common cause of peripheral facial paralysis. Facial paralysis in this syndrome occurs in 60 to 90% of cases and it may precede or appear after the cutaneous lesions with a worse prognosis than idiopathic Bell paralysis. Here we present two cases of herpes zoster from the geniculate ganglia with peripheral facial paralysis that appeared simultaneously with vesicular herpetic otic lesions (multimetameric Ramsay-Hunt syndrome). In the two cases, amplifiable varicella-zoster viral DNA was found in the cerebrospinal fluid by RT-PCR Multiplex.

Manejo terapéutico kinésico en pacientes pediátricos con parálisis facial sometidos a cirugía reconstructiva / Kinesic therapeutic management in pediatric patients with facial palsy undergoing reconstructive surgery

La Parálisis Facial (PF) es una condición infrecuente en pacientes pediátricos, representa un problema clínico relevante y conlleva diversas implicaciones. Tanto el curso natural como el tratamiento y pronóstico no se encuentran bien documentados en la literatura, más aún en sujetos sometidos a cirugía. Se presentan 2 casos de PF sometidos a cirugía reconstructiva, niño de 9 años y niña de 8, ambos casos revisados de forma retrospectiva. Se planteó un bordaje y evaluación kinésica estructurado como tratamiento para estos pacientes. El sistema de graduación facial Sunnybrook (SGFS) fue usado para evaluar resultados funcionales. Durante el seguimiento los sujetos mostraron mejoras continuas con una ganancia promedio de 30 puntos en el SGFS. En nuestra experiencia, la rehabilitación kinésica estructurada con el enfoque presentado, parece ser un coadyuvante efectivo en potenciar el proceso de recuperación de la función muscular y simetría facial en sujetos con PF sometidos a cirugía reconstructiva.

Facial Palsy (FP) is an uncommon condition in pediatric patients, it represents a serious linical problem and carries various implications. Both the natural course, as well as the treatment and prognosis are not well documented in the literature especially in subjects undergoing surgery. Two cases of FP undergoing reconstructive surgery are presented, a 9-year-old boy and an 8-year-old girl, both cases reviewed retrospectively. A structured kinesic approach and valuation was proposed as a treatment for these patients. The Sunnybrook Facial Grading System (SGFS) was applied to evaluate functional outcomes. During follow-up the subjects showed continuous improvement with an average increment of 30 points in the SGFS. In our experience, structured kinesic rehabilitation with the approach presented, seems to be an effective adjunct in enhancing the process of recovery of muscle function and facial symmetry in subjects with FP undergoing reconstructive surgery.

Hypoglossal-Facial Anastomosis for Facial Nerve Reconstruction: Outcomes using the Side-to-End Surgical Technique

Introduction The side-to-end hypoglossal-facial anastomosis (HFA) technique is an excellent alternative technique to the classic end-terminal anastomosis, because itmay decrease the symptoms resulting from hypoglossal-nerve transection. Methods Patients with facial nerve palsy (House-Brackmann [HB] grade VI) requiring facial reconstruction from 2014 to 2017were retrospectively included in the study. Results In total, 12 cases were identified, with a mean follow-up of 3 years. The causes of facial paralysis were due to resection of posterior-fossa tumors and trauma. There was improvement in 91.6% of the patients (11/12) after the HFA. The rate of improvement according to the HB grade was as follows: HB III - 58.3%; HB IV - 16.6%; and HB II - 16.6%. The first signs of improvement were observed in the patients with the shortest time between the paralysis and the anastomosis surgery (3.5months versus 8.5 months; p » 0.011). The patients with HB II and III had a shorter time between the diagnosis and the anastomosis surgery (mean: 5.22 months), while the patients with HB IV and VI had a longer time of paresis (mean: 9.5 months; p » 0.099). We did not observe lingual atrophy or changes in swallowing. Discussion and Conclusion Hypoglossal-facial anastomosis with the terminolateral technique has good results and low morbidity in relation to tongue motility and swallowing problems. The HB grade and recovery appear to be better in patients operated on with a shorter paralysis time.

Síndrome de Ramsay Hunt: reporte de un caso clínico / Ramsay Hunt Syndrome: clinical case report

El virus varicela zoster produce cuadros clínicos por reactivación del mismo en años posteriores a la primoinfección, en sujetos con condiciones particulares, como situaciones de estrés, inmunodepresión, radioterapia, estados infecciosos que cursen con fiebre, entre otros. El síndrome de Ramsay Hunt es uno de ellos. Se caracteriza por una tríada de parálisis facial periférica, vesículas herpéticas en oído externo y otalgia. Objetivo: pr esentar un caso típico del síndr ome de Ramsay Hunt, métodos diagnósticos y tratamiento realizado. Presentación de caso clínico: paciente femenina, de 21 años, originaria de Tegucigalpa, Honduras, se presentó al Hospital Escuela Universitario por cuadro de seis días de evolución, de cambios inflamatorios en el oído externo izquierdo, en la región del pabellón auricular y el conducto auditivo externo, con presencia de vesículas herpéticas eritematosas con costras y restos hemáticos, otorrea, hiperemia, prurito y otalgia intermitente. También refirió parálisis de hemicara izquierda de cuatro días de evolución. Examen físico: conducto auditivo externo izquierdo presentaba vesículas con costras. Hubo ptosis palpebral izquierda e incapacidad para realizar las mímicas faciales. Tratamiento intrahospitalario: aciclovir 800 mg vía oral cada 6 horas, dexametasona 8 mg IV cada 8 horas, diclofenaco 75 mg IV cada 12 horas; citidina-5- monofosfato disódico, más uridin-5-trifosfato trisódico, 1 comprimido cada 12 horas; mupirocina ungüento al 1Universidad Nacional Autónoma de Honduras, Facultad de Ciencias Médicas, Tegucigalpa, Honduras. ORCID 0000-0002-2346-4209 2Universidad Nacional Autónoma de Honduras, Facultad de Ciencias Médicas. Departamento de Cirugía. Tegucigalpa, Honduras. 3Hospital Escuela Universitario, Departamento de Cirugía, Tegucigalpa, Honduras. Autor de correspondencia: Paola Andrea Hincapié Gaviria, paolahincapie23@gmail.com Recibido: 10/07/2020 Aceptado: 03/03/2021 al 2%, aplicado en oído externo cada 8 horas y ejercicios de fisioterapia. Conclusión: el síndrome de Ramsay Hunt se diagnóstica, fundamentalmente, mediante hallazgos clínicos. El tratamiento empírico y adecuado, acompañado de una buena terapia posterior, anticipa un pronóstico favorable sin secuelas neurológicas...(AU)

Craniofacial and neurological manifestations in patients with Guillain-Barré syndrome / Manifestaciones neurológicas craneofaciales en pacientes con síndrome de Guillain-Barré

Introducción: Among the broad range of symptoms of the Guillain-Barré Syndrome (GBS), patients can present craniofacial manifestations. Consequently, the participation of the dental surgeon in the evaluation of the stomatognathic system using a multidisciplinary approach model is very important. Objective: To identify the craniofacial and neurological manifestations of the Guillain-Barré Syndrome in patients from three hospitals in the district of Lambayeque, Peru, in 2019. Material and Methods: A descriptive, prospective, and cross-sectional study was carried out in 59 patients diagnosed with GBS by means of a clinical evaluation carried out by previously calibrated neurologists (k=0.911). Additionally, an oral evaluation of the oral hygiene index, the periodontal status, and the oral pH was carried out. Data were processed using frequency distribution tables. Results: 4 4.07% of the patients presented at least one functional alteration, such as unilateral limitation for facial expressions (25.42%), dysphagia (18.64%), alteration in phonation (11.86%), and loss of the sense of taste (6.78%), showing involvement of the corresponding cranial nerves. In addition, unfavorable conditions of oral hygiene and acid pH were observed in some cases, which proved adverse for the periodontal structures of the patients. Conclusion: The study found craniofacial manifestations of GBS, such as cases of unilateral facial palsy, dysphagia, difficulty in phonation, and loss of the sense of taste, due to the alteration of the cranial nerves that command these functions. In addition, poor oral hygiene, and the presence of acidic pH in some patients created an adverse environment for the integrity of the periodontal structures

Introducción: El Síndrome de Guillain-Barré (SGB) dentro de su amplia sintomatología puede presentar manifestaciones craneofaciales, por lo que resulta importante la participación del cirujano dentista en la evaluación del sistema estomatognático desde un modelo de abordaje multidisciplinario. Objetivo: Identificar las manifestaciones neurológicas craneofaciales del Síndrome de Guillain-Barré en pacientes de tres establecimientos de salud de Lambayeque, Perú en el año 2019. Materiales y Metodos: Se realizó un estudio descriptivo, prospectivo y transversal, con 59 pacientes diagnosticados con SGB, mediante una evaluación clínica realizada por médicos neurólogos previamente calibrados (k=0,911). Adicionalmente se realizó una evaluación bucodental del índice de higiene oral, del estado periodontal y del pH bucal, siendo procesados los datos mediante tablas de distribución de frecuencias. Resultados: El 44,07% de pacientes presentaron por lo menos una alteración funcional, identificando limitación unilateral para expresiones faciales (25.42%), disfagia (18.64%), alteración en la fonación (11.86%) y pérdida del sentido del gusto (6.78%), evidenciando compromiso de los pares craneales correspondientes. Además se observaron condiciones desfavorables de higiene oral y de pH ácido en algunos casos, que resultaron adversas para las estructuras periodontales de los pacientes. Conclusión: Fueron encontradas manifestaciones craneofaciales del SGB, identificando casos con parálisis facial unilateral, disfagia, dificultad para la fonación y pérdida del sentido del gusto, debido a la alteración de los pares craneales que comandan esas funciones. Además las condiciones desfavorables de higiene oral y la presencia de pH ácido en algunos casos, propiciaron un ambiente adverso para la integridad de las estructuras periodontales.

Síndrome de Ramsay Hunt: revisión narrativa / Ramsay Hunt Syndrome: Narrative Review

El síndrome de Ramsay Hunt (SRH) corresponde a la asociación de la parálisis facial periférica con una erupción vesicular localizada en el pabellón auricular, causada por el compromiso del ganglio geniculado secundario a una infección por el virus de la varicela-zóster (VVZ). Este síndrome es la segunda causa más común de parálisis facial atraumática y representa aproximadamente el 10 %-12 % de las parálisis faciales agudas, con una incidencia anual de 5 por cada 100 000 habitantes en Estados Unidos. El diagnóstico es principalmente clínico y entre las manifestaciones más destacadas se encuentran síntomas neurológicos como otalgia, tinnitus, hipoacusia asociada con parálisis facial junto a lesiones herpéticas características. Dentro de las complicaciones que se pueden presentar en esta entidad se encuentra, principalmente, la neuralgia posherpética, seguida de otras menos frecuentes como la encefalitis, el herpes zóster oftálmico y la mielitis. El manejo actual del SRH se basa en la aplicación de terapias duales con corticosteroides asociados a terapia antiviral, lo cual ha demostrado que el inicio temprano del tratamiento mejora el pronóstico y disminuye la aparición de complicaciones. El pronóstico de esta patología es inferior en comparación a patologías menos severas que comprometen el nervio facial (como la parálisis de Bell) y se ve impactado por varios factores como el inicio oportuno de tratamiento, el grupo etario y la presencia de comorbilidades.

Ramsay Hunt syndrome corresponds to the association of peripheral facial paralysis with a vesicular eruption located in the pinna, caused by the involvement of the geniculate ganglion secondary to infection by the varicella zoster virus. This syndrome is the second causes of atraumatic facial paralysis, representing approximately 10 %-12 % of acute facial paralysis, with an annual incidence of 5 per 100,000 inhabitants. The diagnosis is mainly clinical and among the most prominent manifestations are neurological symptoms such as otalgia, tinnitus, hypoacusis associated with facial paralysis together with characteristic herpetic lesions. Among the complications that may occur in this entity is mainly postherpetic neuralgia, followed by less frequent ones such as encephalitis, ophthalmic herpes zoster and myelitis. Current management of Ramsay Hunt syndrome is based on the application of dual therapies consisting of corticosteroids associated with antiviral therapy, showing that early initiation of treatment improves prognosis and reduces the appearance of complications. The prognosis of this pathology is inferior compared to less severe pathologies that compromise the facial nerve (Bell's palsy) and is impacted by several factors such as the timely initiation of treatment, the age group, and the presence of comorbidities.

O uso da kinesio taping no tratamento da paralisia facial pós-acidente vascular cerebral fase aguda / The use of kinesio taping in the treatment of the acute phase of post-stroke facial paralysis

RESUMO Objetivo comparar os resultados da reabilitação da paralisia facial pós-acidente vascular cerebral isquêmico na fase aguda, com e sem o uso da Kinesio Taping. Métodos estudo experimental caso e controle com 46 pacientes com paralisia facial pós-acidente vascular cerebral, distribuídos em dois grupos de forma randomizada, para a reabilitação da mímica facial: o grupo caso realizou terapia miofuncional orofacial e fez uso da Kinesio Taping nos músculos zigomáticos maior e menor e o grupo controle apenas terapia miofuncional orofacial. Para avaliação da paralisia facial, foi utilizada a escala de House e Brackmann e o protocolo de incompetência do movimento para as medições da face. Todos os participantes realizaram 12 dias de intervenção fonoaudiológica para a reabilitação da mímica facial. Para análise, considerou-se a incompetência do movimento por meio das medidas da face e o grau de comprometimento da paralisia facial e foi verificado se a idade poderia ter influenciado os resultados. Foram realizadas análises de associação e o nível de significância adotado foi de 5%. Resultados os dois grupos apresentaram melhora da assimetria facial após intervenção fonoaudiológica, a incompetência do movimento foi menor em todas as medidas da face e a melhora da gravidade da paralisia facial foi semelhante, sem diferença estatística entre os tratamentos. Conclusão tanto a terapia miofuncional orofacial exclusiva, como associada ao uso da Kinesio Taping, são estratégias terapêuticas que promovem melhora da paralisia facial pós-acidente vascular cerebral.

ABSTRACT Purpose To compare the results of treatment of facial paralysis after ischemic stroke in the acute phase with and without the use of Kinesio Taping. Methods Experimental case-control study with 46 patients with facial paralysis after stroke, randomly assigned to two groups for treatment of facial mimicry: the case group underwent orofacial myofunctional therapy and used Kinesio Taping on the zygomatic major and minor muscles while the control group only received orofacial myofunctional therapy. To assess facial paralysis, the House and Brackmann scale and the movement incompetence protocol were used for facial measurements. All participants underwent 12 days of treatment for facial mimicry. The analysis considered movement incompetence by means of the face measurements and the degree of impairment of facial paralysis, checking whether age might have influenced the results. Association analyses were performed and the significance level adopted was 5%. Results both groups showed an improvement in facial asymmetry after treatment, movement incompetence was lower in all facial measurements, and the improvement in the severity of facial paralysis was similar, with no statistical difference between treatments. Conclusion Both the exclusive orofacial myofunctional therapy and the one combined with Kinesio Taping are therapeutic strategies that promote improvement in post-stroke facial paralysis.

Reabilitação fonoaudiológica na paralisia facial periférica: revisão integrativa / Speech-language rehabilitation in peripheral facial paralysis: integrative review

RESUMO Objetivos identificar e analisar a produção científica sobre as estratégias terapêuticas empregadas na reabilitação fonoaudiológica de pessoas com paralisia facial periférica (PFP). Estratégia de pesquisa foi realizada uma revisão integrativa, utilizando-se as bases de dados SciELO, PubMed, Web of Science, ScienceDirect e Portal CAPES. Os descritores foram: paralisia facial e paralisia de Bell, combinados com reabilitação, terapia miofuncional e fonoaudiologia ou seus correlatos em inglês. Critérios de seleção estudos disponíveis na íntegra, que abordaram a reabilitação fonoaudiológica em pessoas com PFP, publicados no período entre 1999 e 2019, em português brasileiro, inglês ou espanhol. Resultados foram identificadas 650 publicações, mas apenas cinco artigos contemplaram os critérios de inclusão propostos. Dentre estes, a SciELO e PubMed obtiveram dois artigos incluídos cada. Além disso, a maioria foi publicada nos últimos dez anos e produzida no Brasil. O português brasileiro foi o idioma de publicação de três dos cinco artigos incluídos, não ocorrendo predominância de um nível de evidência específico. A descrição dos procedimentos utilizados não foi suficientemente detalhada nos estudos. Exercícios isotônicos e isométricos foram abordados mais frequentemente. A bandagem surgiu como recurso terapêutico em um estudo. Conclusão embora haja um grande número de artigos relacionadas à PFP, apenas cinco estudos descreveram procedimentos fonoaudiológicos para pessoas com PFP, com nível de evidência baixo. Portanto, novos estudos abordando o tema são necessários.

ABSTRACT Purpose identify and analyze the scientific production about the therapeutic strategies employed in the speech-language rehabilitation of people with peripheral facial paralysis. Research strategy an integrative review was performed using the SciELO, PubMed, Web of Science, ScienceDirect and Portal CAPES databases. The descriptors were: facial paralysis and Bell's palsy, combined with rehabilitation, myofunctional therapy and Speech, Language and Hearing Sciences or their correlates in english. Selection criteria studies available in their entirety, which addressed speech-language rehabilitation in people with peripheral facial paralysis, published between 1999 and 2019, in Brazilian Portuguese, english or spanish, were selected. Results 650 publications were identified, but only five articles met the proposed inclusion criteria. Among these, SciELO and PubMed obtained two articles included each. In addition, most were published in the last ten years and produced in Brazil. Brazilian Portuguese was the language of publication of three of the five included, with no predominance of a specific level of evidence. The description of the procedures used was not sufficiently detailed in the studies. Isotonic and isometric exercises were approached more frequently. Bandage emerged as a therapeutic resource in one study. Conclusion Although there are a large number of articles related to peripheral facial paralysis, only five studies described speech-language procedures for people with peripheral facial paralysis, with low level of evidence. Therefore, further studies addressing the topic are needed.

Speech-language-hearing instruments to assess peripheral facial palsy: an integrative literature review / Instrumentos de avaliação fonoaudiológica da paralisia facial periférica: revisão integrativa de literatura

ABSTRACT Purpose: to describe and analyze the clinical instruments that assess peripheral facial palsy through an integrative literature review. Methods: the precepts for this type of review were followed: research question, identification, selection of studies, and critical analysis. The Virtual Health Library (VHL), Scientific Electronic Library Online (SciELO), Google Scholar, and PubMed databases were accessed to search for fully available articles published in national journals between January 2008 and July 2018. The terms used in the search were "Speech, Language and Hearing Sciences", "Evaluation", and "Facial Paralysis", in both English and Portuguese. The data obtained were organized per author, title, objective, instruments used, description of the instruments, and application procedures used in the articles. Results: out of the total 992 articles found, only 18 met the inclusion criteria of the research. In most of them, there was only the citation of the assessment instruments or considerations about them, without fully describing the application procedures. Conclusion: the study identified publications that indicate the use of clinical and speech-language-hearing assessment instruments. However, further detailing is necessary regarding the assessment procedures to help develop and refine the speech-language-hearing methodologies and techniques.

RESUMO Objetivo: descrever e analisar os instrumentos clínicos de avaliação de paralisia facial periférica por meio da revisão integrativa de literatura. Métodos: foram seguidos os preceitos deste tipo de revisão: questão norteadora, identificação, seleção de estudos e análise crítica. As bases utilizadas foram: "Biblioteca Virtual em Saúde (BVS)", "Scientific Electronic Library (SCIELO)", "Google Acadêmico" e "Pubmed", na busca de artigos publicados em periódicos nacionais, no período entre janeiro de 2008 e julho de 2018, disponíveis na íntegra, sendo utilizados os termos: "Fonoaudiologia", "Avaliação" e "Paralisia Facial" e na língua inglesa: "Speech, Language and Hearing Sciences", "Evaluation" e "Facial Paralysis. Os dados obtidos foram organizados por autor, título, objetivo, instrumentos utilizados, descrição dos instrumentos e procedimentos de aplicação utilizados nos artigos. Resultados: de um total de 992 artigos encontrados, apenas 18 se encaixaram nos critérios de inclusão da pesquisa. Na maioria dos artigos encontrados, havia apenas citações ou considerações sobre instrumentos de avaliação, sem a plena descrição e procedimentos para aplicação. Conclusão: o estudo permitiu identificar publicações que indicam uso de instrumento de avaliação clínica e fonoaudiológica. No entanto, seria necessário detalhamento quanto a apresentação dos procedimentos de avaliação, visando cooperar na elaboração e no refinamento de metodologias e técnicas fonoaudiológicas.

Uso de láser de baja potencia como coadyuvante en tratamiento con terapias combinadas en paciente con parálisis facial periférica / Use of low level laser therapy as an adjunct in treatment with combined therapies in patients with peripheral facial palsy

La parálisis facial periférica es un trastorno neurológico que tiene consecuencias motoras y sensoriales y que afecta al nervio facial. Ocasiona alteraciones en la acción de los músculos del rostro, en la secreción de saliva, lágrimas y en el sentido del gusto.El objetivo de esta publicación es dar cuenta de un caso en el que se realizó un tratamiento con terapias combinadas mínimamente invasivas junto con el uso de láserterapia de baja potencia, en un paciente femenino, 52 años de edad, con antecedentes médicos relevantes, derivada para evaluación estética. La paciente presenta una parálisis facial moderada sin resolver. Fue sometida a láserterapia con longitud de onda (808 nm) y una energía de 3 Joules por sesión en el lado afectado, complementada con toxina botulinica Tipo A, en el lado sano.El tratamiento de parálisis facial periférica con terapias combinadas mínimamente invasivas ha mostrado ser una herramienta útil terapéutica de las secuelas faciales. A su vez, la terapia de fotobiomodulación con láser de baja potencia es prometedora como coadyuvante en el proceso de reparación nerviosa lo que permitiría la recuperación funcional del nervio facial a mediano y largo plazo.

Peripheral Facial Palsy is a neurological disorder that has motor and sensory consequences and affects the facial nerve. It causes alterations in the action of the muscles of the face, in the secretion of saliva, tears, and in the sense of taste.The objective of this publication is to report a case in which a treatment with minimally invasive combined therapies was performed together with the use of low-level laser therapy, in a 52-year-old female patient. With relevant medical history, referred for aesthetic evaluation and with unresolved moderate facial paralysis. She was subjected to laser therapy with wavelength (808 nm) and an energy of 3 Joules per session on the affected side, supplemented with Botulinum Toxin Type A, on the healthy side.The treatment of peripheral facial paralysis with minimally invasive combined therapies has proven to be a useful therapeutic tool for facial sequelae. In turn, low-level laser photobiomodulation therapy is promising as an adjunct in the nerve repair process, which would allow functional recovery of the facial nerve in the medium and long term.