Neurectomía selectiva del nervio facial en el tratamiento de la hipercinesia contralateral en parálisis facial / Selective neurectomy of the facial nerve in the treatment of contralateral hyperkinesia in facial paralysis

Introducción y objetivo: En el abordaje clínico de la parálisis facial periférica existen opciones terapéuticas enfocadas a restaurar la función motora facial, como son las cirugías estáticas y dinámicas; sin embargo, la asimetría facial es un problema persistente. La neurectomía selectiva del nervio facial (NSNF) es una cirugía utilizada recientemente para el manejo de las sincinesias e hipercinesias producidas como secuela en parálisis facial. El objetivo del presente trabajo es analizar los resultados en la mejoría de la asimetría facial de nuestros pacientes sometidos a NSNF para el tratamiento de la hipercinesia contralateral de la parálisis facial mediante la implementación de la escala Sunnybrook Facial Grading Scale (SFGS). Material y método: Estudio prospectivo observacional descriptivo analizando una muestra de 100 pacientes con diagnóstico de parálisis facial periférica atendidos en el Hospital de San José, Bogotá, Colombia. Describimos variables demográficas, y una vez identificados los pacientes sometidos a NSNF, utilizamos la historia clínica para hacer la estadificación de la escala descrita y comparamos los resultados en el pre y postoperatorio. Describimos también la técnica quirúrgica utilizada. Resultados: Evidenciamos una diferencia en la puntuación de la escala SFGS dada por un incremento en la puntuación en 4 pacientes sometidos al procedimiento, con diferencias estadísticamente significativas. Conclusiones: En nuestra experiencia, La NSNF es útil en el manejo de la asimetría facial persistente como secuela de parálisis facial. Nivel de evidencia científica 4c Terapéutico.(AU)

Background and objective: In the clinical approach of the peripheral facial paralysis there are therapeutic options focused on restoring facial motor function, such as static and dynamic surgeries; however, facial asymmetry is a persistent problem. Selective facial nerve neurectomy (SFNN) is a widely used surgery for the management of synkinesias and hyperkinesias as sequelae of pasalysis. Our objective is to analyze the results in the improvement of facial asymmetry of patients undergoing SFNN for the treatment of contralateral hyperkinesia of facial paralysis through the implementation of the Sunnybrook Facial Grading Scale (SFGS). Methods: A prospective observational descriptive study is designed for a sample of 100 patients diagnosed with peripheral facial paralysis treated at the Hospital de San José, Bogotá, Colombia. Demographic variables were described, and once the patients undergoing SFNN were identified, the clinical history is used to carry out the staging of the scale described and the results are compared in the pre and postoperative period. A description of the surgical technique used was made. Results: A difference in the SFGS scale classification score was identified due to an increase in the score in the postoperative period of 4 patients that were treated with SFNN with statistically significant differences. Conclusions: In our experience, SFNN is useful in the management of persistent facial asymmetry as a consequence of facial palsy.Level of evidence 4c Terapeutic.(AU)

[Facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury caused by closed temporal bone fractures].

Objective: To investigate the effectiveness of facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury resulting from closed temporal bone fractures. Methods: Between January 2017 and December 2019, 9 patients with facial nerve injury resulting from closed temporal bone fracture caused by head and face trauma were treated. Among them, 5 patients were treated with facial nerve-sublingual nerve parallel bridge anastomosis (operation group), and 4 patients were treated with neurotrophic drugs combined with rehabilitation exercise (conservative group). There was no significant difference in gender, age, side, cause of injury, duration of facial nerve injury before surgery, House-brackmann grading (hereinafter referred to as HB grading) of facial nerve injury, and other general information between 2 groups ( P>0.05). HB grading was used to evaluate the improvement of facial nerve function before and after treatment. At the same time, facial nerve neuroelectrophysiological test was performed to evaluate the electrical activity of facial muscles before and after treatment. Tongue function, atrophy, and tongue deviation were evaluated after nerve anastomosis according to the tongue function scale proposed by Martins et al. Results: Patients in both groups were followed up 12-30 months, with an average of 25 months. None of the 5 patients in the operation group showed symptoms such as tongue muscle atrophy, tongue extension deviation, hypoglossal nerve dysfunction (mainly including slurred speech, choking with water), postoperative infection, bleeding, lower limb muscle atrophy or lower limb motor dysfunction after sural nerve injury. Postoperative skin sensory disturbance in lateral malleolus area was found, but gradually recovered to normal. During the follow-up, facial nerve and sublingual motor neurons were innervated to paralyzed facial muscle in the operation group. At last follow-up, the HB grading of 5 patients in the operation group improved from preoperative grade Ⅴ in 2 cases, grade Ⅵ in 3 cases to grade Ⅱ in 3 cases, grade Ⅲ in 1 case, and grade Ⅳ in 1 case. And in the conservative group, there were 1 patient with grade Ⅴ and 3 patients with grade Ⅵ before operation, facial asymmetry continued during follow-up, and only 2 patients improved from grade Ⅵ to grade Ⅴ at last follow-up. There was significant difference in prognosis HB grading between the two groups ( t=5.693, P=0.001). In the operation group, the amplitude and frequency of F wave were gradually improved, and obvious action potential could be collected when the facial muscle was vigorously contracted. On the contrary, there was no significant difference in neuroelectrophysiological results before and after treatment in the conservative group. Conclusion: Facial nerve-sublingual nerve parallel bridge anastomosis can effectively retain the integrity of the facial nerve, while introducing the double innervation of the sublingual nerve opposite nerve, which is suitable for the treatment of severe incomplete facial nerve injury caused by closed fracture.

Therapists' perceptions and attitudes in facial palsy rehabilitation therapy: A mixed methods study.

BACKGROUND: Facial palsy rehabilitation therapy plays an essential role in treating facial palsy. PURPOSE: This study aimed to gain insight into therapists' perceptions and attitudes toward facial palsy rehabilitation therapy and to examine whether therapists could be categorized into distinct groups based on these attitudes and perceptions. METHODS: Thirteen semi-structured, in-depth interviews were conducted in a purposive sample of therapists. Interviews were analyzed using thematic analysis. Next, a questionnaire containing questions about therapists' characteristics and perceptions and attitudes toward facial palsy rehabilitation therapy was sent to all facial palsy rehabilitation therapists in the Netherlands and Flanders (n = 292). Latent class analysis (LCA) was performed to identify and analyze distinct groups of therapists. RESULTS: Seven themes were derived from the interviews: treatment goals, therapy content, indications, measurement instruments, factors influencing success, emotional support, and cooperation with colleagues. The questionnaire was filled out by 127 therapists. A 2-group structure consisting of a positive class and a negative class was found to fit the questionnaire data best. No distinction could be made regarding therapists' characteristics. CONCLUSION: Considerable variation in stated treatment practices was present among therapists. Therapists could be classified into 2 groups. This study raises several hypotheses that require further study.

Facial nerve sacrifice in lateral approaches to the skull base: Simultaneous reconstruction by graft interposition.

PURPOSE: To evaluate the outcome of facial nerve (FN) cable graft interposition in lateral skull base surgery. MATERIALS AND METHODS: A group of 16 patients who underwent FN graft interposition procedure was retrospectively considered. Postoperative FN function was evaluated using the House-Brackmann (HB) grading system, the Sunnybrook Facial Grading System (SFGS), the Facial Disability Index (FDI) and the Oral Functioning Scale (OFS) questionnaires. RESULTS: 56.2% of patients had a good postoperative FN outcome (HB grade II-III). Postoperative electromyography (EMG) showed re-innervation potentials in 60% of patients; median age of these patients was significantly lower compared to who did not manifest re-innervation (p = 0.039). CONCLUSION: FN primary reconstruction remains the advisable rehabilitative option when the nerve is interrupted during lateral skull base surgeries, allowing to satisfactory postoperative results in more than half of patients. EMG confirmed the restoring of nerve conduction and it was more frequent in younger patients. The SFGS, the FDI and the OFS are important tools especially in the setting of a rehabilitation program.

Masseteric-Facial Anastomosis: A Report of Three Cases

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

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

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

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

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

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

The research for the function evaluation of facial nerve and the mechanisms of rehabilitation training.

BACKGROUND: Peripheral facial paralysis (PFP) is a common peripheral neural disease. Acupuncture treatment combined with PFP rehabilitation exercises is a routine method of PFP treatment. This article is to provide a new visual and objective evaluation method for exploring the mechanism and efficacy of acupuncture treatment on PFP, and develop an interactive augmented facial nerve function rehabilitation training system with multiple training models. METHODS: This prospective and observational trial will recruit 200 eligible participants for the following study. In the trial, the laser speckle contrast analysis (LASCA) technology will be applied to monitor the microcirculation of facial blood flow during acupuncture, and real-time monitoring algorithms, data sampling, and digital imaging methods will be conducted by machine learning and image segmentation. Then, a database of patient facial expressions will be built, the correlation between surface blood flow perfusion volume and facial structure symmetry will be analyzed, combined with scale assessment and electrophysiological detection. In addition, we will also explore the objectivity and effectiveness of LASCA in the evaluation of facial paralysis (FP), and the changes in blood flow microcirculation before and after acupuncture treatment will be analyzed. RESULTS: The standard image of the facial target area with facial nerve injury will be manually segmented by the convolutional neural network method. The blood flow images of the eyelid, cheek, and mandible of the patients' affected and healthy side will be compared and evaluated. Laser speckle blood flow symmetry Pr and its changes in FP condition evolution and prognosis outcome will be measured, and relevant characteristic signals values will be extracted. Finally, COX regression analysis method is conducted to establish a higher accuracy prediction model of FP with cross-validation based on laser speckle blood flow imaging technology. CONCLUSIONS: We use modern interdisciplinary high-tech technologies to explore the mechanism of acupuncture rehabilitation training in PFP. And we will provide evidence for the feasibility of using the LASCA technique as a typing diagnosis of FP in the acupuncture rehabilitation treatment of PFP. REGISTRATION NUMBER: ChiCTR1800019463.

A New Neurorehabilitative Postsurgery Intervention for Facial Palsy Based on Smile Observation and Hand-Mouth Motor Synergies.

Objective: To perform a preliminary test of a new rehabilitation treatment (FIT-SAT), based on mirror mechanisms, for gracile muscles after smile surgery. Method: A pre- and postsurgery longitudinal design was adopted to study the efficacy of FIT-SAT. Four patients with bilateral facial nerve paralysis (Moebius syndrome) were included. They underwent two surgeries with free muscle transfers, one year apart from each other. The side of the face first operated on was rehabilitated with the traditional treatment, while the second side was rehabilitated with FIT-SAT. The FIT-SAT treatment includes video clips of an actor performing a unilateral or a bilateral smile to be imitated (FIT condition). In addition to this, while smiling, the participants close their hand in order to exploit the overlapped cortical motor representation of the hand and the mouth, which may facilitate the synergistic activity of the two effectors during the early phases of recruitment of the transplanted muscles (SAT). The treatment was also aimed at avoiding undesired movements such as teeth grinding. Discussion. Results support FIT-SAT as a viable alternative for smile rehabilitation after free muscle transfer. We propose that the treatment potentiates the effect of smile observation by activating the same neural structures responsible for the execution of the smile and therefore by facilitating its production. Closing of the hand induces cortical recruitment of hand motor neurons, recruiting the transplanted muscles, and reducing the risk of associating other unwanted movements such as teeth clenching to the smile movements.

Quantitative analysis of movements in facial nerve palsy with surface electromyography and kinematic analysis.

Facial nerve paralysis (FNP) has a significant effect on a person's quality of life. In individuals with FNP undergoing facial rehabilitation, methods to analyze the loss of function are useful in diagnosis, treatment and follow up. To propose a protocol with kinematic analysis coupled with sEMG to evaluate the outcomes of FNP, quantifying the excursion degrees of the facial muscles and symmetry of voluntary movements. 10 patients (Group A) were followed by diagnosis until the end of the rehabilitation program. Kinematic analysis of 20 healthy adults (group B) was performed as a starting point to have a normality range and to test intra-subject and inter- intra rater reliability. An optoelectronic system and sEMG wireless electrodes were used. In Group A, a significant improvement in the movement of frontalis muscle (P = 0.0118) after 4-week treatment from the beginning (T0) 9.8 ± 4.5 mm to the end of rehabilitation (T1) 16.3 ± 5.8 mm and orbicularis oris (P = 0.0143) from T0 14.8 ± 5.5 mm to T1 20.3 ± 3.3 mm and, a reduction of % of maximum voluntary contractions (MVC) at T1 for frontalis and orbicularis compared to T0. This protocol provides meaningful data in a simple, reliable and objective way for the functional assessment of patients with PNF.

Motor Relearning After Hypoglossal-Facial Nerve Anastomosis.

ABSTRACT: Facial paralysis is a clinical condition associated with significant functional and psychosocial morbidity (Facial Plast Surg FPS. 2011;27(4):346-57). The management paradigm for this condition continues to evolve with the use of both surgical and nonsurgical strategies (Facial Plast Surg FPS. 2011;27(4):346-57). Hypoglossal-facial nerve anastomosis is a surgical technique whereby the hypoglossal nerve acts as a donor motor nerve to restore facial muscle reinnervation via movements of the tongue (Plast Reconstr Surg. 1979;63(1):63-72). This case describes a 33-yr-old woman with unilateral facial paralysis who underwent hypoglossal-facial nerve anastomosis and 14 wks of postoperative rehabilitation. This report highlights the details of her rehabilitation regimen including the specific techniques used to enhance motor relearning of facial expression through movement of the tongue.

Efectividad del tratamiento rehabilitador combinado de láser y magneto en pacientes con parálisis facial periférica / Effectiveness of combined laser and magneto rehabilitation treatment in patients with peripheral facial paralysis

La parálisis facial periférica es una afectación neurológica muy frecuente y en la mayor parte de los casos no se llega a establecer una etiología precisa, denominándolas idiopáticas o parálisis facial de Bell. Se realizó el estudio con el objetivo de evaluar la efectividad del tratamiento rehabilitador combinado de láser y magneto en pacientes con parálisis facial periférica. Se realizó un estudio cuasi-experimental modalidad antes y después sin grupo control, en 37 pacientes con parálisis facial periférica que acudieron a Consulta de Fisiatría del Policlínico “Máximo Gómez Báez” del municipio Río Cauto en el período de enero de 2017 a enero de 2019. Se estudió la comorbilidad de la parálisis facial periférica con otras enfermedades crónicas e infecciosas, resultando que el herpes simple y la otitis fueron las más significativas para un 40,54 y 24,32 por ciento respectivamente; no se tuvieron complicaciones durante la terapia combinada en el 83,78 por ciento; el nivel de severidad fue normal (83,78 por ciento), leve (13,51 por ciento) y moderado (2,70 por ciento); el tratamiento fue efectivo en el 83,78 por ciento de los pacientes. Se concluye que el tratamiento rehabilitador combinado de láser y magneto en pacientes con parálisis facial periférica es efectivo(AU)

Peripheral facial paralysis is a very frequent neurological affectation and in most cases it is not possible to establish an accurate etiology, calling them idiopathic or Bell's facial paralysis. The study was conducted with the objective of evaluating the effectiveness of combined laser and magneto rehabilitation treatment in patients with peripheral facial paralysis. We performed a quasi-experimental modality before and after without a control group in 37 patients with peripheral facial paralysis who attended the Physiatry Consultation of the "Máximo Gómez Báez" Polyclinic in the municipality of Río Cauto from January 2017 to January 2019 The comorbidity of peripheral facial paralysis with other chronic and infectious diseases was studied, resulting that herpes simplex and otitis were the most significant for 40,54 and 24,32 percent respectively; there were no complications during the combined therapy in 83,78 percent; the level of severity was normal (83,78 percent), mild (13,51 percent) and moderate (2,70 percent); the treatment was effective in 83,78 percent of the patients. It is concluded that the combined rehabilitation treatment of laser and magneto in patients with peripheral facial paralysis is effective(EU)

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

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

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

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

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

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

Encuesta de satisfacción del paciente con secuelas de parálisis facial periférica en tratamiento con toxina botulínica A / Satisfaction survey of patients with sequels of peripheral facial palsy treated with botulinum toxin A

INTRODUCCIÓN: El tratamiento de la parálisis facial periférica con toxina botulínica es seguro y eficaz. Si bien es conocido su impacto beneficioso sobre la calidad de vida de los pacientes, hasta ahora no se ha estudiado específicamente su percepción subjetiva. Nuestro objetivo ha sido conocer los resultados del tratamiento con toxina botulínica centrándonos en la opinión del paciente. PACIENTES Y MÉTODOS: Estudio prospectivo realizado en una muestra aleatoria de pacientes con secuelas de parálisis facial periférica, que estaban siendo tratados con toxina botulínica en el Servicio de Medicina Física y Rehabilitación de nuestro hospital. Creamos un cuestionario sencillo para evaluar tanto la satisfacción como la percepción subjetiva de mejoría después del tratamiento con toxina botulínica. RESULTADOS: Después de la infiltración, el 95% de los pacientes se sentía bien o muy bien. Más del 80% de ellos notó mejoría respecto a la sensación de tirantez en la mejilla y el cuello. Alrededor de 3/4 partes de los pacientes percibieron mejoría en el rango de movilidad voluntaria y en aproximadamente el 80% mejoraron las sincinesias. Casi todos ellos volverían a tratarse si se les propusiera de nuevo y el 100% recomendaría la infiltración con toxina botulínica a otros pacientes con parálisis facial. CONCLUSIONES: El tratamiento con toxina botulínica proporciona una mejora subjetiva importante en los pacientes con secuelas de parálisis facial periférica, tanto en reposo como respecto al control de sincinesias. El grado de satisfacción es superior a 8/10 en el 99% de los pacientes estudiados

INTRODUCTION: Treatment of peripheral facial palsy with botulinum toxin A is safe and effective. Although its beneficial impact on patients' quality of life is known, to date, there have been no studies specifically analysing patients' subjective perceptions. PATIENTS AND METHOD: We performed a prospective study in a random sample of patients with sequels of peripheral facial palsy treated with botulinum toxin in the Physical Medicine and Rehabilitation Service of our hospital. We created a simple questionnaire to assess both patient satisfaction and subjective perception of improvement after botulinum toxin treatment. RESULTS: After infiltration, 95% of the patients felt good or very good. More than 80% noted improvement in the sensation of tightness in the cheek and neck. Around 75% of patients perceived an improvement in the range of voluntary movement and approximately 80% reported improvement in synkinesis. Almost all the patients would repeat the treatment, if proposed, and 100% would recommend botulinum toxin infiltration to other patients with facial palsy. CONCLUSIONS: Patients treated with botulinum toxin experience substantial subjective improvement in the sequels of peripheral facial palsy, both in repose and in the control of synkinesis. Satisfaction was higher than 8/10 in 99% of patients in this study

Physical Therapy for Iatrogenic Facial Paralysis: A Systematic Review.

Importance: Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the expectation of facial function recovery. A potential treatment is physical therapy (PT). Objective: To investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP. Evidence Review: Patients with noniatrogenic FP, facial reanimation surgery, and invasive adjunctive treatments (acupuncture or botulinum toxin injection) were excluded. A systematic review was conducted for records discussing iatrogenic FP and PT; a search for these records was performed using Ovid MEDLINE (1946-2019), Embase (1947-2019), Scopus (1823-2019), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform (2004-2019), and ClinicalTrials.gov (1997-2019). The references of all the included articles were also assessed for eligible studies. All human participant, English-language study designs with at least 2 cases were included. Quality assessment was performed using the Methodological Index for Non-randomized Studies (MINORS) and the revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. All search strategies were completed on May 16, 2019, and again on October 1, 2019. Findings: Fifteen studies (7 of which were retrospective cohort studies) and 313 patients with iatrogenic FP were included in the systematic review. Most iatrogenic FP (166 patients [53%]) was associated with parotidectomy; traditional PT (ie, facial massage) was the most common intervention (196 patients [63%]). The use of various facial grading systems and inconsistent reporting of outcomes prevented direct comparison of PT types. Conclusions and Relevance: Because of heterogeneity in reported outcomes of facial nerve recovery, definitive conclusions were unable to be made regarding the association between PT and outcomes of iatrogenic FP. Physical therapy probably has benefit and is associated with no harm in patients with iatrogenic FP.

Raising the Digital Profile of Facial Palsy: National Surveys of Patients' and Clinicians' Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology.

BACKGROUND: Facial nerve palsy leaves people unable to move muscles on the affected side of their face. Challenges exist in patients accessing facial neuromuscular retraining (NMR), a therapy used to strengthen muscle and improve nerve function. Access to therapy could potentially be improved through the use of digital technology. However, there is limited research available on patients' and clinicians' views about the potential benefits of such telerehabilitation based on their lived experiences of treatment pathways. OBJECTIVE: This study aims to gather information about facial palsy treatment pathways in the United Kingdom, barriers to accessing NMR, factors influencing patient adherence, measures used to monitor recovery, and the potential value of emerging wearable digital technology. METHODS: Separate surveys of patients with facial palsy and facial therapy specialists were conducted. Questionnaires explored treatment pathways and views on telerehabilitation, were co-designed with users, and followed a similar format to enable cross-referencing of responses. A follow-up survey of national specialists investigated methods used to monitor recovery in greater detail. Analysis of quantitative data was conducted allowing for data distribution. Open-text responses were analyzed using thematic content analysis. RESULTS: A total of 216 patients with facial palsy and 25 specialist therapists completed the national surveys. Significant variations were observed in individual treatment pathways. Patients reported an average of 3.27 (SD 1.60) different treatments provided by various specialists, but multidisciplinary team reviews were rare. For patients diagnosed most recently, there was evidence of more rapid initial prescribing of corticosteroids (prednisolone) and earlier referral for NMR therapy. Barriers to NMR referral included difficulties accessing funding, shortage of specialist therapists, and limited awareness of NMR among general practitioners. Patients traveled long distances to reach an NMR specialist center; 9% (8/93) of adults reported traveling ≥115 miles. The thematic content analysis demonstrates positive attitudes to the introduction of digital technology, with similar incentives and barriers identified by both patients and clinicians. The follow-up survey of 28 specialists uncovered variations in the measures currently used to monitor recovery and no agreed definitions of a clinically significant change for any of these. The main barriers to NMR adherence identified by patients and therapists could all be addressed by using suitable real-time digital technology. CONCLUSIONS: The study findings provide valuable information on facial palsy treatment pathways and views on the future introduction of digital technology. Possible ways in which emerging sensor-based digital technology can improve rehabilitation and provide more rigorous evidence on effectiveness are described. It is suggested that one legacy of the COVID-19 pandemic will be lower organizational barriers to this introduction of digital technology to assist NMR delivery, especially if cost-effectiveness can be demonstrated.

Development of a smartphone app for neuromuscular facial training.

BACKGROUND: Several studies have demonstrated a significant benefit of neuromuscular facial training in the rehabilitation of patients with facial palsy. However, printed instructions for home training are often not of optimum quality and associated with low adherence to therapy. Professional guidance, e.g., by occupational therapists, is regarded as being of high quality, but is associated with a high cost burden, particularly in chronic forms of disease. OBJECTIVE: The idea to develop a smartphone app for facial training arose from the above-described situation. The aim was to provide structured exercises for the mimic muscles in the sense of neuromuscular training with visual feedback via the front camera of the device. MATERIALS AND METHODS: A native app architecture in iOS was chosen to implement the graphical and content-related concept. In the Apple Xcode (Apple, Cupertino, CA, US) development environment, the app's code was written in the Swift programming language (Apple) and the graphical user interface was created. RESULTS: An app prototype was implemented that provides step-by-step instructions on selected mimic exercises via animated smileys. The duration and speed of the exercise can be varied within a limited range. In the development environment, the correct functionality of both physical and virtual devices was successfully tested. CONCLUSION: App-based facial training offers attractive opportunities to motivate patients for improved adherence to treatment, which could hypothetically lead to a better outcome. Evaluation of this question is planned in a clinical trial after completion of the development.

Using Eye Aspect Ratio to Enhance Fast and Objective Assessment of Facial Paralysis.

A rapid and objective assessment of the severity of facial paralysis allows rehabilitation physicians to choose the optimal rehabilitation treatment regimen for their patients. In this study, patients with facial paralysis were enrolled as study objects, and the eye aspect ratio (EAR) index was proposed for the eye region. The correlation between EAR and the facial nerve grading system 2.0 (FNGS 2.0) score was analyzed to verify the ability of EAR to enhance FNGS 2.0 for the rapid and objective assessment of the severity of the facial paralysis. Firstly, in order to accurately calculate the EAR, we constructed a landmark detection model based on the face images of facial paralysis patients (FP-FLDM). Evaluation results showed that the error rate of facial feature point detection in patients with facial paralysis of FP-FLDM is 17.1%, which was significantly superior to the landmark detection model based on normal face images (NF-FLDM). Secondly, in this study, the Fréchet distance was used to calculate the difference in bilateral EAR of facial paralysis patients and to verify the correlation between this difference and the corresponding FNGS 2.0 score. The results showed that the higher the FNGS 2.0 score , the greater the difference in bilateral EAR. The correlation coefficient between the bilateral EAR difference and the corresponding FNGS 2.0 score was 0.9673, indicating a high correlation. Finally, through a 10-fold crossvalidation, we can know that the accuracy of scoring the eyes of patients with facial paralysis using EAR was 85.7%, which can be used to enhance the objective and rapid assessment of the severity of facial paralysis by FNGS 2.0.