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1.
NeuroRehabilitation ; 54(2): 259-273, 2024.
Article in English | MEDLINE | ID: mdl-38306064

ABSTRACT

BACKGROUND: Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients. OBJECTIVE: To assess rehabilitation outcomes concerning patients with post-parotidectomy facial nerve dysfunction, comparing benign versus malignant neoplasms. METHODS: Prospective study enrolling adults who underwent parotidectomy with facial nerve sparing between 2016 and 2020. The Modified Sunnybrook System (mS-FGS) was used for facial assessments. Physiotherapy began on the first post-operative day with a tailored program of facial exercises based on Neuromuscular Retraining, to be performed at home 3 times/day. From the first outpatient consultation, Proprioceptive Neuromuscular Facilitation was added to the treatment of cases with moderate or severe facial dysfunctions. RESULTS: Benign and malignant groups had a statistically significant improvement in mS-FGS (p < 0.001 and p = 0.005, respectively). There was no significant difference between groups regarding treatment duration or number of physiotherapy sessions performed. The history of previous parotidectomy resulted in more severe initial dysfunctions and worse outcome. Age over 60 years and initially more severe dysfunctions impacted the outcome. CONCLUSION: Patients with benign and malignant parotid neoplasms had significant and equivalent improvement in postoperative facial dysfunction following an early tailored physiotherapy program, with no significant difference in the final facial score, treatment duration, or number of sessions required.


Subject(s)
Facial Paralysis , Parotid Neoplasms , Adult , Humans , Middle Aged , Facial Nerve/surgery , Parotid Gland/surgery , Prospective Studies , Postoperative Complications , Parotid Neoplasms/surgery , Retrospective Studies
2.
Arq Neuropsiquiatr ; 81(11): 970-979, 2023 Nov.
Article in English | MEDLINE | ID: mdl-38035582

ABSTRACT

BACKGROUND: Facial nerve dysfunction is the principal postoperative complication related to parotidectomy. OBJECTIVE: To test the hypothesis that the modified Sunnybrook Facial Grading System (mS-FGS) is superior to the original S-FGS in the assessment of facial nerve function following parotidectomy. METHODS: Prospective, longitudinal study evaluating patients with primary or metastatic parotid neoplasms undergoing parotidectomy with facial nerve-sparing between 2016 and 2020. The subjects were assessed twice, on the first postoperative day and at the first outpatient evaluation, 20-30 days post-surgery. Facial assessments were performed using the original and modified (plus showing the lower teeth) versions of the Sunnybrook System and documented by pictures and video recordings. Intra- and inter-rater agreements regarding the assessment of the new expression were analyzed. RESULTS: 101 patients were enrolled. In both steps, the results from the mS-FGS were significantly lower (p < 0.001). Subjects with a history of previous parotidectomy and those who underwent neck dissection had more severe facial nerve impairment. The mandibular marginal branch was the most frequently injured, affecting 68.3% of the patients on the first postoperative day and 52.5% on the first outpatient evaluation. Twenty patients (19.8%) presented an exclusive marginal mandibular branch lesion. The inter-rater agreement of the new expression assessment ranged from substantial to almost perfect. The intra-rater agreement was almost perfect (wk = 0.951). CONCLUSION: The adoption of the Modified Sunnybrook System, which includes evaluation of the mandibular marginal branch, increases the accuracy of post-parotidectomy facial nerve dysfunction appraisal.


ANTECEDENTES: A disfunção do nervo facial é a principal complicação pós-operatória relacionada à parotidectomia. OBJETIVO: Testar a hipótese de que o sistema Sunnybrook de graduação facial modificado (mS-FGS) é superior ao S-FGS original na avaliação da função do nervo facial após parotidectomia. MéTODOS:: Estudo longitudinal prospectivo avaliando o pós-operatório de pacientes com neoplasias parotídeas primárias ou metastáticas, submetidos à parotidectomia com preservação do nervo facial, entre 2016 e 2020. Os indivíduos foram avaliados duas vezes, no primeiro dia de pós-operatório e na primeira avaliação ambulatorial, 20-30 dias após a cirurgia. As avaliações faciais foram realizadas usando as versões original e modificada (que incluem mostrar os dentes inferiores) do sistema Sunnybrook e documentadas por fotos e vídeos. Foram adicionalmente analisadas as concordâncias intra e interexaminadoras da avaliação da nova expressão. RESULTADOS: Cento e um pacientes foram incluídos. Em ambas as etapas, os resultados do mS-FGS foram significativamente menores (p < 0,001). Indivíduos com história de parotidectomia prévia e aqueles submetidos ao esvaziamento cervical apresentaram comprometimento mais grave do nervo facial. O ramo marginal mandibular foi o mais afetado, acometendo 68,3% dos pacientes no primeiro dia de pós-operatório e 52,5% na primeira avaliação ambulatorial. Vinte pacientes (19,8%) apresentaram lesão exclusiva do ramo marginal mandibular. A concordância interexaminadores da avaliação da nova expressão variou de substancial a quase perfeita. A concordância intraexaminador foi quase perfeita (wk = 0,951). CONCLUSãO:: A adoção do sistema Sunnybrook modificado, que inclui a análise do ramo marginal mandibular, aumenta a precisão da avaliação da disfunção do nervo facial pós-parotidectomia.


Subject(s)
Facial Paralysis , Parotid Neoplasms , Humans , Facial Nerve/surgery , Parotid Gland/surgery , Prospective Studies , Longitudinal Studies , Parotid Neoplasms/surgery , Postoperative Complications , Facial Paralysis/etiology , Retrospective Studies
3.
Arq. neuropsiquiatr ; Arq. neuropsiquiatr;81(11): 970-979, Nov. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1527885

ABSTRACT

Abstract Background: Facial nerve dysfunction is the principal postoperative complication related to parotidectomy. Objective: To test the hypothesis that the modified Sunnybrook Facial Grading System (mS-FGS) is superior to the original S-FGS in the assessment of facial nerve function following parotidectomy. Methods: Prospective, longitudinal study evaluating patients with primary or metastatic parotid neoplasms undergoing parotidectomy with facial nerve-sparing between 2016 and 2020. The subjects were assessed twice, on the first postoperative day and at the first outpatient evaluation, 20-30 days post-surgery. Facial assessments were performed using the original and modified (plus showing the lower teeth) versions of the Sunnybrook System and documented by pictures and video recordings. Intra- and inter-rater agreements regarding the assessment of the new expression were analyzed. Results: 101 patients were enrolled. In both steps, the results from the mS-FGS were significantly lower (p < 0.001). Subjects with a history of previous parotidectomy and those who underwent neck dissection had more severe facial nerve impairment. The mandibular marginal branch was the most frequently injured, affecting 68.3% of the patients on the first postoperative day and 52.5% on the first outpatient evaluation. Twenty patients (19.8%) presented an exclusive marginal mandibular branch lesion. The inter-rater agreement of the new expression assessment ranged from substantial to almost perfect. The intra-rater agreement was almost perfect (wk = 0.951). Conclusion: The adoption of the Modified Sunnybrook System, which includes evaluation of the mandibular marginal branch, increases the accuracy of post-parotidectomy facial nerve dysfunction appraisal.


Resumo Antecedentes: A disfunção do nervo facial é a principal complicação pós-operatória relacionada à parotidectomia. Objetivo: Testar a hipótese de que o sistema Sunnybrook de graduação facial modificado (mS-FGS) é superior ao S-FGS original na avaliação da função do nervo facial após parotidectomia. Métodos: Estudo longitudinal prospectivo avaliando o pós-operatório de pacientes com neoplasias parotídeas primárias ou metastáticas, submetidos à parotidectomia com preservação do nervo facial, entre 2016 e 2020. Os indivíduos foram avaliados duas vezes, no primeiro dia de pós-operatório e na primeira avaliação ambulatorial, 20-30 dias após a cirurgia. As avaliações faciais foram realizadas usando as versões original e modificada (que incluem mostrar os dentes inferiores) do sistema Sunnybrook e documentadas por fotos e vídeos. Foram adicionalmente analisadas as concordâncias intra e interexaminadoras da avaliação da nova expressão. Resultados: Cento e um pacientes foram incluídos. Em ambas as etapas, os resultados do mS-FGS foram significativamente menores (p < 0,001). Indivíduos com história de parotidectomia prévia e aqueles submetidos ao esvaziamento cervical apresentaram comprometimento mais grave do nervo facial. O ramo marginal mandibular foi o mais afetado, acometendo 68,3% dos pacientes no primeiro dia de pós-operatório e 52,5% na primeira avaliação ambulatorial. Vinte pacientes (19,8%) apresentaram lesão exclusiva do ramo marginal mandibular. A concordância interexaminadores da avaliação da nova expressão variou de substancial a quase perfeita. A concordância intraexaminador foi quase perfeita (wk = 0,951). Conclusão: A adoção do sistema Sunnybrook modificado, que inclui a análise do ramo marginal mandibular, aumenta a precisão da avaliação da disfunção do nervo facial pós-parotidectomia.

4.
Arq Neuropsiquiatr ; 77(7): 460-469, 2019 07 29.
Article in English | MEDLINE | ID: mdl-31365637

ABSTRACT

OBJECTIVE: Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. METHODS: We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. RESULTS: The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. CONCLUSION: The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.


Subject(s)
Facial Nerve Injuries/diagnosis , Facial Nerve/surgery , Parotid Neoplasms/surgery , Skin Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Facial Nerve/physiopathology , Facial Nerve Injuries/etiology , Facial Nerve Injuries/physiopathology , Facial Nerve Injuries/surgery , Facial Paralysis/etiology , Facial Paralysis/physiopathology , Female , Humans , Male , Middle Aged , Parotid Gland/surgery , Parotid Neoplasms/physiopathology , Patient Outcome Assessment , Postoperative Complications , Retrospective Studies , Skin Neoplasms/physiopathology , Surgical Procedures, Operative/methods , Surveys and Questionnaires , Young Adult
5.
Arq. neuropsiquiatr ; Arq. neuropsiquiatr;77(7): 460-469, July 2019. tab, graf
Article in English | LILACS | ID: biblio-1011372

ABSTRACT

ABSTRACT Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. Objective To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. Methods We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. Results The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. Conclusion The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.


RESUMO A lesão do nervo facial é a principal complicação neurológica relacionada às parotidectomias e, em geral, o ramo marginal mandibular é o mais frequentemente acometido. Objetivo Testar um Sistema Sunnybrook de Graduação Facial modificado (mS-FGS) como uma nova ferramenta para avaliar a função do nervo facial após a parotidectomia, enfatizando o ramo marginal mandibular. Métodos Estudo retrospectivo, baseado em prontuários de 73 casos (40 do sexo feminino, 18-84 anos, idade média = 53,2), submetidos à parotidectomia, com preservação do nervo facial. Todos os pacientes apresentavam neoplasias parotídeas ou câncer de pele avançado, e foram tratados pela autora principal entre 2006 e 2014. Resultados Neste estudo, os músculos inervados pelo ramo marginal mandibular foram os mais acometidos (72,6% dos casos), principalmente nos pacientes que realizaram esvaziamento cervical (p = 0,023). Os Escores de Movimento Voluntário obtidos pelo sistema modificado foram inferiores aos obtidos pelo original (p < 0,001). As melhores pontuações foram observadas em pacientes com tumores benignos parotídeos e os piores resultados, naqueles com câncer de pele. Pacientes que necessitaram de esvaziamento cervical e ressecção de outras estruturas, além da parótida, apresentaram escores menores (p = 0,031 e p = 0,021), evidenciados apenas pelo sistema modificado. Os tumores malignos geraram escores significativamente menores, independentemente do instrumento empregado. A análise pós fisioterapia envolveu 50 casos. Os piores resultados, após a intervenção fisioterapêutica, também foram observados nos músculos inervados pelo ramo marginal mandibular. Conclusão A avaliação da disfunção facial pós-parotidectomia, através do Sistema Sunnybrook com a modificação proposta permitiu uma apreciação mais detalhada do ramo marginal mandibular, sem prejuízo à avaliação dos demais ramos.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Skin Neoplasms/surgery , Parotid Neoplasms/surgery , Facial Nerve Injuries/diagnosis , Facial Nerve/surgery , Parotid Gland/surgery , Postoperative Complications , Skin Neoplasms/physiopathology , Surgical Procedures, Operative/methods , Parotid Neoplasms/physiopathology , Surveys and Questionnaires , Retrospective Studies , Facial Nerve Injuries/surgery , Facial Nerve Injuries/etiology , Facial Nerve Injuries/physiopathology , Facial Nerve/physiopathology , Facial Paralysis/etiology , Facial Paralysis/physiopathology , Patient Outcome Assessment
6.
Rev. bras. neurol ; 45(2): 21-24, abr.-jun. 2009. ilus
Article in Portuguese | LILACS | ID: lil-518011

ABSTRACT

Idosos com déficit visual por vezes apresentam alucinações visuais relacionadas à síndrome de Charles Bonnet. O surgimento destas alucinoses frequentemente causa ansiedade ao paciente e gera dificuldade diagnóstica e de conduta. Neste artigo descrevemos o caso de uma senhora de 82 anos de idade que se queixou de alucinações visuais complexas e revimos a literatura a respeito da síndrome de Charles Bonnet; condição que promove alucinação visual em pessoas mentalmente saudáveis.


Visually handicapped elderly people sometimes experience visual hallucinations associated with Charles Bonnet syndrome. The appearance of these hallucinosis often causes anxiety to the sufferer and can be difficult for the diagnosis and management. In this article, we report an 82-year-old woman that suddenly complained of complex visual hallucinations, and review the literature on the Charles Bonnet syndrome, a condition involving visual hallucinations in a mentally normal person.


Subject(s)
Humans , Female , Aged, 80 and over , Vision Disorders/diagnosis , Vision, Low , Fantasy , Charles Bonnet Syndrome/diagnosis , Hallucinations/etiology , Magnetic Resonance Imaging
7.
Rev. bras. neurol ; 43(1): 5-11, jan.-mar. 2007. ilus
Article in Portuguese | LILACS | ID: lil-513274

ABSTRACT

Os autores comentam o artigo de Alisdair McNeill a respeito de como evoluiu o exame neurológico ao longo do século XX, e ressaltam alguns sinais simples de serem executados e fáceis de serem interpretados, considerando a importânica de avaliar a sensibilidade dos mesmos.


Subject(s)
Neurologic Examination/trends , Signs and Symptoms
8.
Arq. neuropsiquiatr ; Arq. neuropsiquiatr;50(4): 519-22, dez. 1992. ilus, tab
Article in English | LILACS | ID: lil-122003

ABSTRACT

Os autores descrevem um caso de calcificaçäo encefálica difusa primária, näo familial, cuja primeira manifestaçäo fois disartria. Posteriormente, desenvolveu movimentos coreoatetósicos em mäos e face, discalculia e déficit de memória. A TC de crânio revelou calcificaçöes em hemisférios cerebrais e tranco cerebral


Subject(s)
Humans , Male , Middle Aged , Basal Ganglia Diseases , Calcinosis , Brain Diseases , Tomography, X-Ray Computed
10.
Rev. bras. neurol ; 25(2): 55-60, mar.-abr. 1989. ilus
Article in Portuguese | LILACS | ID: lil-72361

ABSTRACT

Os autores relatam um caso esporádico de Síndrome de keams-Sayre, iniciado aos 11 anos de idade. O paciente sofreu TCE fechado, acompanhado de alteraçäo da consciência, com recuperaçäo graudal em dois meses. Notou-se entäo: disfasia mista, incoordenaçäo motora do tipo cerebral, disfagia e ptose, sem diplopia. Ao exame havia ainda baixa estatura, pé cavo, cifoescoliose, oftalmoplegia extrínseca completa e amiotrofia generalizada. A análise do LCR em duas amostras colhidas mostrou xantocromia e hiperproteinorraquia. A retinografia evidenciou degeneraçäo pigmentar atípica. O eletrocardiograma revelou bloqueio bifascicular (BRD 2§ graus e HBS). A tomografia axial de crânio mostrou atrofia cerebral de predomínio frontal e cerebelar. A biópsia muscular, com estudo histoquímico e por microscopia eletrônica, evidenciou acúmulo subsarcolemal e intermiofibrilar de mitocôndrias de tamanho e morfologia alterados, achados estes, sugestivos de ragged-red cells. Os autores sugerem que a rápida evoluçäo do caso apresentado relaciona-se com o desenvolvimento de degeneraçäo espongiosa predominando na substância branca hemisférica, mas também detectada no tronco cerebral, núcleos da base e cerebelo. Esta rápida evoluçäo clínica é reconhecidamente comum na Síndrome de Kearns-Sayre de início na infância


Subject(s)
Child , Humans , Male , Kearns-Sayre Syndrome
11.
Rev. bras. neurol ; 24(6): 151-3, nov.-dez. 1988.
Article in Portuguese | LILACS | ID: lil-72366

ABSTRACT

O autor se propöe lembrar que pela utilizaçäo de peculiaridades do exame neurológico podemos distinguir algumas alteraçöes histéricas das orgânicas, ressaltando para tal a pesquisa dos movimentos associados


Subject(s)
Hysteria/diagnosis , Neurologic Examination
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