[Sequelae in bell's palsy: Prognostic factors for recovery]. / Facteurs prédictifs des séquelles de paralysie faciale idiopathique : suivi longitudinal.

OBJECTIVES: Facial palsy can be assessed using objective and subjective tools. The main purpose of this work was to use these tools to determine at 12 months the percentage of patients with sequelae and to specify the type of sequelae. MATERIAL AND METHODS: Twenty-three patients with facial palsy were followed in this prospective and longitudinal study. They have been evaluated every 3 months during a year with the House and Brackmann grading scale and the Sunnybrook Facial Grading System. At 12 months, group A was composed of patients with complete recovery and group B, patients with sequelae. RESULTS: At 3 months, in patients of group B, the House-Brackmann grading scale (P=0.0134), the Sunnybrook Facial Grading System global score (P=0.0283) and dynamic score (P=0.0148) were lower than group A. Moreover, the movement "brow lift" (P=0.0181) seems to be relevant to predict follow-up. Synkinesis on "brow lift" (P=0.0270) and the treatment delay (P=0.0384) increased for group B. Sex, age, paralyzed side and recurrence of facial palsy had no influence. CONCLUSION: Objective and subjective tools determine thresholds and predictive scores of recovery with sequelae at 1 year. Nevertheless, it is relevant to assess clinically specific facial movements, such as "brow lift", to specify a recovery potential and to predict sequelae a year after the onset of facial palsy. As the treatment delay influences recovery, drug treatment should be recommended as early as possible.

[Facial palsy rehabilitation: Assessment before surgery]. / Réhabilitation de la face paralysée. Bilan préthérapeutique du patient.

A patient who needs a surgery for facial rehabilitation must have a complete assessment. The etiology of the facial palsy must be clear. It is necessary to have a MRI of the facial nerve for the statement of the initial pathology or to search a lesion on the nerve. The facial palsy must be definite which is depending of the delay of the palsy and the etiology. An electromyography must be done. The choice of the procedure depends on the delay of the palsy, the site on the nerve, the associated diseases and the opinion of the patient after a good explanation.

[Hypoglossofacial anastomosis for facial palsy treatment: Indications and results]. / Réhabilitation de la face paralysée par anastomose hypoglosso-faciale. Indications et résultats.

UNLABELLED: Hypoglossofacial anastomosis is a classical surgical procedure for the treatment of facial paralysis when the trunk of the facial nerve cannot be repaired and its peripheral branches are normal. PATIENTS AND METHODS: Between 2004 and 2015, 77 patients were able to benefit from an hypoglossofacial anastomosis. The etiology of the paralysis was mainly the surgery of vestibular schwannoma, tumors of the facial nerve and diseases of the brainstem. A specific and premature speech therapy remediation was realized for all patients in order to preserve the tongue function and to upgrade the facial motricity. RESULTS: Sixty-nine patients could be studied. The House Brackmann grading scale was used to appreciate the result. Thirty-one patients are grade III, 34 grade IV and in only one case the result is a grade V despite the anastomosis works. The main predictive factor for a good result is a small delay between the onset of the paralysis and the surgery for the rehabilitation. The specific physiotherapy upgrades the result with less side effects of the anastomosis. CONCLUSION: Hypoglossofacial anastomosis is a simple and reliable surgical procedure for rehabilitation of paralysed face. The quality of the result is linked with an early surgery and a specific physiotherapy.

Impact of facial palsy impact on make-up habits: An observational cohort study.

OBJECTIVE: The esthetic problems inherent to peripheral (PFP) are frequent causes of complaint. Make-up is advocated as a form of therapy and can alleviate symptoms of depression. The aim of the present study was to collect data on make-up habits in female PFP patients and assess links with esthetic and/or functional complaints. MATERIAL AND METHODS: Two questionnaires were drawn up to compare make-up habits in female PFP patients and women in the general population. The first was sent out between September and December 2019, to 39 House-Brackmann grade III PFP patients (group A), and the second on-line questionnaire was sent to a control population of 1385 women (group B). RESULTS: PFP patients used make-up more often than controls at weekends (χ2=16.38; P=0.0009) and while at home (χ2=8.21; P=0.042), and more often with foundation (χ2=17.21; P=0.0006) and lip make-up (χ2=59.31; P<0.0001). The greater their functional complaint, the less they made up their eyes. The greater their self-confidence and the more they felt attractive, the less they made up their lips. CONCLUSION: The differences in make-up use found in the present study aimed to mask facial palsy and were related to the esthetic complaint, impacting social life.

[Acoustic analysis of the articulatory disorders of patients affected by peripheral facial paralysis]. / Analyse acoustique des troubles articulatoires chez les patients atteints de paralysie faciale périphérique.

INTRODUCTION: The study of joint disorders in facial paralysis is an important element of support to guide rehabilitation. MATERIAL: The material used for the registration of the database is a digital recorder Zoom H4N (way format, sample rate 44,100 Hz, 16 bit quantization). The microphone used is a Shure Beta 58, super cardioid. All recordings are made in a specific room. METHODS: The annotation of the corpus is done using Praat software and its plug-in EasyAlign order to achieve alignment phonetics. RESULTS: High frequency power ratio (HPR) is a good indicator of the setting in motion of the articulators as the number of explosions of bilabial phoneme was significantly related to the motor of the face and lips, and the score at dynamometer. The VOT was significantly shorter in patients with grade IV and V-VI than in control subjects. The results highlight a significant difference between the values of F3for the vowels /i/ and /y/, depending on the severity of the damage. There is even, for the most severe grades, there are a hundred Hertz difference between F3 of /i/ and that of /y/, which means that these two vowels becomes impossible to discriminate. CONCLUSIONS: If these functional disorders are much discomfort for patients, however, these are not speaking of articulatory disorder in the strict sense, according to the definition of Borel Maisonny. We must therefore focus more specifically to the acoustic analysis of speech in order to check for spectral indices likely to identify these disorders.

[Prosodic analysis of speech of patient affected by peripheral facial paralysis]. / Prosodie et paralysie faciale périphérique.

INTRODUCTION: The aim of study of prosody in facial palsy is to assess the intensity of pathology in suprasegmental viewpoint in order to establish a proper rehabilitation. METHODS: Patients were recorded during a reading and spontaneous speech test and a prosodic observation of speech spectrogram provided by Praat software. RESULTS: The Accentual Groups lowering and significant dysprosodics elements (adverse effects and breaking balance) and a larger amount of disfluencies showed that the prosody of patients with facial palsy is altered because they need to swallow their saliva intentionally. Then, the decrease of Mean Length of Utterance (MLU) and the opinion of the jury highlight a decrease in desire to communicate and a loss of speech informativeness. CONCLUSIONS: In patients with severe facial palsy, there is an impact of swallowing disorder (caused by salivary stasis) on the prosody of speech, with variations in the position of intonations boundaries and the intensity of prosodic marking. This also creates impact on fluency and on the perception of the message by the listener.

[Lengthening temporalis myoplasty for facial palsy reanimation after parotid surgery]. / Réhabilitation de la face paralysée au cours de la chirurgie parotidienne. intérêt de la myoplastie d'allongement du muscle temporal.

AIM OF THE STUDY: Share our experience and our results of lengthening temporalis myoplasty (LTM) for facial palsy reanimation after parotid surgery. MATERIALS AND METHODS: Study of 15 patients after they had had a lengthening temporalis myoplasty, in the same time or after a non conservative parotidectomy of facial nerve. 10 patients suffered from a parotid malignant tumor, one had a jugal epidermoid skin carcinoma invading the parotid, 2 patients had a facial palsy after removal of pleomorphic adenoma recurrence and two patients had a facial nerve schwannoma. 8 patients had a LTM surgery in the same time of the parotid tumoral removal. RESULTS: No recurrence was observed on the 11 patients who had a carcinoma (average follow up: 27 months). The LTM surgery enabled us to obtain good results at rest for 14 patients (93%) and an intermediate result for one person. The ability to smile was described as good for 10 patients (66.6%), intermediate for 4 of them (26.6%) and unsatisfying for 1 person (6,6%). In the group rehabilitation, the results observed are similar, for the patients who had one or two surgical steps. In 3 cases, we noticed an infectious complication, which led us to operate again. In the 8 cases within lengthening was performed in the same time as parotidectomy, there was no additionnal surgical difficulty. CONCLUSION: LTM surgery is an efficient method of rehabilitation. If possible, it should be performed in the same time as tumor removal. As the operational places are different, tumor checking-up and observation are not disturbed by this kind of rehabilitation.

[Smile "forced" smile versus "spontaneous": comparison of 3 techniques of reconstructive surgery of the face. Myoplasty temporal muscle, hypoglossal facial anastomosis and gracilis muscle free flap]. / Sourire "contraint" versus sourire "spontané": comparaison entre 3 techniques de chirurgie réparatrice de la face. Myoplastie du muscle temporal, anastomose hypoglosso faciale et lambeau libre de muscle Gracilis.

The facial palsy cause serious consequences for patients. Studies have also shown that in these patients, the inability to produce an appropriate and spontaneous smile would be a key factor of depression. When facial palsy is considered complete and the nerve cannot be repaired, the patient can benefit from palliative surgery to regain a better quality of life in the aesthetic, functional, and psychological aspects. The hypoglossal-facial anastomosis (AHF), temporal myoplasty (MAT) and gracilis transposition (TG) are the major surgeries currently used for this purpose. The aim of our study is to assess quantitatively and qualitatively the effects of each of these surgeries on the lip mobility and production of smile. From this perspective, we proposed a protocol of an evaluation of facial motricity, of quality of life, and more particularly on the quality and the analysis of the smile. The results underline that there is no significant difference in the recovery of the facial motricity according to the surgery. Only the slower, deferred deadline of recovery at the patients AHF and TG who have to wait several months, it is for the same levels as that of the patients' MAT. A premature and intensive rehabilitation such as the patients of our protocol benefited from it what is nevertheless essential to a good recovery whatever is the surgery.

Contribution of the Synkinesis Assessment Questionnaire and the Sunnybrook Facial Grading System to the evaluation of synkinesis after peripheral facial palsy: A STROBE observational study.

OBJECTIVES: The main aim of the study was to determine whether the perception of synkinesis by patients with peripheral facial palsy (PFP) matched their clinician's severity assessment. Secondary objectives comprised: (1) to determine whether objective measurement of synkinesis matched the patient's perception; and (2) is to identify factors influencing patients' perceptions. METHODS: This retrospective study took place from January to May 2020. Forty patients (8 per PFP grade, I-V/VI; 20 women, 20 men) filled out the Synkinesis Assessment Questionnaire (SAQ) and were assessed on the Sunnybrook Facial Grading System (SFGS). Photographs were analyzed on MEEI-Facegram software. RESULTS: Perceived synkinesis (total SAQ) matched objective grades (SFGS) (Z=2.89; P=0.004), especially for smiling (Z=3.84; P<0.001) and lip protrusion (Z=3.79; P<0.001). Synkinesis on lip protrusion was a more sensitive indicator of perceived synkinesis than synkinesis on smiling (Z=2.96; P=0.003). Duration (ρ=0.5137; P<0.001) and grade of PFP (Chi2=13.82; P=0.008) heightened the perception of synkinesis. CONCLUSION: Patient-reported outcome measures (PROMs) such as the SAQ are relevant for clinical evaluation.

Voice modulation, self-perception and motor branch of the superior laryngeal nerve.

OBJECTIVES: Vocal morbidity resulting from damage to the motor branch of the superior laryngeal nerve (SLN) after endocrine surgery is well known, but diagnosis is often delayed. The present study aimed to quantify these vocal changes acoustically (main objective), and correlate this with the vocal complaints of patients with suspected SLN motor impairment (secondary objective). MATERIAL AND METHODS: Thirty females patients with suspected injury of the SLN cricothyroid branch (CT-) were compared to 30 patients without postoperative vocal impairment (CT+) and to 30 control subjects. Mean, minimal and maximal fundamental frequencies (F0mean, F0min and F0max) and vocal range were measured on /e/ at high frequency, sirens (glissandi), a reading text, and minimal intonation pairs. Subjective vocal impairment was evaluated on the Voice Handicap Index (VHI). RESULTS: A lowering of F0mean associated with vocal range reduction by one fifth (in the reading text) seemed to be specific to CT- patients. Production of questions was affected, with differences in melodic curve and attack. Thyroidectomy within 2 months in itself (without suspected SLN cricothyroid branch injury) also affected these parameters, but to a lesser degree. CT- patients reported greater voice impairment than CT+ patients or controls (P=0.0004). CONCLUSION: Alterations in speech intonation, quantified on minimal pair test, and self-assessed vocal handicap (VHI) are tools that can easily be used in daily practice to screen for SLN motor branch lesion.

[Termino-terminal hypoglossofacial anastomosis, indications, results]. / Anastomose hypoglosso-faciale termino-terminale. Indications. Résultats.

OBJECTIVES: Retrospective study about the indications and the results of the end to-end hypoglossofacial anastomosis (AHF tt). MATERIALS AND METHODS: Between 2004 and 2010, 38 patients were able to benefit from an AHF tt. It was about 13 men and 25 women. The mean age was of 40 years and the average deadline of coverage after facial paralysis was of 21.3 months. The etiology of the paralysis was in 47.7% of the cases a surgery for vestibular schwannoma and in 18% of the cases, of the facial nerve schwannoma. Besides the AHF tt, a golden weight was put to 6 of our patients. A specific and premature speech therapy remediation was realized at our all patient's. RESULTS: The beginning of recovery was spread out between 3 and 9 months. The final result was a grade III HB (37%) and IV HB (60%). Only a case of grade VHB was observed. The complications often reported by the AHF tt were very widely decreased by the specific reeducation. CONCLUSION: AHF tt is a particularly reliable technique, for rehabilitation of facial palsy, when the peripheral branches are intact and it, for the deadline 4-years-old subordinate except particular cases.

French Society of ENT (SFORL) guidelines. Management of acute Bell's palsy.

AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.

[The rehabilitation of the tongue in hypoglossal-facial anastomosis]. / La rééducation de la langue dans l'anastomose hypoglosso-faciale.

UNLABELLED: End to end hypoglossal-facial nerve anastomosis (tt HFA) is a traditional technique for rehabilitation of facial palsy. The sacrifice of the hypoglossal nerve generates a paralysis and an atrophy of the tongue which is thought to lead to speech, chewing and swallowing disorders. In a previous study, we demonstrated that tt HFA does not lead to speech disorders (Gatignol et al 2003). OBJECTIVES: In this work, we were interested in the functional consequences of the lingual atrophy and in the possibilities of rehabilitation with early therapy. MATERIAL AND METHODS: Nine patients were distributed in two groups, in one patients received a specific and early lingual rehabilitation in the other no specific treatment. These two groups (paired with control subjects) were subjected to a series of tests studying the motor function, the articulation (using palatograms). RESULTS: This study highlights the interest of early rehabilitation of the tongue in the first post-operative days. Early rehabilitation was associated with a reduction in lingual atrophy, an improvement in motility of the tongue thus generating a better management of saliva and stagnant food in the oral vestibule on the paralysed side.

Experimental study of focused ultrasonic beams reflected at a fluid-solid interface in the neighborhood of the Rayleigh angle.

A technique for measuring the lateral and axial displacements of the focal point of an acoustic focused beam reflected at a water-aluminum interface in the neighborhood of the Rayleigh angle incidence is presented together with a qualitative representation of other nonspecular phenomena, based on the cartography of the reflected beam. A study of the feasibility of the experiment and the choice of the transducer is carried out. The results obtained are in agreement with theoretical predictions.

[Comparative evaluation of speech disorders and verbal and non verbal communication within two groups of patients: patients with facial paralysis (FP) and those who had undergone hypoglosso-facial anastomosis (HFA)]. / Evaluation comparative des troubles articulatoires et de la communication verbale et non-verbale entre patients porteurs d'une paralysie faciale (PF) et ceux opérés ayant subi une anastomose hypoglossso-faciale (AHF).

INTRODUCTION: Speech disorders were often allotted to hypoglossal-facial anastomosis (HFA) without being clearly shown. We have compared patients with a peripheral facial paralysis at those with HFA. AIMS OF THE STUDY: Retrospective study comparing verbal communication (articulation) and non-verbal within two groups of patients: patients with patient FP versus with HFA. PATIENTS AND METHODS: 10 patients with idiopathic FP versus 7 patients with HFA took part in this study. The series of tests includes an evaluation of the motor possibilities, bilabial pressure measurement (for the patients with FP), speech capacities and finally an evaluation of the verbal and non-verbal communication from a scale of satisfaction. RESULTS: The results highlight: the presence of real speech disorders (permanent) among patients with FP and their absence among patients having profited from HFA; a real satisfaction of the HFA versus FP on the quality of life compared to daily tasks, more specifically concerning verbal and food skills. CONCLUSION: The HFA is not responsible for speech disorders, and makes undeniable improvements confirmed subsequently by the patients.

The role of dominant striatum in language: a study using intraoperative electrical stimulations.

BACKGROUND: The role of the striatum in language remains poorly understood. Intraoperative electrical stimulation during surgery for tumours involving the caudate nucleus or putamen in the dominant hemisphere might be illuminating. OBJECTIVES: To study the role of these structures in language, with the aim of avoiding postoperative definitive aphasia. METHODS: 11 patients with cortico-subcortical low grade gliomas were operated on while awake, and striatal functional mapping was done. Intraoperative direct electrical stimulation was used while the patients carried out motor and naming tasks during the resection. RESULTS: In five cases of glioma involving the dominant putamen, stimulations induced anarthria, while in six cases of glioma involving the dominant caudate, stimulations elicited perseveration. There was no motor effect. The striatum was systematically preserved. Postoperatively, all patients except one had transient dysphasia which resolved within three months. CONCLUSIONS: There appear to be two separate basal ganglia systems in language, one mediated by the putamen which might have a motor role, and one by the caudate which might have a role in cognitive control. These findings could have implications for surgical strategy in lesions involving the dominant striatum.

Intra-operative mapping of the subcortical visual pathways using direct electrical stimulations.

Despite the risk of postoperative visual field defect following surgery within the temporo-parieto-occipital region, visual mapping has rarely been described, in particular at the subcortical level. In this report, we successfully performed a subcortical mapping of the visual pathways using intra-operative electrical stimulations (IES), during surgery under local anesthesia for a low-grade glioma invading the whole temporal lobe and the temporo-occipital junction. The optic radiations then constituted the posterior and deep functional boundary of the resection, avoiding the occurrence of a post-operative hemianopsia, in spite of an asymptomatic quadrantanopsia. This preliminary experience illustrates the possibility to use intra-operative direct electrical stimulation during surgery of lesions involving the posterior afferent visual system, in order to identify and then preserve the visual pathways, as previously reported for sensorimotor and language subcortical fibers.

Factors predicting success in picture naming in Alzheimer's disease and primary progressive aphasia.

The aim of the present study was to determine the predictive value of all important variables in the picture naming performance of 8 patients with probable Alzheimer's disease (AD) and 8 patients with primary progressive aphasia (PPA). The experimental investigation controlled for (i) visual complexity, (ii) name agreement on dominant response, (iii) age of acquisition, (iv) frequency, (v) word length, (vi) concept familiarity, and (vii) category membership. The results of the multiple regression analyses showed that age of acquisition and name agreement were significant for 10/16 subjects. Visual complexity, frequency, familiarity, and category were also significant for four patients respectively. Word length had no effect. These results are at variance with those of series of patients with AD (Gaillard et al., 1998) and with PPA (Lambon Ralph et al., 1998) where concept familiarity was found to be one of the most predictive factors of naming success.

Functional recovery after surgical resection of low grade gliomas in eloquent brain: hypothesis of brain compensation.

OBJECTIVES: To describe functional recovery after surgical resection of low grade gliomas (LGG) in eloquent brain areas, and discuss the mechanisms of compensation. METHODS: Seventy-seven right-handed patients without deficit were operated on for a LGG invading primary and/or secondary sensorimotor and/or language areas, as shown anatomically by pre-operative MRI and intraoperatively by electrical brain stimulation and cortico-subcortical mapping. RESULTS: Tumours involved 31 supplementary motor areas, 28 insulas, 8 primary somatosensory areas, 4 primary motor areas, 4 Broca's areas, and 2 left temporal language areas. All patients had immediate post-operative deficits. Recovery occurred within 3 months in all except four cases (definitive morbidity: 5%). Ninety-two percent of the lesions were either totally or extensively resected on post-operative MRI. CONCLUSIONS: These findings suggest that spatio-temporal functional re-organisation is possible in peritumoural brain, and that the process is dynamic. The recruitment of compensatory areas with long term perilesional functional reshaping would explain why: before surgery, there is no clinical deficit despite the tumour growth in eloquent regions; immediately after surgery, the occurrence of a deficit, which could be due to the resection of invaded areas participating (but not essential) to the function; and why three months after surgery, almost complete recovery had occurred. This brain plasticity, which decreases the long term risk of surgical morbidity, may be used to extend the limits of surgery in eloquent areas.