Facial Grading Scale Research Articles

Effects of Kabat rehabilitation versus mime therapy on facial disability and synkinesis in patients of Bell’s palsy

Objective: To compare the effects of Kabat rehabilitation and Mime therapy on facial disability and synkinesis in patients with Bell’s palsy. Method: The single-blind, randomised clinical trial was conducted at the Physiotherapy Department of the University of Lahore Teaching Hospital, Lahore, Pakistan, from May to October 2023, and comprised adults of either gender aged 25-50 years having sub-acute or chronic unilateral Bell's palsy of non-congenital origin. The patients were randomised into Kabat rehabilitation group A and mime therapy group B. Conventional physical therapy was given to both groups additionally. Facial disability was assessed using the Facial Disability Index scale, and synkinesis was observed using the House-Brackmann Facial Nerve Grading Scale. Data was analysed using SPSS 25. Results: Of the 72 patients, 41(56.9%) were females and 31(43.1%) were males. The overall mean age was 37.77±6.98 years, mean body mass index was 25.71±5.71kg/m2 and 41(56.9%) patients had left-sided palsy. Facial disability and synkinesis were significantly different in both groups post-intervention (p<0.001), while intergroup differences were significant in the 3rd and 6th weeks (p<0.001). Conclusion: Kabat rehabilitation led to more significant improvements in synkinesis and facial disability compared to mime therapy. Clinical Trial Number: Clinical trials.gov registration id: NCT06029855. Key Words: Bell’s palsy, Disability, Rehabilitation, Synkinesis.

Translation and Reliability of the Facial Disability Index (FDI) in Bell’s Palsy

Background: Bell's palsy, a sudden-onset facial paralysis linked to the facial nerve, is often poorly assessed in non-English-speaking populations due to culturally insensitive tools. The Facial Disability Index (FDI) is traditionally used but lacks adaptations for Urdu-speaking patients, leading to potential disparities in care. Objective: This study aimed to translate and evaluate the reliability and validity of the Urdu Facial Disability Index (UFDI) for assessing facial impairment in Bell's palsy patients. Methods: A cross-sectional study design was employed over four months, recruiting 203 Urdu-speaking patients with Bell's palsy from rehabilitation clinics. The UFDI underwent rigorous translation and cultural adaptation processes, including forward and backward translation and expert committee reviews. Participants completed the UFDI and the House-Brackmann Facial Grading Scale (HBFGS) for validity assessment. Descriptive statistics and reliability analyses were conducted using SPSS version 25, with Cronbach's alpha for internal consistency and intraclass correlation coefficient (ICC) for test-retest reliability. Results: The UFDI showed a Cronbach’s alpha of 0.77 and an ICC of 0.99, indicating good internal consistency and excellent test-retest reliability. Spearman’s rho showed significant correlation with HBFGS (r = 0.508, p < 0.05), confirming convergent validity. Conclusion: The UFDI is a reliable and valid tool for assessing facial disability in Urdu-speaking patients with Bell’s palsy, enhancing culturally sensitive clinical care.

A Case Report of Korean Medicine Treatment for a Patient with Left Facial Palsy Diagnosed with Wegener’s Granulomatosis

Background: The study reports the effect of Korean medicine treatment on a patient with left facial palsy caused by Wegener’s granulomatosis.Case information: The patient was receiving steroid treatment for facial palsy and was hospitalized for 21 days. He received acupuncture, electroacupuncture, bee venom pharmacopuncture, and moxibustion treatment along with Ssanghwa-tang and Cheongansohabwon herbal medicine treatment. During hospitalization, the Sunnybrook facial grading scale, House-Brackmann scale and length of time for the eye to completely close were evaluated at 11/16, 11/21, 11/27, 12/1, and 12/6. Post treatment, the degree of the movement in the left eyelid was improved, it took less time for the eye to close completely, the movement of the forehead wrinkle muscles improved, but that of the facial muscles under the eyes and left orbicularis oculi muscle showed little improvement.Conclusion: Korean medicine treatment for facial palsy caused by Wegener’s Granulomatosis helps restore mobility of the forehead and orbicularis oculi muscles.

Botulinum toxin type A in the treatment of synkinesis: a clinical case report and literature review

Synkinesis that develop in the long-term period of damage to the facial nerve significantly reduce the quality of life of patients. However, to date there is no single algorithm for the treatment of this category of patients. The purpose of the article was to describe the principle of treatment of synkinesis that developed after damage to the facial nerve, as well as to summarize the available literature data on the pathophysiological features and principles of botulinum therapy for this category of patients. We present a clinical case of a patient who, 10 months after removal of an acoustic neuroma on the right, developed motor synkinesis. The patient underwent 5 courses of botulinum toxin type A (BTA) injections with a positive effect. The article analyzes in detail the pathophysiological mechanisms of the development of synkinesis. Also presented data from studies since 2015 that assessed the intervals between injections, the total dosage of the drug and the dosage of one injection for patients with synkinesis. Conclusion: long-term treatment of synkinesis with BTA is individual, requires video recording of clinical, written (graphic) recording of injection points and assessment according to the Sunnybrook Facial Grading Scale and Facial Disability Index before and before the next injection session. Future research should focus on personalization rather than standardization of treatments.

Rehabilitation Surgery for Peripheral Facial Nerve Injury after Facial Trauma.

Introduction Facial trauma can cause damage to the facial nerve, which can have negative effects on function, aesthetics, and quality of life if left untreated. Objective To evaluate the effectiveness of peripheral facial nerve direct end-to-end anastomosis and/or nerve grafting surgery for patients with facial nerve injury after facial trauma. Methods Fifty-nine patients with peripheral facial nerve paralysis after facial injuries underwent facial nerve rehabilitation surgery from November 2017 to December 2021 at Ho Chi Minh City National Hospital of Odontology. Results All 59 cases of facial trauma with damage to the peripheral facial nerve underwent facial nerve reconstruction surgery within 8 weeks of the injury. Of these cases, 25/59 (42.3%) had end-to-end anastomosis, 22/59 (37.3%) had nerve grafting, and 12/59 (20.4%) had a combination of nerve grafting and end-to-end anastomosis. After surgery, the rates of moderate and good recovery were 78.4% and 11.8%, respectively. All facial paralysis measurements showed statistically significant improvement after surgery, including the Facial Nerve Grading Scale 2.0 (FNGS 2.0) score, the Facial Clinimetric Evaluation (FaCE) scale, and electroneurography. The rate of synkinesis after surgery was 34%. Patient follow-up postoperatively ranged from 6 to > 36 months; 51 out of 59 patients (86.4%) were followed-up for at least 12 months or longer. Conclusion Nerve rehabilitation surgery including direct end-to-end anastomosis and nerve grafting is effective in cases of peripheral facial nerve injury following facial trauma. The surgery helps restore nerve conduction and improve facial paralysis.

Characterizing the Impact of Facial Rehabilitation on Acute Facial Paralysis.

Evidence on facial rehabilitation therapy (FRT) for acute facial paralysis (FP) remains limited. We present a retrospective review of patients with acute FP who have received FRT with physical therapists within 1 year of FP onset as determined by Sunnybrook Facial Grading Scale (SFGS) composite scores. A total of 702 patients with a clinical diagnosis of FP were referred to a university rehabilitation program between January 1, 2015 and January 1, 2022. Seventy-six patients met the criteria, defined as FP diagnosis <12 months before FRT initiation, ≥3 therapy sessions, and sufficient follow-up data. Average number of treatment sessions between SFGS scores was 7.7. History of cancer, sex, number of treatment sessions, and initial SFGS score were correlated with change in SFGS. Time to treatment was not correlated with change in SFGS score. SFGS improved with each additional treatment session (p < 0.01). Each additional point in the initial SFGS was correlated with less change in the final SFGS score (p < 0.01). FRT can provide meaningful improvement in functionality for patients with acute FP, regardless of time to treatment. Furthermore, patients who present with poorer functionality at baseline and those who undergo more treatment are most likely to see SFGS improvement. Research comparing the effect of facial rehabilitation with other treatment modalities and to a control cohort is warranted.

Five-year follow-up after neurosurgery complicated by facial neuropathy

Botulinum toxin A (BTA) injections are effective for facial neuropathy. However, there is insufficient number of studies devoted to long-term management of these patients. To evaluate the effectiveness and safety of BTA therapy in patients with facial neuropathy after neurosurgical interventions. The study included 86 patients with facial neuropathy after surgical treatment of posterior cranial fossa and cerebellopontine angle tumors. All ones were divided into 2 groups: group I (main) - 57 patients with BTA prescribed early after facial nerve injury, group II (control) - 29 people undergoing exercise therapy, as well as special exercises and acupressure of painful muscle cords. The Sunnybrook Facial Grading Scale (SFGS) was used to assess facial symmetry and synkinesis, the Facial Disability Index (FDI scale) - to assess the quality of life. Overall duration of the study was 5 years (control points: 6 months, 1, 2, 3 and 5 years). The SFGS scores after 1, 2, 3 and 5 years were significantly better in the main group (resting symmetry p<0.01, voluntary movement symmetry p<0.01, synkinesis p<0.01, general condition of facial muscles p<0.01). Scores of physical and social functioning were significantly higher in the main group after 1 (p<0.01), 2 (p<0.01), 3 (p<0.01) and 5 years (p<0.01) after surgery. There was no need to change BTA dosage over 5 years. Thus, this form of BTA may be the most effective for synkinesis of facial muscles. Correction of synkinesis caused by facial neuropathy requires long-term follow-up and long-term treatment. BTA is effective and may be recommended for long-term treatment of these patients.

Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection.

Patients undergoing masseter nerve transfer and CFNG for facial paralysis after skull base tumor resection were consented to participate in video interviews. Facial Clinimetric Evaluation (FaCE) Scale (0-100) patient-reported outcome, eFACE, and Facial Grading Scale scores were compared. Nine patients had unilateral facial paralysis from resection of a schwannoma (56%), acoustic neuroma (33%), or vascular malformation (11%). Five underwent early simultaneous CFNG and masseter nerve transfer (mean 3.6 days after resection), whereas four underwent two-stage reanimation including a babysitter procedure (mean 218 days after resection). Postoperative FaCE scale and Facial Grading Scale scores were similar in both groups (P > 0.05). Postoperative mean eFACE scores were similar for both groups for smile (early: 71.5 versus delayed: 75.5; P = 0.08), static (76.3 versus 82.1; P = 0.32), and dynamic scores (59.7 versus 64.9; P = 0.19); however, synkinesis scores were inferior in the early group (76.4 versus 91.1; P = 0.04). Early simultaneous masseter nerve transfer and CFNG provides reanimated movement sooner and in fewer stages than a staged approach in a delayed timeline. The early technique appears to result in similar clinician- and patient-reported outcomes compared with delayed procedures; however, in this preliminary study, the early approach was associated with greater synkinesis, meriting further investigation.

Comparative Study of Multimodal Therapy in Facial Palsy Patients.

Introduction In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes. Methods Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale. Results FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, –24.51 to –14.66, p < 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly ( p < 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment ( p < 0.01), more chemodenervation episodes ( p < 0.01), increased doses of botulinum toxin ( p < 0.001), and having higher EGGS score ( p < 0.001). Conclusions This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.

Contribution and safety of the side-to-end hypoglossal-to-facial transfer in multidisciplinary facial reanimation.

This study evaluates facial and tongue function in patients undergoing side-to-end hypoglossal-to-facial transfer (HFT) with additional techniques. Thirty-seven patients underwent a side-to-end HFT. Twelve had additional cross-face grafts, and 9 had an additional masseter-to-facial transfer. Facial was assessed with House-Brackmann (HB), Sunnybrook Facial Grading Scale (SFGS), and eFACE. Martins scale and the Oral-Pharyngeal Disability Index (OPDI) were used to assess tongue function. Ninety-four percent of cases reached HB grades III-IV. Mean total SFGS score improved from 16 ± 15 to 59 ± 11, while total eFACE score from 52 ± 13 to 80 ± 5. Dual nerve transfers were a predictor for a better eFACE total score p=0.034, β=2.350 [95% CI, 0.184-4.516]), as well as for a higher SFGS total score (p=0.036, β=5.412 [95% CI, 0.375-10.449]). All patients had Martin's grade I. Mean postoperative OPDI scores were 84 ± 17 (local physical), 69 ± 16 (simple and sensory motor components), 82 ± 14 (complex functions), and 73 ± 22 (psychosocial). The side-to-end HFT offers predictable facial function outcome and preserves tongue function in nearly all cases. Dual nerve transfers appear to improve the final outcome.

Multiple Model Evaluation of the Masseteric-to-Facial Nerve Transfer for Reanimation of the Paralyzed Face and Quick Prognostic Prediction.

Facial paralysis is negatively associated with functional, aesthetic, and psychosocial consequences. The masseteric-to-facial nerve transfer (MFNT) has many advantages in facial reanimation. The aim is to evaluate the effectiveness of our MFNT technique and define the potential factors predictive of outcome. The authors conducted a retrospective review of 20 consecutive patients who underwent MFNT using the temporofacial trunk of facial nerve. Videotapes and images were documented and evaluated according to Facial Nerve Grading Scale 2.0 (FNGS2.0) and Sunnybrook Facial Grading System (FGS). The quality-of-life was obtained using the Facial Clinimetric Evaluation (FaCE) Scale. Moreover, Facial Asymmetry Index (FAI), quantitative measurement of the width of palpebral fissure, deviation of the philtrum, and angles or excursions of the oral commissure were applied to explore the effect of the transfer metrically. Multivariable logistic regression models and Cox regression were prepared to predict the effect of MFNT by preoperative clinical features. The patients showed favorable outcomes graded by FNGS2.0, and experienced significantly improved scores in static and dynamic symmetry with slightly elevated scores in synkinesis evaluated by the Sunnybrook FGS. The score of FaCE Scale increased in all domains after reanimation. The quantitative indices indicated the symmetry restoration of the middle and lower face after MFNT. Regression analysis revealed that younger patients with severe facial paralysis are preferable to receive MFNT early for faster and better recovery, especially for traumatic causes. The findings demonstrate that MFNT is an effective technique for facial reanimation, and case screening based on clinical characteristics could be useful for surgical recommendation.

To Study the Correlation of Nerve Conduction Velocity Studies and The Outcome of Subjects with Bell’s Palsy on Sunnybrook Facial Grading Scale

Background: Due to limited literature, on the usage of Sunnybrook Facial Grading scale (SFGS), we attempt to address SFGS in measuring clinical outcomes and understand its correlation with NVCs to predict the recovery course. Objectives: 1. To correlate the findings of Nerve Conduction Velocity studies on SFGS in subjects with Bell’s palsy. 2. Also based on the correlation to find whether Nerve Conduction Velocity studies can be used as a prognostic indicator/tool in Bell’s palsy. Methodology: A total of 58 subjects with unilateral Bell’s palsy were selected for the study. Outcome measures, SFGS and NCVs were evaluated on the first day and 20th day. Results: Karl Pearson’s correlation coefficient showed a strong positive correlation between the amplitude of frontalis and mentalis muscle. Conclusion: A positive correlation of the amplitude of frontalis and mentalis muscle. KEYWORDS: Nerve Conduction velocity studies, Sunnybrook Facial Grading scale, Bell’s palsy, correlation and prognostic tool.

Surgical Outcomes After Total or Subtotal Resection of Large Vestibular Schwannoma: A Single-Institution Experience.

BackgroundPatients with large vestibular schwannomas have various surgical outcomes. The aim of this study is to evaluate facial nerve outcome and surgical complications in patients who underwent total and subtotal resection.MethodsBetween October 2008 and September 2020, 72 patients underwent surgery in Rajavithi Hospital. Of these, 48 had total or subtotal resection. We classified these participants into two groups: VS ≥3 cm (Group A, n=30); and VS <3 cm (Group B, n=18). Both groups were compared in terms of clinical presentation, imaging data, facial nerve outcomes, and surgical complications. The retrosigmoid approach was used in each case, and all patients had follow-up for at least 1 year. Chi-square and Fisher’s exact test were used for statistical analysis.ResultsThe mean tumor size in Group A was 3.8 cm compared with 1.5 cm in Group B. In Group A, clinical signs of hearing dysfunction, gait ataxia, and facial paresthesia were present in 96.7%, 66.7%, 50% of patients respectively, compared with 100%, 5.6%, and 11.1% respectively in Group B. Radiographic signs of hydrocephalus were observed in 56.7% of Group A subjects, and 5.6% of those in Group B. At 1 year follow-up, 40% of patients with large VS and 94.4% of patients with small to medium size VS had good facial nerve outcomes (House-Brackmann [HB] facial grading scale grade I-III). Significant differences between the two groups were found only in gait ataxia (p<0.001), facial paresthesia (p=0.006), radiographic signs of hydrocephalus (p=0.002), facial nerve outcome 1 month (p<0.001) and facial nerve outcome 1 year (p<0.001).ConclusionIn patients with large size VS, microsurgical resection had poor facial nerve outcomes compared with those of their counterparts with small to medium size VS. Planned subtotal resection with postoperative radiosurgery might attain superior facial nerve outcomes and result in better quality of life in subjects with large VS.

Impact of early eyelid weight placement on the development of synkinesis and recovery in patients with idiopathic facial paralysis.

PurposeDetermine the impact of upper eyelid weight placement at 3 months post onset of idiopathic facial paralysis (IFP) on the recovery of facial function in patients with lagophthalmos.MethodsThis is a retrospective review of patients with incomplete recovery of IFP—defined as a Sunnybrook Facial Grading Scale (FGS) score of less than 100, 3 months after onset. Only patients with FGS and Facial Clinimetric Evaluation (FaCE) scores recorded at 3 and 12 months were included. Patients were categorized into 3 groups: Group A, lagophthalmos with eyelid weight placement; Group B, lagophthalmos without eyelid weight placement; Group C, complete eye closure (CEC) without eyelid weight placement. The eye comfort domain and composite score of the FaCE questionnaire were analyzed. Voluntary eye closure, synkinesis with eye closure, overall synkinesis and the composite score of the FGS were also analyzed. Paired two-tailed t-test was used to evaluate the data comparing the 3 and 12 month FaCE and FGS scores within and between the 3 groups.ResultsThe change in composite FGS score significantly increased from month 3 to month 12 in Group A as compared to Group B (37 vs 4.25, P = 0.01). While Group A had significantly lower eye comfort (−12.5, P = 0.01), voluntary eye closure (−1.75, P = 0.05) and overall FGS scores (−28.75, P = 0.04) at 3 months compared to those in Group C, there were no differences between these two groups at 12 month follow-up.ConclusionsFor patients with lagophthalmos at 3 months, early eyelid weight placement may lead to improved facial function at 12 months.

COMPARISON OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION AND NEUROMUSCULAR RE-EDUCATION WITH CONVENTIONAL TREATMENT AND HOME BASED EXERCISE PLAN ALONG WITH FACIAL NERVE STIMULATION FOR REDUCING FACIAL DISABILITY IN PATIENTS WITH BELL’S PALSY

The purpose of the present study was to compare the proprioceptive neuromuscular facilitation and neuromuscular re-education with conventional treatment and home based exercise plan along with facial nerve stimulation for reducing facial disability in patients with Bell’s Palsy. In the present study, purposively selected 20 patients (both male and female) with Bell’s palsy with age group 20-70 years were considered. Further, the patients were allocated equally into two treatment groups. In Group-A, patients were treated with Proprioceptive Neuromuscular Facilitation (PNF) and Neuromuscular Re-Education (NRE) along with interrupted galvanic stimulation, facial massage and home based exercises. In Group-B, patients received the treatment of interrupted galvanic stimulation and manual facial massage along with home based facial exercises program in front of mirror. The outcome measures included Facial Disability Index-Physical Function (FDI-PF), Facial Disability Index-Social Function (FDI-SF), Synkinesis Assessment Questionnaire (SAQ) and Sunnybrook Facial Grading Scale (SFGS). In results. it was found that in pre-intervention condition, no significant differences were noted in FDI-PF, FDI-SF, SAQ and SFGS between these two groups. However, significant differences (p&lt;0.001) were observed in FDI-PF, FDI-SF and SFGS in post intervention condition between the patients treated in Group-A and Group-B. Statistically significant increase (p&lt;0.001) was found in FDI-PF and SFGS and significant decrease (p&lt;0.013-0.001) was found in FDI-SF and SAQ between pre- and post-intervention in Group-A. Statistically significant decrease (p&lt;0.003-0.001) was found in FDI-PF, FDI-SF, SAQ and SFGS between pre- and post-intervention in patients treated in Group-B. From the findings of the study it could be concluded the treatment protocol comprised of PNF and NRE along with interrupted galvanic stimulation, facial massage and home based exercises was more effective than only interrupted galvanic stimulation, facial massage and home based exercises in improving facial symmetry and reducing facial disability in patients with Bell’s palsy.&#x0D; Keywords: Proprioceptive neuromuscular technique, Neuromuscular re-education technique, Interrupted galvanic stimulation, Facial massage, Home based exercises, Bell’s palsy, Facial disability, Synkinesis.

Masseter nerve-innervated free gracilis muscle transfer for smile reanimation in adults

Objective: To investigate the outcomes of masseter nerve-innervated free gracilis muscle transfer for smile reanimation in adults and to explore surgical indications. Methods: A retrospective chart review of 37 patients (11 males, 26 females, with (40.3±12.7) years old)who underwent masseter nerve-innervated free gracilis muscle transfer for smile reanimation between 2016 and 2017 was performed. Patient-reported quality of life (facial clinimetric evaluation, FaCE), physician-reported facial function (eFACE facial grading scale), and oral commissure excursion were compared preoperatively and postoperatively. SPSS 11.0 software was used to analyze the data. Results: Thirty-seven patients were followed up in one year after surgery. Significant postoperative improvements were demonstrated for commissure excursion with smile (preoperatively: (-1.2±3.1) mm, postoperatively: (6.1±3.5) mm, t=-31.1, P<0.01), ipsilateral FaCE (preoperatively: (29.4±14.1), postoperatively: (57.6±23.4), t=-38.1, P<0.01), eFACE score (Composite score t=-35.8, Static score t=-29.1, Dynamic score t=-41.3,Midface score t=-43.9, all P<0.01), respectively. Conclusion: Masseter nerve-innervated free gracilis muscle transfer is an good option for dynamic smile reanimation in adult patients who have undergone treatment for long-standing facial paralysis.

Computerized Sunnybrook facial grading scale (SBface) application for facial paralysis evaluation.

BackgroundThe Sunnybrook facial grading scale is a comprehensive scale for the evaluation of facial paralysis patients. Its results greatly depend on subjective input. This study aimed to develop and validate an automated Sunnybrook facial grading scale (SBface) to more objectively assess disfigurement due to facial paralysis.MethodsAn application compatible with iOS version 11.0 and up was developed. The software automatically detected facial features in standardized photographs and generated scores following the Sunnybrook facial grading scale. Photographic data from 30 unilateral facial paralysis patients were randomly sampled for validation. Intrarater reliability was tested by conducting two identical tests at a 2-week interval. Interrater reliability was tested between the software and three facial nerve clinicians.ResultsA beta version of the SBface application was tested. Intrarater reliability showed excellent congruence between the two tests. Moderate to strong positive correlations were found between the software and an otolaryngologist, including the total scores of the three individual software domains and composite scores. However, 74.4% (29/39) of the subdomain items showed low to zero correlation with the human raters (κ<0.2). The correlations between the human raters showed good congruence for most of the total and composite scores, with 10.3% (4/39) of the subdomain items failing to correspond (κ<0.2).ConclusionsThe SBface application is efficient and accurate for evaluating the degree of facial paralysis based on the Sunnybrook facial grading scale. However, correlations of the software-derived results with those of human raters are limited by the software algorithm and the raters’ inconsistency.

COMPLETE MANAGEMENT OF ARDITA (BELL’S PALSY) AS PER AYURVEDA CHIKITSA SUTRA – A CASE REPORT

Bell’s palsy, also known as acute idiopathic lower motor neuron facial paralysis, is characterized by sud-den onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. In contemporary science, administration of steroids is the treatment of choice for complete facial palsy. Cer-tain Panchakarma procedures and internal Ayurvedic medicines have been proved to be beneficial in the management of Ardita vata. The present report deals with a case of 62-year-old male patient diagnosed as Ardita vata was treated with various Panchakarma procedures like Nasya, Shirobasti, Kukkutanda Swedana, Dashmoola Ksheer Dhoom, Gandoosh and oral Ayurveda medicines. Criteria of assessment was based on the scoring of House-Brackmann Facial Nerve Grading scale. After completion of Ayurveda treatment, the patient Shown almost complete recovery without any adverse effects. This case is an evi-dence to demonstrate the effectiveness of Ayurveda treatment in case of Ardita vata (Bell’s palsy).

Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis.

Background: Hypoglossal and masseteric nerve transfer are currently the most popular cranial nerve transfer techniques for patients with facial paralysis. The authors performed a systematic review and meta-analysis to compare functional outcomes and adverse effects of these procedures. Methods: A review of online databases was performed to include studies with four or more patients undergoing hypoglossal or masseter nerve transfer without muscle transfer or other cranial nerve transposition. Facial nerve outcomes, time to reinnervation, and adverse events were pooled and studied. Results: A total of 71 studies were included: 15 studies included 220 masseteric-facial transfers, and 60 studies included 1312 hypoglossal-facial transfers. Oral commissure symmetry at rest was better for hypoglossal transfer (2.22 ± 1.6 mm vs. 3.62 ± 2.7 mm, p = 0.047). The composite Sunnybrook Facial Nerve Grading Scale was better for masseteric transfer (47.7 ± 7.4 vs. 33.0 ± 6.4, p < 0.001). Time to first movement (in months) was significantly faster in masseteric transfer (4.6 ± 2.6 vs. 6.3 ± 1.3, p < 0.001). Adverse effects were rare (<5%) for both procedures. Conclusions: Both nerve transfer techniques are effective for facial reanimation, and the surgeon should consider the nuanced differences in selecting the correct procedure for each patient.

Comparison of Facial Muscle Activation Patterns Between Healthy and Bell's Palsy Subjects Using High-Density Surface Electromyography.

Facial muscle activities are essential for the appearance and communication of human beings. Therefore, exploring the activation patterns of facial muscles can help understand facial neuromuscular disorders such as Bell’s palsy. Given the irregular shape of the facial muscles as well as their different locations, it should be difficult to detect the activities of whole facial muscles with a few electrodes. In this study, a high-density surface electromyogram (HD sEMG) system with 90 electrodes was used to record EMG signals of facial muscles in both healthy and Bell’s palsy subjects when they did different facial movements. The electrodes were arranged in rectangular arrays covering the forehead and cheek regions of the face. The muscle activation patterns were shown on maps, which were constructed from the Root Mean Square (RMS) values of all the 90-channel EMG recordings. The experimental results showed that the activation patterns of facial muscles were distinct during doing different facial movements and the activated muscle regions could be clearly observed. Moreover, two features of the activation patterns, 2D correlation coefficient (corr2) and Centre of Gravity (CG) were extracted to quantify the spatial symmetry and the location of activated muscle regions respectively. Furthermore, the deviation of activated muscle regions on the paralyzed side of a face compared to the healthy side was quantified by calculating the distance between two sides of CGs. The results revealed that corr2 of the activated facial muscle region (classified into forehead region and cheek region) in Bell’s palsy subjects was significantly (p < 0.05) lower than that in healthy subjects, while CG distance of activated facial region in Bell’s palsy subjects was significantly (p < 0.05) higher than that in healthy subjects. The correlation between corr2 of these regions and Bell’s palsy [assessed by the Facial Nerve Grading Scale (FNGS) 2.0] was also significant (p < 0.05) in Bell’s palsy subjects. The spatial information on activated muscle regions may be useful in the diagnosis and treatment of Bell’s palsy in the future.