Facial Grading Research Articles

Facial Nerve Reanimation Using Free-functioning Gracilis Muscle Transfer in Adolescent Patients. Long-term Follow-up With Outcome Assessment Using House-Brackmann Facial Nerve Grading System.

Facial nerve palsy is a condition that carries significant consequences, especially when it occurs during adolescence. It represents a considerable clinical problem due to limited treatment options, as well as the fact that it has significant cosmetic and functional implications. In adolescents with persistent facial palsy, microsurgical procedures for dynamic facial reanimation may effectively restore facial symmetry. A commonly performed intervention is free-functioning muscle transfer. The study group includes 10 pediatric patients aged 11 to 17 with diagnosed persistent facial nerve palsy, surgically treated for the restoration of mimic muscle function between 2018 and 2022. All patients included in the study underwent surgical treatment using free-functioning muscle transfer. The average observation period was 38 months (range: 21-54mo). To objectively assess the return of function of the transferred innervated muscle flap during treatment and postoperative recovery, the House-Brackmann Facial Nerve Grading System was used. At an average observation period of 38 months, at least grade 3 according to the HBGS scoring system was demonstrated in all cases. Twelve months after the procedure, 6 patients (60%) were classified as grade 3, and in 4 cases (40%), the achieved symmetry was sufficient to obtain grade 2. No patient reported limitations in the adduction of the lower limb resulting from the harvest of the gracillis muscle. Further research should focus on patient-reported outcomes, conducting studies on a large study group could lead to the development of a clinical algorithm that could facilitate the assessment and effectively assist in the treatment of facial palsy.

Compare the Effectiveness of Mime Therapy on Facial Synkinesis in Idiopathic and Traumatic Lower Motor Neuron Facial Palsy

Background: The seventh cranial nerve has a core function of regulating emotional displays and speech. Facial paralysis, characterized by the loss of voluntary motor control on one or both sides, is commonly attributed to Bell’s palsy which accounts for 50-75% of cases and trauma responsible for 10-23% of cases. Various rehabilitation methods, including Mime Therapy, are employed to enhance facial muscle function. Objective: This study aims to compare Mime Therapy's impact to reduce the synkinesis of a face in individuals with idiopathic and traumatic lower motor neuron facial nerve palsy. Study Design: Experimental, Comparative Study Study Setting: Physiotherapy OPD, Neurology ward, and ENT ward of Himalayan Hospital, Dehradun Participant: This study involved 30 patients, with 20 in Group A (Idiopathic) and 10 in Group B (Traumatic), all of whom had House-Brackmann Scores of 3-5. The patient’s ages ranged from 20 to 70. Outcome Measure: Two outcome measures were used: House Brackmann Score and Sunnybrook Facial Grading System. Result: A noticeable difference in both outcome measures was observed. In the House Brackmann Score for group A (p-value <0.001) and B (p-value=0.016), In Sunnybrook Facial Grading System for group A (p-value<0.001) and B (p-value=0.002). However, when comparing the post-intervention results of both groups, no distinct variation was found in the outcome variables (p-value>0.05). Conclusion: The study provides evidence demonstrating that Mime Therapy has been successful in effectively reducing Facial Synkinesis in patients with both idiopathic and traumatic LMN Facial Palsy. The results indicate a significant improvement in the condition, suggesting that Mime therapy can be an efficacious treatment approach for this type of facial paralysis. KEYWORDS: Mime Therapy, Facial Synkinesis, Idiopathic LMN Facial palsy, Traumatic LMN facial palsy, Bell’s palsy.

Creation and Validation of the Facial Diplegia Scale for Assessment of Bilateral Facial Palsy.

Objectives: House-Brackmann (HB) classification and the Sunnybrook Facial Grading System (SFGS), both reference tools for the assessment of facial palsy, are not suitable for bilateral facial palsy. The aim of this study was to develop, standardize, and validate the Facial Diplegia Scale (FDS). Methods: The FDS was standardized in a healthy population (n = 111) and validated in 40 patients with diplegia. Correlations with the SFGS were sought to prove its criterion validity. The comparison between healthy subjects and patients with diplegia was used to test the construct validity. The diagnostic performance of the FDS was verified using an ROC curve based on the HB classification. Internal and external consistency were investigated. Results: The FDS and the SFGS were significantly correlated for the right hemiface [F(39) = 51.51, p < 0.0001, R2 = 0.575] as well as for the left one [F(39) = 95.10, p < 0.0001, R2 = 0.714]. A significant difference between control subjects and patients with diplegia was found [t(149) = -9.95, p < 0.0001]. Good specificity and sensitivity were confirmed. Finally, internal consistency, inter-rater reliability, and test-retest reliability were largely proven. Conclusions: The FDS has been standardized and validated for the subjective assessment of facial diplegia in adults to improve comprehensive assessment.

Functional Outcomes and Self-Reported Quality of Life in Patients with Facial Nerve Impairment Following Vestibular Schwannoma Surgery

Objective: The aim of this observational retrospective study was to report quality of life (QoL) in patients with postoperative facial nerve (FN) palsy after vestibular schwannoma (VS) surgery, investigating clinical factors related to functional outcomes. Methods: Forty-eight consecutive patients (M:F 25:23; median age: 52.5 years) with facial palsy following surgery for sporadic VS were considered retrospectively. FN palsy was graded by using the Sunnybrook facial grading system (SBFGS), while postoperative QoL and subjective functional aspects were assessed by using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale, the Synkinesis Assessment Questionnaire, and questions on eating and drinking. Results: A significant correlation emerged between all Sunnybrook scores and median PANQOL domain regarding facial function. Increasing overall SBFGS scores were associated with reduced risk of slow chewing on the affected side (p = 0.004), lack of masticatory strength (p = 0.025), masticatory fatigue (p &lt; 0.001), accumulation of food in the oral vestibule (p &lt; 0.001), difficulty in drinking from a glass (p = 0.019), and fluid spillage while drinking (p = 0.016). Conclusions: This study suggests that the clinical evaluation of patients with FN palsy after VS surgery should be integrated with patient reports about functional outcomes and perceived QoL to help clinicians guide rehabilitation choices.

A longitudinal study of facial function, quality of life, and depression in Bell’s palsy during pregnancy and puerperium

Bell’s palsy can reduce facial function and quality of life. Pregnancy may also be physically and psychologically challenging. This study investigates depression among pregnant and puerperal women with and without Bell’s palsy and if degree of facial palsy and depression was correlated. Thirty-one women with pregnancy-associated Bell’s and 31 women without Bell’s palsy were prospectively included and followed one year at two University Hospitals, Stockholm. Depression was assessed with Edinburgh Postnatal Depression Scale (EPDS). In women with Bell’s palsy, Facial Disability Index (FDI), Facial Clinimetric Evaluation (FaCE) scale, and Sunnybrook Facial Grading System (SFGS) were collected. The association between Bell’s palsy and EPDS ≥ 11 was assessed by logistic regression, and between EPDS and FDI, FaCE, and SFGS, respectively, by Spearman rank correlation. Median EDPS did not differ between groups (7.0 vs. 6.0, p = 0.74, one month, 6.5 vs. 6.0, p = 0.87, 12 months). EPDS at one month was correlated to FDI (p = 0.002) and FaCE (p = 0.004) and at 12 months to FDI (p = 0.009) but not to FaCE (p = 0.08). No correlation was found between EPDS and SFGS. In summary, no association appeared between pregnancy-associated Bell’s palsy and depression. Patient-reported function correlated well with depression in pregnancy-associated Bell’s palsy, while physician-reported facial function did not.

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&lt;0.001), while intergroup differences were significant in the 3rd and 6th weeks (p&lt;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.

The Systemic Inflammatory Response Index as a Novel Diagnostic Indicator for Bell's Palsy.

Aims/Background The systemic inflammatory response index (SIRI), an emerging hematological marker of inflammation, has shown promise as a promising biomarker for a variety of inflammatory conditions. This study aims to explore the diagnostic role of SIRI in Bell's palsy (BP). Methods For this retrospective study, 73 people diagnosed with BP between January 2021 and December 2023 were recruited, along with 73 healthy controls who were age- and sex-matched. The SIRI and other blood inflammatory markers, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were determined for all participants, by enumerating their peripheral blood cell counts. Facial nerve function was assessed upon admission and after one month of treatment using the House-Brackmann Facial Nerve Grading System (H-B). According to this system, patients with an H-B grade of 1-2 are considered recovered, while those with an H-B grade of 3-6 are regarded as not recovered. Results The SIRI (0.94 vs 0.48, p < 0.001), SII (480.3 vs 329.12, p < 0.001), NLR (2.42 vs 1.41, p < 0.001), and PLR (141.05 vs 117.28, p = 0.001) showed a significant increase in the BP group compared to the control group. The receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for SIRI was higher than those for SII, NLR, and PLR, respectively. Upon one-month follow-up, significant differences in the values of SIRI, SII, and NLR were observed between the favorable prognosis group and the poor prognosis group (SIRI: 1.07 vs 0.87, p = 0.011; SII: 647.85 vs 422.11, p = 0.005; NLR: 3.31 vs 2.11, p = 0.013). The AUC of ROC curve for SIRI was found to be lower than that of SII but higher than that of NLR. Conclusion The SIRI has the potential to be an important BP diagnostic and prognostic marker.

Motor unit number index in Bell's palsy: A potential electrophysiological biomarker for early evaluation.

Reliable, noninvasive early diagnostics of neuromuscular function in Bell's palsy, which causes facial paralysis and reduced quality of life, remain to be established. Here, we aimed to evaluate the utility of the motor unit number index (MUNIX) for the quantitative electrophysiological assessment of early-stage Bell's palsy, its correlation with clinical assessments, changes following treatment, and association with clinical prognosis. MUNIX measures were recorded from the bilateral zygomaticus, orbicularis oculi, and orbicularis oris muscles of 10 healthy individuals and 64 patients with Bell's palsy. The patients were assessed by two specialist neurologists using the House-Brackmann and Sunnybrook Facial Grading Systems. Repeat assessments were performed on 20 patients with Bell's palsy who received treatment. Additionally, the 64 patients were reassessed using clinical scales after a 1-month interval. The MUNIX values of the main affected muscles on the affected side were lower than those on the healthy side in patients with Bell's palsy (p<.05). The MUNIX measurements significantly correlated with the clinical facial nerve palsy scale scores (p<.05). Significant improvements were observed in the MUNIX values on repeat testing following treatment (p<.05). The baseline motor unit size index (the compound muscle action potential amplitude divided by MUNIX) was positively associated with improved clinical presentation after 1 month (p<.05). MUNIX can be used as an electrophysiological biomarker for the quantitative assessment of facial nerve palsy and treatment response, and as a prognostic biomarker, in patients with early Bell's palsy, and is recommended as a complement to conventional neurophysiological examinations.

Normal Facial Function in the Sunnybrook Facial Grading System: Is the 100% Score too Restrictive?

The primary objective of this study was to describe the distribution of the Sunnybrook Facial Grading System scores in the general population. Secondary objectives included analyzing the effects of age, gender and facial side on these scores. Two speech therapists specializing in facial motor skill assessment evaluated the healthy participants using the Sunnybrook Facial Grading System, first with the right hemiface as a reference and then with the left hemiface as a reference. The study was conducted in our ENT department from September 2022 to June 2023. One hundred eleven healthy participants were included (57 women and 54 men), aged 18 to 79 years. SFGS composite scores (SFGS-Total) and sub-scores at rest (SFGS-Rest) and in movement (SFGS-Movement) were studied according to three age categories (18-39 years) (40-59 years) and (60-79 years) and gender. Inter-rater reliability was collected between the two evaluators with Cronbach's alpha. Taking the right hemiface as a reference, SFGS-Total scores ranged from 65% to 100% (median = 96, IQR [91-100]). When the left hemiface was considered as the reference, scores ranged from 78% to 100% (median = 95; IQR [90-100]). Right and left SFGS-Total scores showed high inter-rater reliability (respectively α = 0.953 and α = 0.926). There was a slight negative correlation between age and SFGS-Total scores. By embracing a more realistic approach that acknowledges natural variations and asymmetry in facial movements, we can enhance patient care and promote a more holistic understanding of facial rehabilitation outcomes.

Clinical observation on acupuncture at infusion points of "four seas" on refractory peripheral facial paralysis

To observe the clinical effect of acupuncture at the infusion points of "four seas" for refractory peripheral facial paralysis on the basis of conventional acupuncture. A total of 52 patients with refractory peripheral facial paralysis were randomized into an observation group (26 cases, 2 cases dropped out) and a control group (26 cases, 1 case dropped out). On the basis of conventional acupuncture (Yintang [GV 24+] and Yangbai [GB 14], Dicang [ST 4] at affected side, etc.), acupuncture at the infusion points of "four seas", i.e. Baihui (GV 20), Dazhui (GV 14) and bilateral Shangjuxu (ST 37), Xiajuxu (ST 39), Zusanli (ST 36), was delivered in the observation group. On the basis of conventional acupuncture, shallow acupuncture was applied at corresponding non-meridian and non-acupoint points of the infusion points of "four seas" in the control group. The needles were maintained for 30 min, the treatment was given once every other day, 3 times a week for 4 weeks in the two groups. Before and after treatment, the House-Brackmann (H-B) facial nerve grading and the dynamic view score of the facial nerve function scoring system were observed, and the clinical efficacy was evaluated after treatment in the two groups. After treatment, the H-B facial nerve grading was improved compared with that before treatment in the two groups (P<0.05), and the grading in the observation group was superior to that in the control group (P<0.05); the dynamic view scores of the facial nerve function scoring system were increased compared with those before treatment in the two groups (P<0.05), and the score in the observation group was higher than that in the control group (P<0.05). The total effective rate was 91.7% (22/24) in the observation group, and that in the control group was 84.0% (21/25), there was no significant difference in the total effective rate between the two groups (P>0.05). The cure rate was 62.5% (15/24) in the observation group, which was higher than 20.0% (5/25) in the control group (P<0.05). On the basis of conventional acupuncture, acupuncture at infusion points of "four seas" can effectively treat refractory peripheral facial paralysis, improve the facial nerve function and increase the cure rate.

Clinical and electrophysiological prognostic factors in predicting poor outcomes in patients with idiopathic facial nerve paralysis

ObjectiveThis study was designed to verify whether one or more clinical and neurophysiological parameters could predict a poor prognosis in idiopathic facial paralysis. MethodsSeventy-three outpatients with unilateral idiopathic facial nerve paralysis who visited our hospital within 7 days of onset. All patients received treatment according to a standard therapy protocol and ocular care. Patients’ baseline characteristics were assessed before initiating treatment, including demographic characteristics, facial nerve function assessment and previous medical history. House-Brackmann (H-B) grading system was performed at baseline and six months after the onset. Electroneurography (ENoG) and blink reflex tests were conducted 7–10 days after the onset of paralysis. Sunnybrook Facial Grading System (SFGS) was conducted at baseline, days 7–10 post-onset when the electrophysiological tests were performed, and one month after the onset. ResultsAccording to the H-B grade at 6 months following the onset, 58 patients (79.5 %) had a good prognosis, while 15 patients (20.5 %) had a poor prognosis. The CMAP amplitudes in three facial muscles (frontalis, orbicularis oculi, and orbicularis oris) were decreased, and ENoG values were increased in the poor prognosis group compared with the good prognosis group (all p < 0.01). The results of the blink reflex study showed that the group with a poor prognosis had a longer R1 latency compared to the group with a good prognosis. Additionally, the group with a poor prognosis exhibited a higher rate of R1 absence on the affected side (both p < 0.01). The findings of conditional logistic regression indicated that the absence of R1 on the affected side, frontalis ENoG, orbicularis oculi ENoG, and orbicularis oris ENoG were predictive factors of a poor prognosis for facial nerve palsy. The receiver operating characteristic (ROC) curves showed that the SFGS at 1 month after onset of 55 is considered a critical cutoff value for poor prognosis, with a sensitivity of 86.7 % and specificity of 91.4 %. ConclusionElectroneurography (ENoG) and blink reflex tests acquired within 7–10 days after the onset of paralysis are significant and highly valuable for predicting the prognosis of idiopathic facial nerve paralysis. Higher ENoG values of the muscles innervated by the facial nerve and the absence of R1 on the affected side of the blink reflex are predictive factors for a poor prognosis. The SFGS is a clinical tool that plays an important role in evaluating the prognosis of idiopathic facial paralysis, particularly one month after onset.

Translation and Reliability of Urdu Version of House-Brackmann Facial Grading System (HBFGS) in Patients with Bell's Palsy

Background: Bell's palsy is characterized by the sudden onset of facial paralysis due to facial nerve inflammation. Accurate assessment tools, such as the House-Brackmann Facial Grading System (HBFGS), are essential for evaluating the severity of facial nerve dysfunction. This study aimed to translate and validate the Urdu version of HBFGS for Urdu-speaking patients, enhancing its reliability and applicability. Objective: To translate the HBFGS into Urdu and evaluate its reliability and validity in assessing facial nerve function among Urdu-speaking patients with Bell's palsy. Methods: A cross-sectional study was conducted with 245 participants diagnosed with Bell's palsy. The UHBFGS was developed through forward-backward translation and cultural adaptation. Participants' facial motor function was assessed using the UHBFGS by trained physiotherapists. Reliability was evaluated using Cronbach’s alpha and intraclass correlation coefficient (ICC), while SPSS version 25 was used for data analysis. Results: The UHBFGS demonstrated high internal consistency (Cronbach’s alpha = 0.951) and excellent test-retest reliability (Pearson’s r = 0.907). Inter-rater reliability was confirmed with an ICC of 0.888. Grade 3 severity was most common, affecting 43% of participants. Conclusion: The Urdu version of the HBFGS is a reliable and valid tool for assessing facial nerve function in Urdu-speaking patients, facilitating improved clinical evaluation and patient management.

Systematic Review On Effectiveness Of Low-Level Laser Therapy In The Treatment Of Bell’s Palsy

Background: Bell's palsy is a condition characterized by the sudden onset of facial paralysis or weakness, often linked to viral infections such as herpes simplex. Low-level laser therapy (LLLT) has emerged as a potential treatment due to its anti-inflammatory and nerve-regenerative properties. This systematic review evaluates the effectiveness of LLLT in improving outcomes for patients with Bell's palsy. Objective: The objective of this systematic review was to assess the efficacy of LLLT in treating Bell's palsy by comparing its outcomes with control treatments in randomized controlled trials (RCTs). Methods: A comprehensive literature search was conducted across databases such as PubMed, Google Scholar, ScienceDirect, and PEDro, using keywords like "Bell’s Palsy," "Low-Level Laser Therapy," and "randomized controlled trial." Five RCTs were included, comprising a total of 349 participants, with 155 in the LLLT groups and 194 in control groups. Data were extracted using a modified Cochrane template and analyzed using SPSS version 25, focusing on outcome measures such as the House-Brackmann Scale and Sunnybrook Facial Grading System. Results: LLLT showed significant improvements in facial function compared to control treatments, with effect sizes favoring LLLT (Effect size: 0.65, 95% CI: 0.35-0.95, p&lt;0.001). The review identified moderate heterogeneity (I² = 48%). Conclusion: LLLT appears to be a promising non-invasive treatment for Bell's palsy, enhancing facial nerve function and recovery. Further high-quality RCTs are needed to standardize treatment protocols and confirm these findings.

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 &lt; 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.

Masseteric-facial anastomosis and hypoglossal-facial anastomosis after lateral skull base and middle ear surgery.

Lateral skull base (LSB) and middle ear pathologies often involve the facial nerve (FN), and their treatment may require FN sacrifice. Cases with unidentifiable proximal stump or intact FN with complete FN palsy, necessitate FN anastomosis with another motor nerve in order to restore innervation to the mimicking musculature. The results of hypoglossal-to-facial nerve anastomosis (HFA) and masseteric-facial nerve anastomosis in patients with facial paralysis after middle ear and LSB surgeries, are presented and compared. Adult patients with total definitive facial paralysis after middle ear or LSB surgery undergoing facial nerve reanimation through hypoglossal or masseteric transfer anastomosis were enrolled. The facial nerve function was graded according to the House Brackmann grading system (HB). The facial function results at 3months, 6months, 12months, 18months and at the last follow up (more than 18months) are compared. 153 cases of LSB and middle ear surgery presented postoperative facial palsy and underwent facial nerve reanimation surgery with HF in 85 patients (55.5%) and MF in 68 patients (44.5%). The duration of the FN palsy before reconstructive surgery was inversely associated to better FN results, in particular with having a grade III HB (p = 0.003). Both techniques had significantly lower HB scores when an interval between palsy onset and reanimation surgery was 6months or less (MF p = 0.0401; HF p = 0.0022). Patients who underwent a MF presented significant improvement of the FN function at 3months from surgery (p = 0.0078). At the last follow-up, 63.6% recovered to a grade III HB and 22.7% to a grade IV. On the other hand, the first significant results obtained in the HF group were at 6months from surgery (p < 0.0001). 67.8% of patients had a grade III HB after a HF at the last follow-up, 28.8% a grade IV. FN grading at 6months from surgery was significantly lower in the MF group compared to the HF (p = 0.0351). The two techniques had statistically similar results at later follow-up evaluations. MF was associated to initial superior results, presenting significant facial recovery at 3months, and significantly better functional outcomes at 6months from surgery compared to HF. Although later results were not significantly different in this study, earlier results have an important role in order to limit the duration of risk of corneal exposure.

Automated analysis of spontaneous eye blinking in patients with acute facial palsy or facial synkinesis

Although patients with facial palsy often complain of disturbed eye blinking which may lead to visual impairment, a blinking analysis is not part of routine grading of facial palsy. Twenty minutes of spontaneous eye blinking at rest of 30 patients with facial palsy (6 with acute palsy; 24 patients with facial synkinesis; median age: 58 years, 67% female), and 30 matched healthy probands (median age: 57 years; 67% female) was smart phone video recorded. A custom computer program automatically extracted eye measures and determined the eye closure rate (eye aspect ratio [EAR]), blink frequency, and blink duration. Facial Clinimetric Evaluation (FaCE), Facial Disability Index (FDI) were assessed as patient-reported outcome measures. The minimal EAR, i.e., minimal visible eye surface during blinking, was significantly higher on the paretic side in patients with acute facial palsy than in patients with synkinesis or in healthy controls. The blinking frequency on the affected side was significantly lower in both patient groups compared to healthy controls. Vice versa, blink duration was longer in both patient groups. There was no clear correlation between the blinking values and FaCE and FDI. Blinking parameters are easy to estimate automatically and add a functionally important parameter to facial grading.

LncRNA GAS5 modulates Schwann cell function and enhances facial nerve injury repair via the miR-138-5p/CXCL12 axis.

Facial nerve is an integral part of peripheral nerve. Schwann cells are important microglia involved in the repair and regulation of facial nerve injury. LncRNA growth arrest‑specific transcript 5 (GAS5) is involved in the behavioral regulation of Schwann cell and the regeneration of peripheral nervous system. However, there is little research about the effect of GAS5 on the repair of facial nerve injury (FNI) by regulating Schwann cells. This study aimed to investigate the role of GAS5 in Schwann cell function and FNI repair, focusing on the miR-138-5p/CXCL12 axis. Hematoxylin and eosin staining, Luxol fast blue staining, transmission electron microscope, and immunofluorescence (IF) experiments were used to verify the effect of GAS5 on FNI rats. Reverse transcription real-time polymerase chain reaction was performed to detect GAS5, miR-138-5p, and C-X-C motif chemokine ligand 12 (CXCL12) mRNA expression. IF staining was used to detect the inflorescence of S100 calcium binding protein B (S100β), SRY-box transcription factor 10 (SOX10), and tubulin beta 3 class III (β-Tubulin III). Glial fibrillary acidic protein (GFAP), nerve growth factor receptor (NGFR), S100β, brain derived neurotrophic factor (BDNF), ciliary neurotrophic factor (CNTF), and CXCL12 proteins were detected using western blot. The5-bromo-2'-deoxyuridine staining, Transwell, and flow cytometry assays were conducted to detect Schwann cell function. Dual-luciferase, RNA immunoprecipitation, and RNA pulldown assaywere used to identify the interaction among GAS5, miR-138-5p, and CXCL12. Results found thatGAS5 was downregulated in facial nerve tissues of FNI rats. Overexpressed GAS5 decreased facial grading, inhibited demyelination, and promoted proliferation, migration, and suppressed apoptosis of Schwann cells. Mechanistically, GAS5 was a sponge of miR-138-5p and positively regulated CXCL12 expression. GAS5 inhibition repressed CXCL12 expression and decreased cell proliferationand migration, increased apoptosis rate of Schwann cells by sponging miR-138-5p. In conclusion,overexpression of GAS5 accelerates facial nerve repair in FNI rats by regulating miR-138-5p/CXCL12 axis.

Effectiveness of novel facial stretching with structured exercise versus conventional exercise for Bell’s palsy: a single-blinded randomized clinical trial

The purpose of the study was to assess the effects of a novel technique involving facial stretching of the unaffected side along with a structured exercise for the affected side on facial symmetry and facial functions as compared to conventional exercise. A hospital-based parallel-group randomized trial was completed among patients with acute Bell’s palsy in Mangalore, India. Participants were randomized to receive facial stretching and a structured exercise program (experimental group) or the conventional exercise regimen (conventional group). Primary outcomes were facial symmetry and voluntary movement; assessed by the Sunnybrook Facial Grading System (SFGS). Both regimens were given for 3 weeks, with baseline, 10th day, and 20th day assessments. Out of 31 participants screened, 24 were eligible and 12 participants each were assigned to experimental and conventional groups. Change scores revealed greater improvement in the SFGS score (p = 0.002) for the experimental group participants. Facial stretching and structured exercise program exhibited promising results in enhancing facial symmetry and function in acute Bell’s palsy when compared to conventional exercise regimen.

Reflectance confocal microscopy as noninvasive tool for monitoring tirbanibulin efficacy in actinic keratosis

Actinic keratosis (AK) is a common precancerous condition found on sun-damaged skin. Tirbanibulin 1 % ointment has been approved for the topical treatment of non-hyperkeratotic facial and scalp Olsen grade I AKs over a contiguous area of 25 cm2 with a daily application for 5 consecutive days. Our aim was to investigate the use of in vivo RCM in the assessment of the response of AKs treated with tirbanibulin, as it has never been described in the published Literature. A total of 10 AKs in 10 consecutive outpatients were enrolled in the present study in May 2023. The follow-up visit was scheduled after 30 days from last application of tirbanibulin ointment. At follow-up visit, a complete response was described by clinical, dermoscopic and in vivo RCM examination in 10 out of 10 lesions, with a recovery of stratum corneum, decrease in atypical honeycomb pattern and changes in dermal collagen. All patients were followed up for at least 8 months and further recurrences were not registered. Based on our experience, we confirm the efficacy and safety of tirbanibulin in treating AKs and the usefulness of RCM in vivo examination for the therapeutic monitoring of such lesions, even in a very early stage.

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.