Application of Artificial Intelligence in Recognition and Evaluation of Facial Paralysis / 中国医疗器械杂志

This paper reviews some recent studies on the recognition and evaluation of facial paralysis based on artificial intelligence. The research methods can be divided into two categories: facial paralysis evaluation based on artificial selection of patients' facial image eigenvalues and facial paralysis evaluation based on neural network and patients' facial images. The analysis shows that the method of manual selection of eigenvalues is suitable for small sample size, but the classification effect of adjacent ratings of facial paralysis needs to be further optimized. The neural network method can distinguish the neighboring grades of facial paralysis relatively well, but it has a higher requirement for sample size. Both of the two methods have good prospects. The features that are more closely related to the evaluation scale are selected manually, and the common development direction may be to extract the time-domain features, so as to achieve the purpose of improving the evaluation accuracy of facial paralysis.

Síndrome de Moebius incompleto. Presentación de un caso clínico / Incomplete Moebius syndrome. Clinical case presentation

RESUMEN El síndrome de Moebius es un trastorno polimalformativo no progresivo que se caracteriza por parálisis facial congénita. Se define como una "parálisis congénita de los núcleos de los pares craneales VI y VII, cuyo espectro clínico es variable y se asocia a múltiples malformaciones óseas y musculares. Es poco frecuente y de etiología vascular, genética o multifactorial. El trabajo, basándose en los fundamentos teóricos más actualizados, pretendió describir las manifestaciones clínicas del síndrome de Moebius y su posible etiología, a propósito de un caso. Se trató de un paciente de 11 años de edad, que al nacimiento presentó asimetría facial, desviación de la comisura labial hacia la izquierda, boca semiabierta, lagrimeo constante y pabellón auricular derecho malformado. Por ser una entidad clínica poco conocida, se expuso el presente caso, portador de un síndrome de Moebius incompleto de causa vascular y multifactorial (AU).

ABSTRACT Moebius syndrome is a non-progressive poli-formative disorder characterized by facial congenital paralysis. It is defined as a congenital paralysis of the VI and VII cranial nerves nuclei, the clinical spectrum of which is variable and associated to several bone and muscular malformations. It is few frequent and has vascular, genetic or multifactorial etiology. This work, based on more updated theoretical fundaments, pretended to describe the clinical manifestations of the Moebius syndrome and its possible etiology on the purpose of a case. It is the case of a patient, aged 11 years, who presented facial asymmetry, lips commissure deviation to the left, semi-opened mouth, constant lagrimeo and deformed right auricular pavilion (pabellon auricular). Because it is a little known clinical entity, this case of a patient having an incomplete Moebius syndrome of vascular and multifactorial cause was presented (AU).

The Contribution of Surface Electromyographic Assessment for Defining the Stage of Peripheral Facial Paralysis: Flaccid or Sequelae Stage

Abstract Introduction Surface electromyographic activity may not be symmetric, even in subjects with no facial paralysis history. Objective To evaluate the contribution of the index of electromyographic (IEMG) activity in the identification of the two extremes of the facial paralysis course. Methods Thirty-four subjects with unilateral peripheral facial paralysis were selected. A control group was composed of volunteers without a history of facial paralysis. The electromyographic assessment of the facial muscle was performed by placing surface electrodes during movements of the forehead, eyes and lips using MIOTEC equipment, such as the MIOTOOL (Miotec, Porto Alegre, Brazil) software. The electromyographic activity was also recorded in other channels during the primary activity to identify the presence of synkinesis. The statistical analysis was performed using the Statistical Package for Social Sciences for Macintosh (SPSS Inc, Chicago, IL, USA). The IEMG activity was obtained from the division of the electromyographic activity root mean square (RMS) values on both sides. Results There was a statistically significant difference among the groups in all the analyzed indexes. The ocular-oral synkinesis in all patients must be correctly identified (with 100% sensitivity and specificity) using an IEMG activity of 1.62 as a cutoff point. The oral-ocular synkinesis must be correctly identified (93.3% sensitivity and 95.9% specificity) using the IEMG activity of 1.79 as a cutoff point. Conclusion The IEMG activity is below the normal scores in patients in the flaccid stage, whereas patients in the sequelae stage can either show normal values or values above or below the normal scores. The IEMG activity was shown to have high sensitivity and specificity in the identification of synkinesis.

Mycoplasma pneumoniae: manifestaciones neurológicas y controversias diagnósticas. A propósito de un caso / Mycoplasma pneumoniae: neurologic manifestations and diagnostic controversies. A case report

Mycoplasma pneumoniae (Mp) es el agente causal de un 30% de las manifestaciones respiratorias de la población general. La neumonía ocupa el primer lugar dentro de este grupo. Las manifestaciones neurológicas representan las formas más frecuentes de presentación clínica extrapulmonar (40%). Las encefalitis y meningoencefalitis son las formas más habituales de sintomatología neurológica asociada a infección por Mp. La presentación de más de una variante clínica en un mismo paciente asociada a primoinfección por Mp es posible. El diagnóstico serológico plantea, habitualmente, controversias en su interpretación. A partir del caso de una niña de 7 años con inyección conjuntival, adenopatía cervical, rash descamativo y fotofobia con "pseudoedema de papila bilateral", que desarrolla durante su evolución parálisis facial periférica y meningitis aséptica, se analizarán las controversias que se plantean en relación con la interpretación diagnóstica asociada al compromiso neurológico por Mp.

Mycoplasma pneumoniae (Mp) is responsible for 30% of the respiratory manifestations of the general population. Pneumonia occupies the first place within this group. Among the extra-respiratory forms (40%), the neurological ones are the most frequent. Meningoencephalitis and aseptic meningitis are the most common. The presentation of more than one clinical variant in the same patient associated with primoinfection by Mp is possible. In relation to the serological diagnosis, controversies in interpretation sometimes occur. This is a 7-year-old girl with conjunctival injection, cervical adenopathy, photophobia with bilateral papilla pseudoedema, and scaly rash that develops peripheral facial paralysis and aseptic meningitis. We will discuss diagnostic controversies.

Parálisis facial neonatal: identificación del virus del herpes simple 1 en el líquido cefalorraquídeo. Caso clínico / Neonatal facial palsy: Identification of herpes simplex virus 1 in cerebrospinal fluid. Case report

En los neonatos, la parálisis facial es muy infrecuente y, por lo general, diagnosticada al nacer. Se presenta el primer caso de parálisis facial neonatal con identificación del virus del herpes simple 1 en el líquido cefalorraquídeo. Un varón de 35 días de vida acudió a Urgencias por la desviación de la comisura bucal hacia la izquierda y la ausencia de cierre del ojo derecho, sin sintomatología infecciosa ni antecedentes relevantes. La exploración física fue compatible con parálisis facial periférica. Las exploraciones complementarias de urgencia (hemograma, bioquímica, coagulación y citoquímica de líquido cefalorraquídeo) fueron normales. Fue ingresado con prednisolona oral y aciclovir intravenoso. La resonancia magnética craneal fue normal. A las 48 horas, se recibió el resultado positivo de la reacción en cadena de la polimerasa para el virus del herpes simple 1 en el líquido cefalorraquídeo. Con evolución favorable, completó 7 días de prednisolona oral y fue dado de alta tras 21 días de aciclovir intravenoso, con exploración neurológica previa normal.

Neonatal facial palsy is very uncommon and is generally diagnosed at birth. We present the first published case of neonatal facial palsy with identification of herpes simplex virus 1 in cerebrospinal fluid. A 35-day-old male was presented at the Emergency Department with mouth deviation to the left and impossibility of full closure of the right eye. There were no symptoms of infection or relevant medical history. Physical examination was compatible with peripheral facial palsy. Studies performed at admission were normal (blood count, biochemical analysis and coagulation blood tests and cerebrospinal fluid analysis). The patient was admitted on oral prednisolone and intravenous aciclovir. Cranial magnetic resonance was normal. Polymerase chain reaction test for herpes simplex virus 1 in cerebrospinal fluid was reported positive after 48 hours of admission. Patient followed good evolution and received prednisolone for 7 days and acyclovir for 21 days. At discharge, neurological examination was normal.

Resultados del tratamiento kinésico precoz y oportuno en un niño con Parálisis Facia / Results of early and timely kinetic treatment in a child with Facia paralysis

the case of a 12 years old male patient with right Facial Paralysis diagnosis begin his treatment in the SUK (Physiotherapy University Service). At the beginning of the treatment, the patient presents: a fascial alteration with noticeable muscle weakness on the right side and a increased muscular tone on the opposite side. The patient receive nine (9) sessions of physiotherapy treatment based on indirect selective electromiostimultion with exponential and rectangular current, asociated with muscle rehabilitation exercises and massotherapy. By this tecnic, the muscular thofysm is mantein. Once that the patient recovered the muscular functions, he were able to develop symmetry and sychrony on his gesture. The patient achive his total recuperation in a short time and with a low number of session without any complication associate to the treatment

Paciente de 12 años, de sexo masculino, con diagnóstico médico de parálisis facial derecha, que ingresa al Servicio Universitario de Kinesiología de la Facultad de Medicina de la UNNE. Al inicio del tratamiento, el paciente presenta: alteración de la fascie con una marcada hipotonía de la hemicara afectada y una leve hipertonía en el lado contralateral. Se realizaron nueve sesiones de tratamiento kinésico basado en electroestimulación muscular selectiva indirecta con corriente exponencial y rectangular, asociada a ejercicios de reeducación muscular y masoterapia. Mediante esta técnica se logra mantener el trofismo muscular; una vez que el paciente recupera las funciones musculares, posteriormente desarrolla simetría y sincronía en la realización de los gestos de la mímica. El paciente logra su recuperación total en un corto considerado breve, sin ninguna complicación derivada de la utilización de electroestimulación

Parálisis facial recidivante en vuelos comerciales: reporte de un caso / Recurrent facial paralysis during comercial flights / Case report

La parálisis facial asociada a cambios bruscos de presión en el oído medio es un fenómeno poco común que ha sido reportado tanto en actividades de buceo como en aviación. Se produciría una incapacidad, por parte de la tuba auditiva, de equilibrar las presiones entre el oído medio y el ambiente, lo que generaría una neuropraxia del facial en presencia de ciertas condiciones. Presentamos el caso de un paciente que desarrolló un cuadro de parálisis facial recidivante durante vuelos comerciales, se describe la evaluación realizada y la probable fisiopatología involucrada.

Facial paralysis, associated with sudden changes in pressure in the middle ear, is a rare phenomenon that has been reported in both diving and aviation. It occurs because the Eustachian tube is unable to compensate middle ear pressure changes which would lead to a facial neuropraxia in the presence of certain conditions. A case of a patient who developed recurrent facial paralysis during comercial flights. The possible involved pathophysiology is described.

Vibração palpebral: o teste clínico mais sensível na paralisia facial / Palpebral vibration: the clinical test more sensitive in facial paralysis

Nesta nota os autores chamam atenção para a importância do fenômeno da vibração palpebral e ressaltam um teste de beira de leito, descrito por Wartenberg, capaz de antever a paralisia facial.

In this note the authors call attention to the importance of the eyelid vibration phenomenon, and highlight a predictor bedside test, described by Wartenberg, able to foresee a facial palsy.

Diplejía facial como variante inusual del síndrome de Guillain-Barré: primer caso reportado en Venezuela / Facial diplegia as unusual variant of Guillain-Barré syndrome: first case reported in Venezuela

El síndrome de Guillain-Barré (SGB) es la causa más común de parálisis generalizada aguda. El SGB es una polirradiculoneuropatia aguda inflamatoria desmielinizante que generalmente se presenta como una parálisis que inicia en miembros inferiores y luego progresa de forma ascendente y simétrica. El presente trabajo, tiene como objetivo, informar un caso de diplejía facial como manifestación inicial de SGB. Paciente masculino, 37 años de edad, diabético tipo 2, que luego de ocho días de haber padecido una sinusitis aguda, presentó de forma gradual, cefalea hemicraneana derecha, derramamiento salival y disartria. En la exploración neurológica se observó ausencia bilateral de los pliegues frontales, lagoftalmos bilateral acompañado de epífora, signo de Bell bilateral y derramamiento salival a través de ambas comisuras labiales. A las 48 horas de su ingreso hospitalario, presentó paresia en ambos miembros superiores. El estudio del líquido cefalorraquídeo reportó 1,1 células/mm³ representadas en su totalidad por linfocitos de aspecto normal, y proteínas totales 196,9mg/dL. La electromiografía fue compatible con polineuropatía desmielinizante aguda de predominio motor con mayor afectación facial. Con los hallazgos clínicos y paraclínicos se realizó el diagnóstico de SGB. Se inició tratamiento a base de plasmaféresis e inmunoglobulina endovenosa, con posterior mejoría de la clínica. La diplejía facial forma parte de las variantes regionales del SGB. A pesar que cerca del 60% de los pacientes con SGB presentan debilidad facial en el curso del trastorno, ésta habitualmente es precedida por debilidad en extremidades. El presente caso permite evidenciar que el SGB puede debutar clínicamente como una diplejía facial.

The Guillain-Barré syndrome (GBS) is the most common cause of acute generalized paralysis. GBS is an acute inflammatory demyelinating polyradiculoneuropathy. It usually presents as a paralysis that starts in the lower limbs and then progresses symmetrically upward. The present study reports a case of bilateral facial palsy as the initial manifestation of GBS. This is a report of a case of a 37-year-old male, diabetic, that eight days after having suffered acute sinusitis, gradually presented with right hemicranial headache, dysarthria and sialorrhea. The neurological examination disclosed the absence of the bilateral frontal folds, accompanied by epiphora, bilateral lagophthalmos, bilateral Bell sign and salivary drooling through both commissures of lips. At 48 hours after hospital admission the patient showed paresis in both upper limbs. The cerebrospinal fluid analysis reported 1.1cells/mm³, fully represented by lymphocytes of normal aspect and total proteins were 196.9 mg/dL. The electromyography was consistent with acute demyelinating polyneuropathy, with a predominant motor component and a major facial involvement. With the clinical and laboratory findings, a diagnosis of GBS was established. Treatment was started with plasmapheresis and intravenous immunoglobulin, with the subsequent improvement of the clinic. The facial diplegia is part of the regional variants of GBS. Although about 60% of GBS patients present with facial weakness, it is usually preceded by weakness in the limbs. This case makes evident that GBS may present clinically as a facial diplegia.

Facial diplegia: etiology, clinical manifestations, and diagnostic evaluation / Diplegia facial: etiologia, manifestações clínicas, e avaliação diagnóstica

ABSTRACT Objective Facial diplegia (FD) is a rare neurological manifestation with diverse causes. This article aims to systematically evaluate the etiology, diagnostic evaluation and treatment of FD. Method The study was performed retrospectively and included 17 patients with a diagnosis of FD. Results Patients were diagnosed with Guillain-Barré syndrome (GBS) (11), Bickerstaff’s brainstem encephalitis (1), neurosarcoidosis (1), non-Hodgkin’s Lymphoma (1), tuberculous meningitis (1) herpes simplex reactivation (1) and idiopathic (1). In addition, two patients had developed FD during pregnancy. Conclusion Facial diplegia is an ominous symptom with widely varying causes that requires careful investigation.

RESUMO Objetivo Diplegia facial (DF) é uma manifestação neurológica rara proveniente de diferentes causas. Este artigo visa avaliar sistematicamente a etiologia, avaliação diagnóstica e tratamento de DF. Método O estudo foi retrospectivo e incluiu 17 pacientes com diagnóstico de FD. Resultados Os pacientes foram diagnosticados como casos de síndrome de Guillain-Barré (SGB) (11), encefalite de tronco de Bickerstaff (1), neurosarcoidose (1), linfoma não-Hodgkin’s (1), meningite tuberculosa (1) reativação de herpes simplex (1) e causa idiopática (1). Além disto, duas pacientes haviam desenvolvido DF durante a gestação. Conclusão Diplegia facial é uma manifestação com diversas causas que requer investigação cuidadosa.

Scales of degree of facial paralysis: analysis of agreement / Escalas de grau da paralisia facial: análise de concordância

INTRODUCTION: It has become common to use scales to measure the degree of involvement of facial paralysis in phonoaudiological clinics. OBJECTIVE: To analyze the inter- and intra-rater agreement of the scales of degree of facial paralysis and to elicit point of view of the appraisers regarding their use. METHODS: Cross-sectional observational clinical study of the Chevalier and House & Brackmann scales performed by five speech therapists with clinical experience, who analyzed the facial expression of 30 adult subjects with impaired facial movements two times, with a one week interval between evaluations. The kappa analysis was employed. RESULTS: There was excellent inter-rater agreement for both scales (kappa > 0.80), and on the Chevalier scale a substantial intra-rater agreement in the first assessment (kappa = 0.792) and an excellent agreement in the second assessment (kappa = 0.928). The House & Brackmann scale showed excellent agreement at both assessments (kappa = 0.850 and 0.857). As for the appraisers' point of view, one appraiser thought prior training is necessary for the Chevalier scale and, four appraisers felt that training is important for the House & Brackmann scale. CONCLUSION: Both scales have good inter- and intra-rater agreement and most of the appraisers agree on the ease and relevance of the application of these scales. .

INTRODUÇÃO: A utilização das escalas para mensurar o grau de comprometimento da paralisia facial tem se tornado rotina cada vez mais comum na clínica fonoaudiológica. Objetivos: Analisar a concordância inter- e intra-avaliadores das escalas do grau de paralisia facial e a opinião dos avaliadores quanto à sua utilização. MÉTODO: Estudo clínico observacional transversal das escalas de Chevalier e de House e Brackmann, realizado com cinco fonoaudiólogos com experiência clínica que analisaram a expressão facial de 30 indivíduos adultos com variação de comprometimento da mímica facial, por duas vezes, com intervalo de uma semana entre sessões. A análise de kappa foi empregada. RESULTADOS: Houve excelente concordância inter-avaliadores para as duas escalas (kappa > 0,80) e na escala de Chevalier foi observada concordância substancial intra-avaliadores na 1 a avaliação (kappa = 0,792) e excelente na 2 a avaliação (kappa = 0,928). A escala de House e Brackmann apresentou excelente concordância nos dois momentos da avaliação (kappa = 0,850 e 0,857). Quanto à opinião dos avaliadores, na escala de Chevalier um dos profissionais acha necessário treinamento prévio; na escala de House e Brackmann, quatro profissionais acham importante haver o treinamento. CONCLUSÃO: Ambas as escalas apresentam boa concordância inter- e intra-avaliadores e a maioria dos profissionais concorda quanto à facilidade e à relevância da aplicação destas escalas. .

Parâmetros salivares, proteoma e saúde bucal na síndrome de Moebius / Salivary parameters, proteome and oral health in Moebios syndrome

A síndrome de Moebius (SM) é uma diplegia congênita rara caracterizada por paralisia total ou parcial do VI e VII nervos cranianos, que leva à ausência ou deficiência dos movimentos dos músculos envolvidos na mímica facial e ao estrabismo convergente. As características bucais descritas nesses indivíduos incluem o palato ogival, micrognatia, malformação de língua, filtro curto, falta de coaptação de lábios, e maior incidência de lesões de cárie. O objetivo deste estudo foi avaliar as características salivares quantitativas e qualitativas, incluindo o proteoma salivar, de indivíduos com SM, associá-las com a saúde bucal, e compará-las com as características salivares de um grupo controle, não afetado pela SM. Foram incluídos 15 indivíduos com SM e 15 controles. O comprometimento facial do individuos com a SM foi avaliada e graduada em scores 0,1 ou 2, uni ou bilateral, para os nervos II, III, IV, V, VI, VII e XI. Os pesquisadores determinaram o índice de cárie (ICDAS), de doença periodontal (PSR) e de placa (Silness Lõe) nos dois grupos de estudo. Também realizaram coletas de saliva total não estimulada, estimulada e parotídea bilateral, sendo o fluxo salivar estabelecido em ml/min. A capacidade tampão foi avaliada na saliva total estimulada através da titulação de HCl 0,01N. A atividade de ?-amilase nas amostrasmfoi medida através da produção de maltose. Para a análise proteômica optou-se pela divisão das amostras de saliva de acordo com o fluxo em ml/min. Desta forma, para cada grupo, estudo e controle, os 4 tipos de saliva (estimulada, não estimulada, parotídea esquerda, parotídea direita) foram subdivididos de acordo com baixo fluxo (abaixo da média do grupo) ou alto fluxo (acima da média do grupo), resultando em 16 subgrupos.

O proteoma foi obtido por duas metodologias distintas, a primeira a partir da cromatografia líquida espectrometria de massas e a segunda que utilizou a técnica de eletroforese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE) associada à eletroforese em gel de poliacrilamida (native cationic). A ocorrência das lesões de cárie foi significativamente mais alta entre os participantes com SM (p>0,05) no corte 2, bem como a ocorrência de doença periodontal (p>0,05), quando comparado ao grupo controle. Não houve diferença no índice de placa entre os grupos. A análise proteômica mostrou diminuição de cistatinas B, S e SN nos indivíduos com SM. Não houve diferença no perfil proteico entre os grupos de baixo e de alto fluxo salivar, para indivíduos com SM e controle. Houve aumento na quantidade de amilase salivar em e de histatina 1,3 e 5 em indivíduos com SM. Concluímos que indivíduos com SM apresentam diminuição de fluxo salivar, de capacidade tampão e alterações proteicas que colocam esses indivíduos em situação de maior risco para cárie e para doença periodontal.

The Moebius syndrome (MS) is a rare congenital diplegia characterized by total or partial palsy of the VI and VII cranial nerves, leading to the absence or disability of the movements of facial expression muscles and to convergent strabismus. The oral features described in these individuals include high-arched palate, micrognathia, tongue malformation, short filter, lack of lips coaptation, and higher incidence of caries lesions. The aim of this study was to evaluate the quantitative and qualitative salivary characteristics, including the salivary proteome of individuals with MS, associate them with the oral health, and compare them to the salivary characteristics of a control group, unaffected by SM. We included 15 subjects with MS and 15 controls. The facial involvement of individuals with MS was evaluated and graded on scores 0, 1 or 2, uni or bilateral to the nerves II, III, IV, V, VI, VII and XI. The researchers established the caries (ICDAS), periodontal disease (PSR) and plate (Silness Lõe) indexes in both groups. We also performed unstimulated, stimulated and bilateral parotid saliva collections, and salivary flow was calculated (ml / min). The buffer capacity was measured in stimulated saliva by titration of 0.01N HCl. The ?-amylase activity was determined by maltose production. For proteomic analysis it was decided to split the saliva samples in accordance with the flow in ml/min. Thus, for each group, study and control, the 4 types of saliva (stimulated, unstimulated, left parotid, right parotid) were subdivided according to low flow (below the group average) or high flow (above average group), resulting in 16 subgroups.

The proteome was obtained by two different methodologies, the first was liquid chromatography mass spectrometry and the second was sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) associated with cationic PAGE. The occurrence of caries lesions, related to cut-off 2, as well as the occurrence of periodontal disease, was significantly higher (p> 0.05) in participants with MS when compared to the control group. There was no statistical difference in plaque index between groups. Proteomics analysis showed decrease of cystatin B, S and SN in individuals with MS. There was no difference in protein profile between the low and high salivary flow groups, for individuals with MS and control. There was an increase in the amylase amount and histatin 1, 3 and 5 in individuals with MS. We concluded that individuals with MS present decreased salivary flow, decreased buffer capacity and protein alterations that place these individuals at increased risk for caries and periodontal disease.

Parâmetros salivares, proteoma e saúde bucal na síndrome de Moebius / Salivary parameters, proteome and oral health in Moebios syndrome

A síndrome de Moebius (SM) é uma diplegia congênita rara caracterizada por paralisia total ou parcial do VI e VII nervos cranianos, que leva à ausência ou deficiência dos movimentos dos músculos envolvidos na mímica facial e ao estrabismo convergente. As características bucais descritas nesses indivíduos incluem o palato ogival, micrognatia, malformação de língua, filtro curto, falta de coaptação de lábios, e maior incidência de lesões de cárie. O objetivo deste estudo foi avaliar as características salivares quantitativas e qualitativas, incluindo o proteoma salivar, de indivíduos com SM, associá-las com a saúde bucal, e compará-las com as características salivares de um grupo controle, não afetado pela SM. Foram incluídos 15 indivíduos com SM e 15 controles. O comprometimento facial do individuos com a SM foi avaliada e graduada em scores 0,1 ou 2, uni ou bilateral, para os nervos II, III, IV, V, VI, VII e XI. Os pesquisadores determinaram o índice de cárie (ICDAS), de doença periodontal (PSR) e de placa (Silness Lõe) nos dois grupos de estudo. Também realizaram coletas de saliva total não estimulada, estimulada e parotídea bilateral, sendo o fluxo salivar estabelecido em ml/min. A capacidade tampão foi avaliada na saliva total estimulada através da titulação de HCl 0,01N. A atividade de ?-amilase nas amostrasmfoi medida através da produção de maltose. Para a análise proteômica optou-se pela divisão das amostras de saliva de acordo com o fluxo em ml/min. Desta forma, para cada grupo, estudo e controle, os 4 tipos de saliva (estimulada, não estimulada, parotídea esquerda, parotídea direita) foram subdivididos de acordo com baixo fluxo (abaixo da média do grupo) ou alto fluxo (acima da média do grupo), resultando em 16 subgrupos. O proteoma foi obtido por duas metodologias distintas, a primeira a partir da cromatografia líquida espectrometria de massas e a segunda que utilizou a técnica de eletroforese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE) associada à eletroforese em gel de poliacrilamida (native cationic). A ocorrência das lesões de cárie foi significativamente mais alta entre os participantes com SM (p>0,05) no corte 2, bem como a ocorrência de doença periodontal (p>0,05), quando comparado ao grupo controle. Não houve diferença no índice de placa entre os grupos. A análise proteômica mostrou diminuição de cistatinas B, S e SN nos indivíduos com SM. Não houve diferença no perfil proteico entre os grupos de baixo e de alto fluxo salivar, para indivíduos com SM e controle. Houve aumento na quantidade de amilase salivar em e de histatina 1,3 e 5 em indivíduos com SM. Concluímos que indivíduos com SM apresentam diminuição de fluxo salivar, de capacidade tampão e alterações proteicas que colocam esses indivíduos em situação de maior risco para cárie e para doença periodontal.

The Moebius syndrome (MS) is a rare congenital diplegia characterized by total or partial palsy of the VI and VII cranial nerves, leading to the absence or disability of the movements of facial expression muscles and to convergent strabismus. The oral features described in these individuals include high-arched palate, micrognathia, tongue malformation, short filter, lack of lips coaptation, and higher incidence of caries lesions. The aim of this study was to evaluate the quantitative and qualitative salivary characteristics, including the salivary proteome of individuals with MS, associate them with the oral health, and compare them to the salivary characteristics of a control group, unaffected by SM. We included 15 subjects with MS and 15 controls. The facial involvement of individuals with MS was evaluated and graded on scores 0, 1 or 2, uni or bilateral to the nerves II, III, IV, V, VI, VII and XI. The researchers established the caries (ICDAS), periodontal disease (PSR) and plate (Silness Lõe) indexes in both groups. We also performed unstimulated, stimulated and bilateral parotid saliva collections, and salivary flow was calculated (ml / min). The buffer capacity was measured in stimulated saliva by titration of 0.01N HCl. The ?-amylase activity was determined by maltose production. For proteomic analysis it was decided to split the saliva samples in accordance with the flow in ml/min. Thus, for each group, study and control, the 4 types of saliva (stimulated, unstimulated, left parotid, right parotid) were subdivided according to low flow (below the group average) or high flow (above average group), resulting in 16 subgroups. The proteome was obtained by two different methodologies, the first was liquid chromatography mass spectrometry and the second was sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) associated with cationic PAGE. The occurrence of caries lesions, related to cut-off 2, as well as the occurrence of periodontal disease, was significantly higher (p> 0.05) in participants with MS when compared to the control group. There was no statistical difference in plaque index between groups. Proteomics analysis showed decrease of cystatin B, S and SN in individuals with MS. There was no difference in protein profile between the low and high salivary flow groups, for individuals with MS and control. There was an increase in the amylase amount and histatin 1, 3 and 5 in individuals with MS. We concluded that individuals with MS present decreased salivary flow, decreased buffer capacity and protein alterations that place these individuals at increased risk for caries and periodontal disease.

Prise en charge des paralysies faciales compliquant un traumatisme de l'os temporal

Introduction : Les paralysies faciales peripheriques (PFP) compliquant les traumatismes de l'os temporal sont devenues de plus en plus frequentes; du fait de developpement de 'activite humaine. Le but de ce travail est de rapporter nos resultats en matiere de prise en charge de ces PFP; et a travers une revue de la litterature; de preciser les caracteristiques cliniques; paracliniques et de proposer une conduite a tenir adequate devant cette pathologie. Materiel et methodes : Il s'agit d'une etude retrospective a propos de 16 patients; pris en charge dans notre service sur une periode de 12 ans (2001-2012). Tous les patients ont beneficie d'un interrogatoire; d'un examen ORL complet. Une tomodensitometrie des rochers a ete realisee dans tous les cas. Les explorations du nerf facial ont ete basees surtout sur l'EMG de detection. Le traitement a ete medical ou medico-chirurgical. Le suivi a ete clinique avec un recul moyen de 26 mois. Resultats : Il s'agissait de 14 hommes et de 2 femmes. L'age moyen etait de 27 ans (6-73 ans). La PF etait d'installation immediate apres le traumatisme chez 10 patients et tardive dans 6 cas. La TDM des rochers a montre une fracture extra-labyrinthique dans 7 cas (43;7); trans-labyrinthique dans 5 cas (31;2) et mixte dans 4 cas (25). L'atteinte du canal facial a ete notee chez 12 patients. L'EMG de detection a ete pratiquee dans 4 cas. Tous nos patients ont beneficie d'un traitement medical; consistant en une corticotherapie par voie generale; des vasodilatateurs et une reeducation motrice. Sept patients ont beneficie d'une decompression du nerf facial. L'indication a ete retenue devant l'installation d'une PF immediate et complete. En per-operatoire; nous avons decouvert un trait de fracture du canal facial dans 5 cas; mais la continuite du nerf etait conservee dans tous les cas. Nous avons realise une decompression de la 2e portion; du coude et de la 3e portion. La decompression etait etendue au ganglion genicule dans 2 cas. Sur les 7 patients operes; 4 ont ete ameliores. Un des 3 patients non ameliores a garde un grade V et a beneficie d'une anastomose VII-XII. Pour les 9 patients non operees; une amelioration a ete notee dans 5 cas. Au total; le pourcentage d'amelioration de la PF etait de 55;5 apres traitement medical et de 71;4 apres traitement medico-chirurgical. Conclusion : Les paralysies faciales constituent une complication assez frequente des traumatismes de l'os temporal. L'imagerie est indispensable pour le diagnostic topographique des lesions. La conduite a tenir therapeutique depend aussi bien de la severite et du delai de l'installation de la paralysie que des donnees electrophysiologiques et evolutives

Parálisis facial alternante en una niña con hipertensión arterial: Informe de un caso / Alternating facial paralysis in a girl with hypertension: Case report

La parálisis de Bell es la causa más común de parálisis del nervio facial unilateral en la infancia. Aunque el diagnóstico depende de la exclusión de otras causas menos comunes, como infecciosas, traumáticas, asociada a tumores o a hipertensión, los pediatras tienden a diagnosticar la parálisis idiopática de Bell siempre que un niño presenta parálisis facial. En este informe se presenta una niña de ocho años con parálisis facial recurrente y alternante como primer síntoma de hipertensión arterial sistémica. Recibió tratamiento con esteroides sin previa medición de la tensión arterial, lo cual pudo agravar su cuadro. Debe tenerse en cuenta esta asociación y medir siempre la tensión arterial antes de considerar la terapia con esteroides para la parálisis de Bell. Deben tenerse en cuenta las causas menos comunes de parálisis facial adquirida, especialmente cuando se presentan episodios recurrentes y alternantes.

Bell's palsy is the most common cause of acquired unilateral facial nerve palsy in childhood. Although the diagnosis depends on the exclusion of less common causes such as infectious, traumatic, malignancy associated and hypertension associated etiologies, pediatricians tend to diagnose idiopatic Bell's palsy whenever a child admits with acquired facial weakness. In this report, we present an eight year old girl, presenting with recurrent and alternant facial palsy as the frst symptom of systemic hypertension. She received steroid treatment without measuring blood pressure and this could worsen hypertension. Clinicians should be aware of this association and not neglect to measure the blood pressure before considering steroid therapy for Bell's palsy. In addition, the less common causes of acquired facial palsy should be kept in mind, especially when recurrent and alternant courses occur.

Paralisia facial: quantos tipos clínicos você conhece? Parte II / Facial palsy: how many clinical types do you know? Part II

Em dois manuscritos, os autores comentam aspectos clínicos de 17tipos de paralisia/paresia facial subdivididos em três grupos. Num artigo anterior (parte I), os dois primeiros grupos de paralisias faciais (periféricas e centrais) foram comentados. No presente artigo (parte II), o grupo III (outros tipos de paralisia facial) é abordado. Composto por sete fenótipos clínicos, esse grupo de prosopoplegias abrange desde a paralisia facial congênita, passando pelas paralisias faciais ramusculares e segmentares, até concluir com as paralisias faciais psicogênicas.

In two articles, the authors comment on aspects of seventeen facialparalysis/paresis types subdivided into three groups. The first article (part I) addressed the first two groups of facial paralysis (peripheral and central). At present (part II), group III (other types of facial paralysis) is approached. Composed of seven clinical phenotypes, this group ranges from congenital facial palsy, passing by branches and segmental facial paralysis, and concludes with conversive facial paralysis.

Paralisia facial: quantos tipos clínicos você conhece? Parte I / Facial falsy: how many clinical types do you know? Part I

A presente revisão aborda 17 tipos clínicos de paralisias/paresias faciais divididos em três grupos (grupo I: paralisias faciais periféricas; grupo II: paralisias faciais centrais; grupo III: outros tipos de paralisia facial). Devido à extensão do tema, ele é apresentado em duas partes. Neste primeiro artigo são comentados aspectos clínicos das paralisias faciais periféricas e centrais.

The present review discusses 17 different clinical types of facial paralysis/paresis. They were divided into three groups (group I: peripheral facial paralysis; group II: central facial paralysis; and group III: other types of facial paralysis). Because of the extension of this theme it is presented in two parts. In this first article the peripheral and central facial paralysis are addressed.

Avaliação objetiva computadorizada dos parâmetros normais de contração dos músculos faciais / Objective computorized evaluation of normal patterns of facial muscles contraction

Diferentes métodos criados para a avaliação dos movimentos da musculatura facial variam quanto à subjetividade e confiabilidade. Discute-se a praticidade na utilização na clínica diária ou a precisão para uso em pesquisa científica. OBJETIVO: Obter um padrão de contração dos músculos faciais em indivíduos normais por meio de um método objetivo, o sistema Vicon. MATERIAL E MÉTODO: Em 12 indivíduos, marcadores refletivos foram colocados em pontos de interesse na face. Os movimentos foram capturados por câmeras que enviaram as imagens para um computador. Foram medidos os deslocamentos dos pontos e calculadas as médias e os desvio padrão (DP). RESULTADOS: Ficou demonstrado que, ao sorrir, a variação deverá ser de 6,45 a 12,11 mm, média de 9,28 mm e DP de 2,83; ao enrugar a testa, a variação deverá ser de 6,00 a 13,08 mm, média de 10,57 mm e DP de 2,51; ao movimentar a pálpebra, a variação devera ser de 6,89 a 11,29 mm, média de 9,09 mm e DP de 2,20; ao franzir a testa, a variação deverá ser de 4,26 a 10,85 mm, média de 7,56 mm e DP 3,29. CONCLUSÃO: Foram obtidos os padrões normais de contração dos músculos faciais.

Different methods used to evaluate the movements of the face have many degrees of subjectivity and reliability. The authors discuss the ease of using these methods in clinical practice or their accuracy in scientific research. AIM: To obtain the standard for normal facial muscles movements using an objective method - the Vicon system. MATERIALS AND METHODS: Light reflective markers were placed at points of interest on the face of 12 normal subjects. The movements were captured by cameras that sent the images to a computer. The points' displacements were measured between rest and maximum muscle contraction; and we calculated the means and the standard deviations (SD) were calculated. RESULTS: When smiling, the variation of the oral commissures was between 6.45 and 12.11 mm, mean of 9.28 mm and SD od 2.83; for lifting the eyebrow, it is between 6.0 and 13.08 mm, mean of 10.57 mm and SD of 2.51; for eyelids movement there was a variation of 6.89 and 11.29 mm, with a mean value of 9.09 mm and SD of 2.20; for the movement of wrinkling the forehead, the results showed a variation of 4.16 and 10.85 mm, with a mean value of 7.56 and SD of 3.29. CONCLUSION: The authors obtained normal patterns for facial muscle contraction.