Future treatment options for facial nerve palsy: a review on electrical stimulation devices for the orbicularis oculi muscle.

Facial nerve palsy can cause diminished eyelid closure (lagophthalmos). This occurs due to functional deficits of the orbicularis oculi muscle, potentially leading to sight-threatening complications due to corneal exposure. Current management options range from frequent lubrication with eye drops, to the use of moisture chambers and surgery. However, achieving functional restoration may not always be possible. Recent efforts have been directed towards the support of orbicularis oculi muscle function through electrical stimulation. Electrical stimulation of the orbicularis oculi muscle has been demonstrated as feasible in human subjects. This article offers a comprehensive review of electrical stimulation parameters necessary to achieve full functionality and a natural-looking eye blink in human subjects. At present, readily available portable electrical stimulation devices remain unavailable. This review lays the foundation for advancing knowledge from laboratory research to clinical practice, with the ultimate objective of developing a portable electrical stimulation device. Further research is essential to enhance our understanding of electrical stimulation, establish safety standards, determine optimal current settings, and investigate potential side effects.

Surgery for patients with facial palsy in Germany: a diagnosis-related-groups-based nationwide analysis, 2005-2019.

PURPOSE: Chronic flaccid paralysis of the facial nerve leads to permanent dysfunction of eye closure, problems with drinking and eating, and lack of emotional expression. Modern facial surgery can help those affected. An analysis of the development of facial surgery in Germany over time is presented. METHODS: Nation-wide population-baes diagnosis-related case group (DRG) data of virtually all inpatients who underwent facial surgery for facial palsy between 2005 and 2019 were included. Binomial regression models for changes in surgery rates over time were calculated in relation to gender and treating specialty. RESULTS: Between 2005 and 2019, there were 28,622 inpatient stays for facial surgery. Most surgeries were provided by otolaryngology (39%) and ophthalmology or dentistry, oral and maxillofacial surgery (20% each). The mean treatment rate was 2.33 ± 0.53 surgeries per 100,000 person-years. The surgery rate was highest for nerve reconstruction surgery (0.46 ± 0.15) and static sling surgery (0.44 ± 0.0.16). The greatest increase was seen in men for nerve surgery (3.9-fold; relative risk [RR] = 3.68; confidence interval [CI] = 3.18-4.26) and sling surgery (5.0-fold; RR = 4.25; CI = 3.38-5.33). CONCLUSIONS: While nerve and sling surgery increased significantly over time, this was less true or not true at all for surgical techniques. Surgical rates and their change over time were greater in men, without explanation from the data.

Surgery for facial palsy in the hands of otorhinolaryngologists: a population-based study.

PURPOSE: Modern facial surgery can improve eye closure and address facial functional and emotional expression disabilities in case of severe acute facial paralysis with low probability of recovery and in cases of chronic flaccid facial paralysis. Reports on outcome typically originate from specialized tertiary care centers, whereas population-based data from routine care beyond specialized centers is sparse. METHODS: Therefore, patients' characteristics, surgical techniques, postoperative complications, and patients' satisfaction with the final outcome were analyzed for all inpatients with facial paralysis undergoing facial surgery in Thuringia, a federal state in Germany, between 2006 and 2022. 260 patients (female 41.5%; median age 65 years) were included. RESULTS: On average, the surgery rate was higher for men than for women (0.83 ± 0.39 versus 0.58 ± 0.24 per 100,000 population per year). For first surgery, static procedures were dominating (67.3%), followed by dynamic reconstruction (13.8%), and combined static and dynamic reconstructions (13.5%). The most frequent type of surgery was upper lid weight loading (38.5%), hypoglossal-facial jump nerve suture (17.3%), and facial-facial interpositional graft suture (16.9%). Bleeding/hematoma formation needing revision surgery was the most frequent complication (6.2%). Overall, 70.4% of the patients were satisfied with the final result. The satisfaction was higher if the target was to improve eye closure (65.2%) or to improve upper face function (65.3%) than to improve the lower face function (53.3%). CONCLUSIONS: If facial nerve reconstruction surgery and/or upper lid weight placement was performed, the satisfaction was significantly higher. If revision surgery was needed to improve the result, the satisfaction was significantly lower.

Technique of Adolescent Shoulder Reanimation in Brachial Plexus Birth Injury.

BACKGROUND: Brachial plexus birth injury (BPBI) is common and while most recover, 8-36% of patients experience permanent impairment. Typically, adolescents with untreated BPBI lack active and passive external shoulder rotation (ER) and overhead shoulder function. Limited shoulder function is due to 1) nonoperative BPBI 2) untreated BPBI or 3) unrecognized glenohumeral joint dysplasia. We describe a technique for achieving reanimation in adolescents who did not receive timely/effective BPBI care, a postoperative rehabilitation protocol, and results from a series of eight patients who underwent shoulder reanimation. METHODS: A comprehensive shoulder reanimation approach is performed. Anteriorly, the pectoralis minor, major, and anterior capsule necessitate release. In severe dysplasia, a coracoidectomy, posterior glenoid osteotomy, and/or subscapularis slide may be necessary. Acromial dysplasia is also common, frequently necessitating osteoplasty. The deltoid is usually nonfunctional, and we use a bipolar latissimus muscle transfer for reanimating abduction and forward flexion. To assist with ease of rehabilitation we will often transfer the tendon of the teres major. Levator scapulae transfer to the supraspinatus is often performed to assist with the initiation of abduction. For external rotation, the ipsilateral lower trapezius is used. Finally, ipsilateral rhomboid advancement and contralateral lower trapezius muscle transfer is performed for dynamic scapular stabilization. After surgery, all patients participated in our rigorous postoperative rehabilitation protocol. RESULTS: Eight patients (13.8±5.6 years, 35±24 weeks follow-up) were included. All patients participated in our rehabilitation protocol. Preoperatively, patients generally achieved 0° ER from neutral and in maximum abduction. Postoperatively, patients achieved an average of 71° (30-90°) ER from neutral and an average of 82° (65-90°) ER in maximum abduction. Preoperatively, patients generally had 0-20° of abduction, which they achieved through scapulothoracic motion. Postoperatively, patients could achieve an average of 115° (90-180°) of abduction. Preoperatively, patients had 0-20° of FF that was mediated through scapulothoracic motion. Postoperatively, patients' FF increased to an average of 91° (20-170°). CONCLUSION: This technique is intended to restore a congruent glenohumeral joint and reanimate structures allowing for abduction, FF, and ER. While we advocate for early treatment of BPBI, applying this technique to undertreated/untreated adolescent patients paired with our rehabilitation protocol results in significant functional improvement, allowing for an improved quality of life.

The effect of increasing motor end-plate innervation on smile activation in acute and early facial palsy.

While it has been over half a century since primary cross-facial nerve grafting was first described for facial reanimation, the outcome of this procedure, remains inconsistent and provide lesser smile excursion when compared to the likes of the masseteric nerve. However, the latter itself has limitations in terms of the lack of spontaneity and resting tone. While combinations have been attempted more proximally, we ask the question as to whether more distal nerve transfers with vascularized nerve grafts are a better option. In a retrospective review of clinical practice at our institute, 16 consecutive patients had single, double, and finally triple distal nerve transfers, close to the target facial muscle to reinnervate the motor endplates directly, over a 6-year period (2018-23). All patients had the onset of facial palsy within 18 months. Statistical analysis of the comparison between three sub-cohorts was performed using student's t-test and one-way ANOVA, respectively. Qualitatively, masseteric neurotization of a single facial nerve branch translated into smile improvement in 50% of cases, as opposed to all cases of double- and triple-neurotization of the smile muscles. In terms of upper lip elevation, single neurotization showed improvement in 25% of cases, double-neurotization in 40% of cases and triple-neurotization in 100% of cases. Upper lip elevation was also significantly better in those who had a vascularized cross-facial nerve graft (Student's t-test <0.05). In summary, increasing neural input to the motor endplates of smile muscles can significantly improve smile activation, in acute flaccid facial palsies.

[Acute care of patients with cerebral palsy in neuro-resuscitation surgery]. / La prise en soins des patients cérébrolésés à la phase aiguë en neuroréanimation chirurgicale.

Severe head trauma, with or without polytrauma, subarachnoid haemorrhage due to aneurysm rupture, is an unexpected tragedy for patients and their families. These accidents are likely to result in extremely serious neurological damage, with many of the patients under our care facing a life-threatening prognosis. To protect the brain, one solution is to put the patient into a deep sleep during the so-called "acute" phase, making it impossible to assess the repercussions of the initial injuries at the time: this is what we call "waiting resuscitation".

[Management of SAH]. / Prise en charge de la HSA.

Every year, the neurosurgical intensive care unit at Grenoble's university hospital (CHU) receives a large number of cerebrovascular patients. Data collected in the department during 2023 show that subarachnoid hemorrhage (SAH) is one of the most frequent causes of the pathologies treated. In this article, we focus on the appropriate course of action.

[The cultural diversity of professionals in migrant care]. / La diversité culturelle des professionnels au profit des soins aux personnes migrantes.

A qualitative study was carried out with five professionals in a pediatric intensive care unit in 2022. Semi-structured interviews were used to find out how they felt about patients from their own culture, and about the role of their mother tongue in hospital care. Caregivers find it difficult to bring their own culture to the fore when caring for their patients. A description of the obstacles they encounter, as well as the advantages, is included.

The evolution of facial reanimation techniques.

This review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.

[When pediatric resuscitation and anesthesia teams simulate together]. / Quand des équipes de réanimation et d'anesthésie pédiatrique simulent ensemble.

At the Grenoble-Alpes University Hospital Center, a high-fidelity simulation training project was born from the collaboration of the intensive care and pediatric anesthesia teams. The objective of these sessions was to improve practices by developing the technical and non-technical skills of the teams. Fifteen days were organized from 2018 to 2022, training 170 healthcare professionals. The results highlighted excellent satisfaction and helped improve professional practices.

[Ballistic wound in the pre-hospital and emergency room: Damage Control Resuscitation]. / Plaies balistiques en préhospitalier et aux urgences : Damage Control Resuscitation.

Damage Control Resuscitation (DCR) is a strategy designed to prioritize hemostasis procedures, from the point of injury to surgical management, whether faced with an influx of bleeding casualties or a single casualty with severe hemodynamic instability. Widely disseminated, it provides clear objectives for prioritizing physiological restoration to the anatomy required for short-term survival. Initially applied to surgery, DCR has now been extended to the entire upstream care chain, including first aid and emergency medicine.

[The benefits of a psychologist working alongside caregivers in neonatal and pediatric intensive care units]. / De l'intérêt d'un psychologue aux côtés des soignants en réanimation néonatale et pédiatrique.

Neonatal and pediatric intensive care units take care of patients in very critical condition. Professionals in these departments are faced with extreme clinical conditions and a heavy burden of care. The heavy burden of care and the constant confrontation with illness and death have prompted some departments to create psychologist posts dedicated to the nursing staff. By providing a space for thought and reflection, these psychologists act as psychic containers and emotional receptacles for the teams. By working on the otherness of caregivers, the psychologist takes care of those who care.

[Consideration of parents when caring for children in acute situations]. / La considération des parents lors de la prise en charge de l'enfant en situation aiguë.

A child's illness and hospitalization have repercussions for parents and siblings. Caregivers have a duty not only to care for their young patient, but also to welcome the family, whose dynamics are disrupted. Beyond the somatic and technical aspects, the challenge lies in caring for each member of the family, particularly the parents. The complexities of supporting parents when dealing with a child in an emergency situation will be explored through the testimony of a nursery nurse.

[Siblings in a pediatric intensive care unit]. / L'accueil des fratries dans un service de réanimation pédiatrique.

Welcoming visitors has long had difficulty finding its place in intensive care units, including pediatric units. This article describes the reflective approach adopted by a working group in the pediatric intensive care unit at the regional university hospital in Tours, with the aim of fully integrating the reception of siblings into the child's hospitalized care project. The momentum generated by this reflection has gradually enabled the family environment to be restructured around the child in care, reinvigorating a breath of life that extends far beyond the purely biological.

[Multidisciplinary reflections on parental support in congenital cardiac resuscitation]. / Réflexions pluridisciplinaires autour de l'accompagnement parental en réanimation cardiaque congénitale.

Half of all children with congenital heart disease develop specific neurodevelopmental disorders. As these are influenced as much by factors intrinsic to the pathology as by the environmental and family support that the young patient receives from birth, the team at the congenital heart disease unit at Bordeaux's university hospital has devised an individualized global pathway for these families to support the neurodevelopment of these toddlers from the antenatal period onwards.

La stabilisation néonatale au Canada : des mises à jour aux pratiques du Programme de soins aigus aux nouveau-nés à risque (ACoRN).

On constate des écarts dans les taux de prématurité et de mortalité néonatale au Canada, en partie à cause d'une formation insuffisante en réanimation et en stabilisation néonatales et de même que d'une adhésion inégale aux pratiques exemplaires. Depuis les années 1990, le Programme de réanimation néonatale est la norme dans tous les établissements qui prodiguent des soins périnatals, mais les fournisseurs et les formateurs de soins périnatals ont continué d'observer des lacunes sur le plan des connaissances et des habiletés en matière de stabilisation des nouveau-nés après la réanimation, particulièrement dans les milieux où ces soins sont rarement requis. Le Programme de soins aigus aux nouveau-nés à risque (ACoRN) a été mis sur pied pour corriger ces lacunes. Dans l'ACoRN, une évaluation primaire et des trajectoires pour soigner les divers systèmes organiques (les séquences) priorisent et orientent l'évaluation, les soins essentiels et la prise en charge des nouveau-nés à risque ou malades pendant les premières heures et les premiers jours de vie. Le présent point de pratique fait ressortir les changements aux pratiques et aux recommandations depuis 2012, année de la dernière révision du texte et du fonctionnement de l'ACoRN, qui n'était alors offert qu'en anglais. À l'instar du Programme de réanimation néonatale, l'ACoRN est géré par la Société canadienne de pédiatrie au Canada. Un manuel et un programme d'enseignement révisés, mis à jour, traduits en français et lancés en 2021 standardiseront les soins, accroîtront les compétences et la confiance chez les dispensateurs de soins périnatals et amélioreront les pronostics néonatals au Canada et ailleurs au cours des prochaines années.

[Breathing filters in hospital, COVID first-wave experience]. / Filtres respiratoires à l'hôpital, l'expérience de la première vague de COVID.

During the coronavirus pandemic, breathing filters have been essential in the medical care of infected patients. The worldwide demand caused a disruption in the supply, which led to a multiplication of the references used. The lack of formation available on the subject was an impediment for pharmacists (buyer, medical devices, intensive car unit) and it appears to be necessary to redact a formation about those filters, from the experience acquired during the sanitary crisis. Multiple breathing filters references exist which may be classify according to their filtration mechanism (mechanical filtration or electrostatic filtration) and by the eventual presence of a humidifying action (Heat and Moisture Exchangers; hydrophobic, hygroscopic, or mixed). In anaesthesia, the use of pure mechanical filter is preferred; in resuscitation unit, heat and moisture exchangers filter or simple filter plus heated humidifier are used. During the COVID-19 pandemic, the filters duration of use has been lengthened to limit the disruption risk.

Mining the Twittersphere: Insights about Public Interest in Facial Reanimation Surgery from a Decade of Twitter Data.

Background With 500 million tweets posted daily, Twitter can provide valuable insights about public discourse surrounding niche topics, such as facial paralysis surgery. This study aims to describe public interest on Twitter relating to facial paralysis and facial reanimation surgery over the last decade. Methods Tweets containing the keywords "facial paralysis" and "Bell's palsy" posted between January 1, 2009, and January 1, 2019, were collected using Twitter Scraper. Tweets were screened by keywords relating to facial paralysis, and usage of these terms trended over time. Logistic regression was used to identify correlations between the quantity of publications per year and these terms posted on Twitter. Results 32,880 tweets were made during the study period, with no significant difference in the number of tweets per year. A very strong ( r = 0.8-1.0) positive correlation was found between time and frequency of the term "plastic surgery" and "transfer" ( p < 0.05). A strong ( r = 0.60-0.79) correlation was found between time and frequency for the following terms: "facial reanimation," "gracilis," "masseter," "plastics," "transplant" ( p < 0.05). A total of 619 studies with the keyword "facial reanimation" were published in PubMed within the study period. A very strong, positive correlation between publications per year and frequency was found for the terms "plastic surgery," "function" and "esthetic," and a strong, positive correlation was found for the "plastics," "transplant," "Botox," "surgery," "cosmetic," "aesthetic" and "injection" ( p < 0.05). Conclusions An increasing number of discussion about facial paralysis on Twitter correlates with increased publications and likely surgeon discourse on facial reanimation surgery, driving public interest.

[Caregivers' experiences with extreme prematurity]. / Vécu des soignants face à l'extrême prématurité.

Neonatal intensive care units receive very immature premature newborns. Mortality and morbidity rates remain high in this particularly fragile population. Caregivers involved with the child and his or her parents may experience moral distress. There are few studies on the experience of caregivers in these situations. Training, service architecture and sharing of experiences with specifically trained psychologists can improve this experience in these highly technical services.

[Traumatic motherhood in Covid-19 times]. / Maternités traumatiques en temps de Covid-19.

In the context of maternal vital emergency due to Covid-19, dire situations of birth questioned the health practitioners of a neonatal intensive care unit. How can mothers take care of their baby when their own life has been threatened ? The analysis of two clinical cases underlines the importance of talking for these mothers who have been through disastrous experiences, which could lead to a post-traumatic stress disorder. Restoring a connection to outside reality thanks to psychological care in the acute post-trauma period helps these mothers take care of their child.