Facial Exercises Research Articles

Efficacy of high and low level laser therapy in the treatment of Bell's palsy: A randomized double blind placebo-controlled trial

The aim of the present study was to investigate and compare the effects of high intensity laser therapy (HILT) and low level laser therapy (LLLT) on the treatment of patients with Bell's palsy. Forty-eight patients participated in and completed this study. The mean age was 43 ± 9.8 years. They were randomly assigned into three groups: HILT group, LLLT group, and exercise group. All patients were treated with facial massage and exercises, but the HILT and LLLT groups received the respective laser therapy. The grade of facial recovery was assessed by the facial disability scale (FDI) and the House-Brackmann scale (HBS). Evaluation was carried out 3 and 6 weeks after treatment for all patients. Laser treatments included eight points on the affected side of the face three times a week for 6 successive weeks. FDI and HBS were used to assess the grade of recovery. The scores of both FDI and HBS were taken before as well as 3 and 6 weeks after treatment. The Friedman test and Wilcoxon signed ranks test were used to compare the FDI and HBS scores within each group. The result showed that both HILT and LLLT significantly improved the recovery of patients with Bell's palsy. Moreover, HILT was the most effective treatment modality compared to LLLT and massage with exercises. Thus, both HILT and LLLT are effective physical therapy modalities for the recovery of patients with Bell's palsy, with HILT showing a slightly greater improvement than LLLT.

Zonal Analysis of Facial Asymmetry and Its Clinical Significance in Facial Plastic Surgery

To describe common patterns of facial asymmetry and to augment the facial analysis paradigm for improved preoperative counseling and surgical planning. We conducted a frontal photographic analysis of 50 patients who were seeking various types of facial cosmetic surgical procedures. The horizontal zonal thirds of the face were analyzed, and the bilateral data points were compared in regard to brow height, width of midface at maximum distance, malar eminence height,nasal alar height, and mandible width measured from the oral commissure to the gonial angle. Forty-five patients demonstrated measurable asymmetry of the midface. The malar eminence was found to be more superiorly positioned and defined on the narrower side of the face in all cases. In contrast, the contralateral wider side of the face appeared flatter, with a more hypoplastic, inferiorly positioned malar eminence.Also, the wider side of the face more often demonstrated a wider mandibular dimension and a superiorly displaced ala. The upper third of the face, in regard to brow height, was the most variable and showed little correlation to the lower two-thirds of the face. This facial analysis exercise can assist the surgeon in (1) preoperative counseling, (2) managing expectations,(3) choosing appropriate-sized implants for improved symmetry, and (4) offering a more detailed assessment during the counseling of patients before faceliftsurgery

Efficacy of Taping in Bell's Palsy

Objectives: To study &compare the efficacy of taping protocol/Technique over Conventional treatment technique protocol in Bells Palsy. Materials and Method: The study was conducted on 30 subjects. Subjects were divided into two groups. One group was given Electrical stimulation and exercises and other group was given electrical stimulation , facial exercises and taping. Results- There exists significant difference between post-treatment scores of both the groups. The study concluded that the treatment of Es+facial exercise+tapping is effective in curing bell's palsy Conclusion: Group B protocol is more effective for functional retraining than conventional treatment in subjects with Bells Palsy.

Nonsurgical Scar Management of the Face

Special emphasis is placed on the clinical management of facial scarring because of the profound physical and psychological impact of facial burns. Noninvasive methods of facial scar management include pressure therapy, silicone, massage, and facial exercises. Early implementation of these scar management techniques after a burn injury is typically accepted as standard burn rehabilitation practice, however, little data exist to support this practice. This study evaluated the timing of common noninvasive scar management interventions after facial skin grafting in children and the impact on outcome, as measured by scar assessment and need for facial reconstructive surgery. A retrospective review of 138 patients who underwent excision and grafting of the face and subsequent noninvasive scar management during a 10-year time frame was conducted. Regression analyses were used to show that earlier application of silicone was significantly related to lower Modified Vancouver Scar Scale scores, specifically in the subscales of vascularity and pigmentation. Early use of pressure therapy and implementation of facial exercises were also related to lower Modified Vancouver Scar Scale vascularity scores. No relationship was found between timing of the interventions and facial reconstructive outcome. Early use of silicone, pressure therapy, and exercise may improve scar outcome and accelerate time to scar maturity.

A Prospective Study of Physical Therapy in Facial Nerve Paralysis: Experience at a Multispeciality Hospital of Kashmir

BACKGROUND: Bell's palsy is an acute weakness of seventh cranial nerve leading to loss of movement on one side of the face. It usually recovers of its own without treatment in most of the patients but not all. Physical therapy in the form of electrotherapy, massage and facial exercises is used as adjuvant to hasten recovery.
 OBJECTIVES: To analyze the role of physiotherapy in the form of electrotherapy in patients with peripheral facial paralysis attending multispecialty hospital in Kashmir.
 METHODS: A prospective study was carried out on 50 patients of facial nerve paralysis attending OPD between Jan 2009 and Jan 2010. All of the patients were subjected to medical treatment. The patients were put to Physical Therapy in the form of electrotherapy followed by facial exercises. All patients received electrotherapy to the paralyzed facial muscles for a period of 2 weeks but some were given extended doses for 4 weeks. 20 patients presented for the treatment in the first week, 12 in second week and 18 presented after three weeks or later.
 RESULTS: Fifty patients (30 female, 20 male) of facial nerve paralysis were included. Time span between medical diagnosis and physical therapy was from 1 week to 4 weeks. Patients were assessed at 4 weeks, 2 months and 6 months after the treatment. Out of 20 patients who presented in 1st week and received steroids and electrotherapy 19(95%) had fully recovered except for one case that was irregular for treatment. Out of 12 Patients who presented in 2nd week of illness, 8(66.6%) patients had full recovery and partial recovery in rest of 4 (33.4%) patients. Eighteen patients (100%) who presented in third week onwards of illness had partial recovery.
 CONCLUSION: Physiotherapy in the form of electrotherapy and facial exercises has a effective role in the early management of peripheral facial palarlysis. JMS 2012;15(2):145-48

Long-term outcome of Cavalier King Charles spaniel dogs with clinical signs associated with Chiari-like malformation and syringomyelia

The disease complex Chiari-like malformation (CM) and syringomyelia (SM) has been associated with the development of neuropathic pain (NeP), and commonly affects Cavalier King Charles spaniels (CKCS). This prospective cohort...

A Comparison of Facial Muscle Squeezing versus Non-facial Muscle Squeezing on the Efficacy of BotulinumToxin-A Injections for the Treatment of Facial Dystonia

Background:This study was performed to address whether voluntary muscle squeezing post botulinum toxin-A treatment with increased neuronal activity translates into noticeable patient benefit in practice.Methods: This was a prospective, consecutive, double crossover interventional study. Participants were receiving regular (3 monthly) botulinum toxin-A treatment for aberrant facial nerve regeneration (AFNR), benign essential blepharospasm (BEB) or hemifacial spasm (HFS). Twenty-six participants were recruited and these were randomised into two groups (A and B). Group A performed a program of intensive facial exercises for 5 minutes after their first and third treatment whereas after their second treatment, they were asked to rest in a seated position for 5 minutes, and instructed not to talk or perform any voluntary movements of their face. Conversely group B were only asked to perform squeezing exercises after their second treatment. Outcomes were evaluated objectively using video-recordings and subjectively by questionnaire and telephone interview of participants.Results: Video-recording data was complete for 21 participants. There was a mean 40% reduction in the frequency of facial muscle spasms and a 33% lower severity score (video-recordings graded by 1 masked investigator) where intensive facial exercises were performed post-treatment. These findings did not reach statistical significance (Mann- Whitney two-tailed test; p = 0.367).Conclusion: Although statistical significance was not achievable, this study suggested a possible trend towards an increased efficacy of botulinum toxin-A, with facial muscle squeezing post BTX treatment. Future studies with a larger number and a better defined subset of subjects may lead to statistical significance.

Myofunctional and speech rehabilitation after orthodontic-surgical treatment of dento-maxillofacial dysgnathia

ObjectivesThe lingual dysfunctions play a considerable role in the pathogenesis of dentoskeletal dysmorphisms. The treatment of dento-maxillofacial dysgnathia implies a functional rehabilitation to re-harmonize the stomatognathic system. This study aims to demonstrate the importance of a rehabilitation protocol of functional orofacial parameters at the end of a surgical-orthodontic treatment in order to achieve long-term success. Materials and methodsAfter orthognathic surgery, facial expression exercises and jaw exercises are prescribed to promote the recovery of neuromuscular function. At the end of treatment, a sample of 30 dysgnathic patients underwent a functional evaluation of the orofacial district to identify any lingual or articulatory dysfunctions. The information gathered led to an individual re-education program that consisted of an active myofunctional-logopedic approach integrated with appliances used as retention. Results19 patients needed myofunctional therapy to re-educate deglutition and tongue posture. Articulatory disorders were found in 7 patients originally suffering from Class III and/or open-bite skeletal disharmony; 5 of these completed rehabilitation with speech therapy. After rehabilitation the functional parameters were completely normalized in 12 patients; in 5 cases, partial improvements were obtained, while in 2 cases the therapy was ineffective. ConclusionsIn a patient undergoing post-surgical reconsolidation of his/her functional equilibrium even an uncontrolled speech defect may lead to an instable result. Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia.

2A1-C09 顔面運動の計測・評価の一考察(感覚・運動・計測(1))

There is a tendency that the elderly persons decline in feeding and swallowing. It is known that the oral training such as a facial exercise has an effect to facilitate a smoothness swallowing motion. This paper describes a perspective on measurement and evaluation of face movements in the oral training practices, based on the Electromyography (EMG). Here, the zygomaticus major and minor muscles, and orbicularis oris muscle were focused for an evaluation. As a result of APDF analysis, it could be confirmed that the motion of puffing the cheeks had an effect to enhance the activity of the orbicularis oris muscle.

Physical therapy for Bell's palsy (idiopathic facial paralysis)

Bell's palsy (idiopathic facial paralysis) is commonly treated by various physical therapy strategies and devices, but there are many questions about their efficacy. To evaluate physical therapies for Bell's palsy (idiopathic facial palsy). We searched the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2011), MEDLINE (January 1966 to February 2011), EMBASE (January 1946 to February 2011), LILACS (January 1982 to February 2011), PEDro (from 1929 to February 2011), and CINAHL (January 1982 to February 2011). We included searches in clinical trials register databases until February 2011. We selected randomised or quasi-randomised controlled trials involving any physical therapy. We included participants of any age with a diagnosis of Bell's palsy and all degrees of severity. The outcome measures were: incomplete recovery six months after randomisation, motor synkinesis, crocodile tears or facial spasm six months after onset, incomplete recovery after one year and adverse effects attributable to the intervention. Two authors independently scrutinised titles and abstracts identified from the search results. Two authors independently carried out risk of bias assessments, which , took into account secure methods of randomisation, allocation concealment, observer blinding, patient blinding, incomplete outcome data, selective outcome reporting and other bias. Two authors independently extracted data using a specially constructed data extraction form. We undertook separate subgroup analyses of participants with more and less severe disability. For this update to the original review, the search identified 65 potentially relevant articles. Twelve studies met the inclusion criteria (872 participants). Four trials studied the efficacy of electrical stimulation (313 participants), three trials studied exercises (199 participants), and five studies compared or combined some form of physical therapy with acupuncture (360 participants). For most outcomes we were unable to perform meta-analysis because the interventions and outcomes were not comparable.For the primary outcome of incomplete recovery after six months, electrostimulation produced no benefit over placebo (moderate quality evidence from one study with 86 participants). Low quality comparisons of electrostimulation with prednisolone (an active treatment)(149 participants), or the addition of electrostimulation to hot packs, massage and facial exercises (22 participants), reported no significant differences. Similarly a meta-analysis from two studies, one of three months and the other of six months duration, (142 participants) found no statistically significant difference in synkinesis, a complication of Bell's palsy, between participants receiving electrostimulation and controls. A single low quality study (56 participants), which reported at three months, found worse functional recovery with electrostimulation (mean difference (MD) 12.00 points (scale of 0 to 100) 95% confidence interval (CI) 1.26 to 22.74).Two trials of facial exercises, both at high risk of bias, found no difference in incomplete recovery at six months when exercises were compared to waiting list controls or conventional therapy. There is evidence from a single small study (34 participants) of moderate quality that exercises are beneficial on measures of facial disability to people with chronic facial palsy when compared with controls (MD 20.40 points (scale of 0 to 100), 95% CI 8.76 to 32.04) and from another single low quality study with 145 people with acute cases treated for three months where significantly fewer participants developed facial motor synkinesis after exercise (risk ratio 0.24, 95% CI 0.08 to 0.69). The same study showed statistically significant reduction in time for complete recovery, mainly in more severe cases (47 participants, MD -2.10 weeks, 95% CI -3.15 to -1.05) but this was not a prespecified outcome in this meta analysis.Acupuncture studies did not provide useful data as all were short and at high risk of bias. None of the studies included adverse events as an outcome. There is no high quality evidence to support significant benefit or harm from any physical therapy for idiopathic facial paralysis. There is low quality evidence that tailored facial exercises can help to improve facial function, mainly for people with moderate paralysis and chronic cases. There is low quality evidence that facial exercise reduces sequelae in acute cases. The suggested effects of tailored facial exercises need to be confirmed with good quality randomised controlled trials.

Frowning muscle activity and perception of effort during constant-workload cycling

We have recently demonstrated that electromyogram (EMG) amplitude of the frowning muscles correlates with perception of effort during leg-extension exercise. However, during aerobic exercise the relationship between facial EMG and perception of effort has never been investigated. The aim of the present study was to investigate whether facial EMG reflects perception of effort also during constant-workload cycling. We investigated the effects of exercise duration and exercise intensity on facial EMG of the corrugator supercilii muscles, rating of perceived effort, heart rate, and blood lactate concentration. Twenty recreationally active male and female volunteers performed a constant-workload time to exhaustion test on a cycle ergometer. Participants were randomly allocated to the heavy-intensity [63 ± 3% peak power output (P(peak))], or the severe-intensity (80 ± 5% P(peak)) group. The results show that facial EMG can differentiate between two exercise intensities during constant-workload cycling. The effects of exercise duration are inconclusive. Facial EMG increased over time in the severe-intensity group, but not in the heavy-intensity group. Future studies testing a wider range of exercise intensities are required to establish a correlation between facial EMG and exercise intensity during aerobic exercise, and further investigations are needed to establish why there is a discrepancy between facial EMG and perception of effort during lower-intensity aerobic exercise.

여성 얼굴의 불균형 개선을 위한 프로그램 구축

This study shows that the self-satisfaction individually is rising and social life is attracted effective and successful in image making field by structuring the facial image improvement program through experimental study in order to improve unbalance of women's face. Experiment is conducted by electing 3 samples for 12 weeks and analyzing the measurement and visual analysis, infrared thermography, and evaluation of experts in order to check the facial unbalance. Subject 1 had the effect at approximately in 4 weeks with the severely distorted chin line and mouth appendage. The facial outline became softer to turn entire image to be softer and more feminine. Subject 2 had the severe distortion of location and size of eyes and nose. But the skin was getting better at first, followed by eyes getting clearer with the location changed in left and right. Subject 3 had the twisted nose and lower chin, but after two weeks, the eye area and skin were better and the width of left and right chin was similarly changed. On the basis of the above research result, the program to effectively improve the image was structured and presented with the resolution of facial unbalance. Program is consist of the training of breathing method, face washing method, facial muscle exercise.

Effects of strength training on neuromuscular facial rehabilitation

Objective: Physical trauma is the third leading cause of facial nerve damage, which can disrupt communication, social interaction and emotional expression. The objective of this report was to investigate the effects of facial muscle exercise as a stand-alone treatment in a young adult with unilateral facial nerve damage 13-years post-onset.Method: This single case study examines the long-term results of a 7-week intensive facial exercise programme followed by a 16-week moderate facial exercise programme.Results: Intensive exercise increased facial strength and upper lip elevation on the affected side and upper and lower lip strength on the affected and non-affected sides. With subsequent moderate exercise followed by 24 weeks of rest, strength was maintained but not increased.Conclusion: With intensive facial exercise, muscle weakness resulting from facial nerve damage sustained during childhood can be improved years after injury.

Facial Resistance Exercise Training Improves Elasticity In Middle-aged Women's Facial Skin

Facial Resistance Exercise Training Improves Elasticity In Middle-aged Women's Facial Skin

Facial exercise therapy for facial palsy: systematic review and meta-analysis

The effectiveness of facial exercises therapy for facial palsy has been debated in systematic reviews but its effects are still not totally explained. Objective: To perform a systematic review with meta-analysis to evaluate the effects of facial exercise therapy for facial palsy. Data sources: A search was performed in the following databases: Cochrane Controlled Trials Register Library, Cochrane Disease Group Trials Register, MEDLINE, EMBASE, LILACS, PEDro, Scielo and DARE from 1966 to 2010; the following keywords were used: ‘idiopathic facial palsy’, ‘facial paralysis’, ‘Bell’s palsy’, ‘physical therapy’, ‘exercise movement techniques’, ‘facial exercises’, ‘mime therapy’ ‘facial expression’, ‘massage’ and ‘randomized controlled trials’. Review methods: The inclusion criteria were studies with facial exercises, associated or not with mirror biofeedback, to treat facial palsy. Results: One hundred and thirty-two studies were found but only six met the inclusion criteria. All the studies were evaluated by two independent reviewers, following the recommendations of Cochrane Collaboration Handbook for assessment of risk of bias (kappa coefficient = 0.8). Only one study presented sufficient data to perform the meta-analysis, and significant improvements in functionality was found for the experimental group (standardized mean difference (SMD) = 13.90; 95% confidence interval (CI) 4.31, 23.49; P = 0.005). Conclusion: Facial exercise therapy is effective for facial palsy for the outcome functionality.

The Effects of Symmetrical Self-performed Facial Muscle Exercises on the Neuromuscular Facilitation of Patients with Facial Palsy

[Purpose] The present study was designed to evaluate the effect of symmetric self-performed facial muscle exercises on the facial muscle function of patients with facial palsy. [Subjects] The subjects were 26 persons (men=12, women=14) who suffered from facial palsy and were treated by western-oriental medical treatment. [Methods] We educated patients to conduct symmetric self-performed facial muscle exercises three times per day for four weeks by themselves to facilitate neuromuscular function. We evaluated them before and after the exercise period using Yanagihara's Unweighted Grading System and the House-Brackmann Grading System. [Results] After 4 weeks' symmetric self-performed facial muscle exercises, patients showed a significant improvement in facial palsy. The control group also showed a significant improvement. According to both Yanagihara's Unweighted Grading System and the House-Brackmann Grading System, the intervention group showed a greater improvement of scores than the control group. [Conclusion] These results suggest that adding symmetric self-performed facial muscle exercises to the western-oriental medical treatment is a more effective treatment than western-oriental medical treatment alone for recovery from facial palsy.

Sensory retraining: burden in daily life related to altered sensation after orthognathic surgery, a randomized clinical trial

Assess the long-term effect of sensory retraining exercises, age, gender, type of surgery, and pre-surgical psychological distress on patients' perception of the interference related to altered sensation 2 years after orthognathic surgery. A total of 186 subjects with a developmental dentofacial disharmony were enrolled in a multicenter randomized clinical trial: one center was a community-based practice and the other a university-based center. Subjects were randomly allocated to two groups: standard of care mouth opening exercises after BSSO or a progressive series of sensory retraining facial exercises in addition to the opening exercises. At 1, 3, 6, 12, and 24 months after surgery, subjects scored unusual feelings on the face, numbness, and loss of lip sensitivity from 'no problem (1)' to 'serious problem (7)'. A marginal proportional odds model was fit for each of the ordinal outcomes. Up to 2 years after surgery, the opening exercise only group had a higher likelihood of reporting interference in daily activities related to numbness and loss of lip sensitivity than the sensory retraining exercise group. The difference between the two groups was relatively constant. Older subjects and those with elevated psychological distress before surgery reported higher burdens related to unusual facial feelings, numbness, and loss of lip sensitivity (p < 0.02). The positive effect of sensory retraining facial exercises observed after surgery is maintained over time. Clinicians should consider the patient's age and psychological well-being prior to providing pre-surgical counseling regarding the impact on daily life of persistent altered sensation following a mandibular osteotomy.

Toxina botulínica y parálisis facial. Nuestra experiencia

Introduction and objectives Therapeutic indication of peripheral facial paralysis depends on the degree of nerve injury. Severe facial palsy (electroneuronographic study less than or equal to 10%) leads to healing with sequelae. The sequelae of facial paralysis are contractures, hemifacial spasm and synkinesis.Our purpose was to demonstrate that these patients could benefit from rehabilitation treatment. Methods We present a study of 48 patients with severe peripheral facial paralysis. They were treated from the beginning of reinnervation with botulinum toxin and facial exercises according to the Wisconsin School. Results The subjective efficacy of rehabilitation is high. Conclusions Rehabilitation treatment can inform patients about their chances of recovery, give them control over and quality of facial expression and help to achieve greater facial symmetry. These factors provide better functionality and quality of life.

Intraoperative facial nerve monitoring in parotid gland surgery

To re-evaluate the value and the methods of intraoperative facial nerve monitoring in parotid gland surgery. Sixty-five cases received intraoperative facial nerve monitoring in parotidectomy (test group) since 2000 - 2008. The facial nerve was identified through central trunk method (n = 18), branch method (n = 35) and mixed method (n = 12). Most patients accepted general anesthesia by incubation. The operating duration and minimum electronic stimulation threshold values of EMG in evoked facial muscle were recorded. Facial nerve was identified though branch method (n = 44) and no intraoperative facial nerve monitoring was performed in parotidectomy (control group). There were four cases (6.1%) of mild temporary paralysis and no permanent post-operative paralysis of facial nerve in the test group. The average operating duration was 1.8 hour. The minimum reactive electronic stimulation threshold of EMG in evoked facial muscle was 0.08 mA. The range of suitable electronic stimulation threshold of EMG was from 0.2 mA to 1.0 mA. While there were nine cases (20.5%) of mild temporary paralysis and two cases (4.5%) of permanent post-operative paralysis of facial nerve in the control group and the average operating duration was 3.0 hours. Intraoperative facial nerve monitoring (IFNM) in parotidectomy can assist a surgeon to confirm and identify the facial nerve and exercise precautions so as to shorten operating duration and prevent potential surgical complications.

Botulinum toxin and facial palsy. Our experience

Introduction and objectivesTherapeutic indication of peripheral facial paralysis depends on the degree of nerve injury. Severe facial palsy (electroneuronographic study less than or equal to 10%) leads to healing with sequelae. The sequelae of facial paralysis are contractures, hemifacial spasm and synkinesis. Our purpose was to demonstrate that these patients could benefit from rehabilitation treatment. MethodsWe present a study of 48 patients with severe peripheral facial paralysis. They were treated from the beginning of reinnervation with botulinum toxin and facial exercises according to the Wisconsin School. ResultsThe subjective efficacy of rehabilitation is high. ConclusionsRehabilitation treatment can inform patients about their chances of recovery, give them control over and quality of facial expression and help to achieve greater facial symmetry. These factors provide better functionality and quality of life.