Facial Palsy Research Articles

Evaluation of the Rehabilitation Effect of Nanometric Ion Medicine Steam Combined with Facial Muscle Training in the Treatment of Post-Stroke Peripheral Facial Nerve Palsy

This work aimed to investigate the rehabilitation effect of nanometer ion medicine steaming combined with facial muscle training in the treatment of post-stroke peripheral facial nerve palsy (PFNP), and to analyze the therapeutic effect of artificial skin continuous negative pressure drainage on stroke pressure ulcers. 120 patients with post-stroke PFNP who were admitted to Qilu Hospital (Qingdao), Cheeloo College of Medicine were recruited and rolled into the medicine steaming group (MS group, nanometer ion medicine steam) and the joint group (J group, nanometer ion medicine steam plus facial muscle training). The treatment effects, facial functional recovery, and pressure ulcer treatment outcomes were compared between patients in different groups. Results: After treatment, the facial disability index scores and facial nerve function scores of both groups of patients greatly increased, with a more drastic increase in J group (P < 0.05), so did the scores of various traditional Chinese medicine symptoms (P < 0.05). Furthermore, the proportion of patients in J group with facial function classified as level I or level II was obviously higher (P < 0.05). The treatment effectiveness and satisfaction rate in J group were dramatically superior to in MS group (P < 0.05). Conclusion: the joint treatment of nanometer ion medicine steam and facial muscle training has a significant effect in the rehabilitation of post-stroke PFNP, with faster facial functional recovery and higher patient acceptance.

Computed tomography navigation radiofrequency ablation for Meige's syndrome: A game-changer in treatment

BackgroundMeige's syndrome severely impacts quality of life. Current treatments struggle to balance cost, risk, and effectiveness. MethodsPatients with blepharospasm were treated with facial nerves partial radiofrequency ablation guided by CT. Treatment efficacy, complications, and recurrences were evaluated during follow-up. Results116 facial nerves in 58 patients with Meige's syndrome were treated using CT guidance. The average temperature at the end of radiofrequency treatment was 77.93 ± 9.8 °C, and the procedure lasted an average of 30.79 ± 7.69 min. Spasms stopped after treatment, but mild facial paralysis remained. Follow-ups ranging from 12 to 57 months showed that facial paralysis improved in an average of 3.12 ± 0.94 months. Nine patients had unilateral recurrence within 6–13 months, and three had bilateral recurrence at 14, 18, and 22 months. ConclusionsPartial radiofrequency ablation of the facial nerve through percutaneous access to the bilateral stylomastoid foramen using CT navigation is an effective, safe, promising treatment for blepharospasm in Meige's syndrome patients.

Dual versus Single Innervation of Gracilis Free Functional Muscle Transfer in Facial Paralysis: Long-Term Resting and Dynamic Outcomes.

The purpose of this study was to compare long-term tone and excursion in single- versus dual-innervated free functional muscle transfer (FFMT) in patients with longstanding facial paralysis. Patients with longstanding facial palsy treated with an FFMT innervated either by a nerve-to-masseter graft (single-innervation group) or nerve-to-masseter and cross-facial-nerve grafts (dual-innervation group) were included. One-year minimum follow-up was required. Outcome measures, based on standardized photographs, included excursion, smile angle, teeth exposure, commissure height deviation, and upper lip height deviation in repose and in closed and open-teeth smile preoperatively and at 3 months, 1 year, and 3 years postoperatively. Emotrics software and ImageJ software were used to take measurements. Between-group and within-group longitudinal comparisons were analyzed. At 3 years (single, n = 24; dual, n = 13), significance was found between groups in commissure position (single, 26.42 mm versus dual, 31.51 mm; P < 0.0001) and excursion with open-mouth smile (single, 31.32 mm versus dual, 26.59 mm; P < 0.001). Single-innervation FFMT within-group analysis lacked significant improvement in commissure height deviation and upper lip height deviation at 3 years in repose, whereas the dual-innervation group revealed significant improvements (3.67 mm [ P < 0.001], 3.17 mm [ P < 0.001], respectively). Teeth exposure revealed an increase in the dual-innervation group (single, 35.753 mm 2 versus dual, 64.177 mm 2 ), but significance was not observed. Dual-innervated FFMT revealed improvements in resting tone and teeth exposure with minimal decrease in smile excursion compared with single-innervated FFMT. Therapeutic, III.

Clinical outcome of cats with suppurative otitis media and intact tympanum submitted to myringotomy: retrospective findings from 26 cases.

The efficacy of medical treatment associated with single myringotomy in cats with suppurative otitis media (OM) and intact tympanum was retrospectively evaluated. Patients' records were retrieved from cats with suppurative OM. Cats were included in this retrospective study based on fluid content within the tympanic cavity on imaging, intact tympanum on otoendoscopic examination and neutrophils on ear bulla exudate cytological examination. A total of 26 cats with middle ear suppurative otitis were included. Just over half of the cats (54%) presented bilateral involvement. Clinical signs included head tilt (13/26), otalgia (9/26), Horner's syndrome (7/26), external ear discharge (5/26), and nystagmus and facial paralysis (1/26). Cocci were identified on cytological examination in 18/40 samples and rods in 2/40. Bacterial culture results were positive in 15/40 samples, with Pseudomonas species (4/15), Pasteurella multocida (3/15), Staphylococcus felis (3/15), Staphylococcus schleiferi (2/15), Staphylococcus canis (2/15), Escherichia coli (2/15), Staphylococcus pseudintermedius (1/15) and Serratia marcesens (1/15) isolation. After myringotomy and gentle flushing of middle ear bullae (0.5-2 ml saline per ear), all cats were treated with oral corticosteroids and a 1-month course of systemic antibiotics according to sensitivity testing. In total, 19 (73%) cats were clinically healed 60-240 days after treatment. One cat was euthanased because of failure to eradicate a Pseudomonas species infection. Another cat died a few hours after the procedure. The five remaining cats were cured after ventral bulla osteotomy. OM without an aural polyp is a frequent diagnosis in cats, but data on medical treatment are scarce. This simple therapeutic technique, single myringotomy procedure and mild ear flushing, offers a practical, safe and efficient first-line treatment of suppurative OM with an intact tympanum in cats with or without neurological signs.

The Effectiveness of Facial Neuromuscular Retraining on Patients with Facial Nerve Dysfunction: A Mental Health and Quality of Life Analysis.

Background: Facial muscle dysfunction can have drastic psychosocial effects. Objectives: To evaluate the impacts of customized neuromuscular retraining on mental health, quality of life (QoL), facial muscle function, and synkinesis. Methods: Thirty patients with facial nerve dysfunction completed a course of neuromuscular retraining. Patients' mental health, QoL, facial muscle function, and synkinesis were evaluated using Patient Health Questionnaire (PHQ-9), Facial Clinimetric Evaluation (FaCE) scale, electronic, clinician-graded facial function scale (eFACE), and Synkinesis Assessment Questionnaire (SAQ) at the initial and final visits. Scores were compared before and after treatment. Results: Patients (n = 30) included had a mean age of 59.4 ± 13.4 years (range 32.3-82.8) and were mostly female (22/30, 73.3%). The most common etiology was Iatrogenic facial nerve paralysis (11/20, 36.7%). Most patients had postfacial paralysis synkinesis (15/30, 50%), while 10 had complete flaccid paralysis. The median house-Brackmann score was 2 (range 1-6). The mean duration of facial palsy was 39.5 ± 106.9 (range 1-576 months). The duration of follow-up after the initial treatment session was 5.5 months, including 10 sessions. After neuromuscular retraining median PHQ-9 scores improved from 5 (range 0-25) to 3 (range 0-20) (p = 0.002). Mean FaCE PROM scores increased from 47.7 ± 11.5 to 56.5 ± 8.8 (p = 0.001). The mean eFACE score increased from 55.8 ± 15.1 to 71.7 ± 13.6 (p < 0.001). Median SAQ score was lower at the final visit (34.6 ± 13.4) compared to the initial visit (47.7 ± 17.8; p < 0.001). Conclusion: Customized neuromuscular retraining may improve patient-reported mental health, QoL, and facial muscle function and reduce synkinesis in facial nerve dysfunction.

Patient-centered innovation for facial nerve palsy: Bionic reanimation for the paralytic eyelid

Patient-centered innovation for facial nerve palsy: Bionic reanimation for the paralytic eyelid

Exploration of technique for preservation of external-middle ear structure in surgery of jugular foramen paraganglioma （appended 2 case reports）

Objective:To investigate the feasibility and effect of the modified surgery of the classic infratemporal fossa type A approach for the surgical treatment of jugular foramen paraganglioma with preservation of the external and middle ear structures. Methods:The medical data of 2 patients with jugular foraminal paraganglioma treated by sublabyrinthic-transmastoid approach were retrospectively analyzed. The clinical feature, degree of tumor resection, postoperative facial nerve function and hearing retention, and the incidence of postoperative complications were evaluated. Results:Two patients were both female, and were pathologically confirmed as paraganglioma. The tumor of case 1 was staged as C2De1, and case 2 as C1De1. Tumors were completely resected in both patients. Case 1 suffered infection after surgery, with residual tympanic membrane perforation and mixed deafness. Case 2 developed mild facial paralysis（grade Ⅱ） after surgery, and recovered after symptomatic treatment. There was no tumor residue or recurrence during half a year of follow-up. Conclusion:Surgical treatment of certain paragangliomas in the jugular foramen with a combined sublabyrinthic-transmastoid and upper neck approach might achieve both complete resection of the tumor and preserving the structure and function of the outer-middle ear. This procedure is suitable for paragangliomas restricted in the jugular foramen area, with no or limited involvement of the internal carotid artery（C1 or C2）, and with no or mild hearing loss.

An analysis of health-related quality of life in children and adolescents after parotidectomy based on patient-reported outcomes.

To assess health-related quality of life (HRQoL) and its influencing factors in these pediatric patients undergoing parotidectomy. This was a cross-sectional study that included 37 children and adolescents (≤ 19years) with parotid gland tumors who were treated in Sichuan Cancer Hospital between January 2006 and November 2021. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The Wilcoxon rank sum test was used to analyze the factors influencing patients' HRQoL. 37 children and adolescents were included in the study, including 22 cases of benign tumors and 15 cases of malignant tumors. All patients underwent surgery, and some patients with malignant tumors received radiotherapy or chemotherapy. Malignancy, permanent facial palsy, and Frey syndrome were associated with worse HRQoL in children and adolescents with parotid gland tumors. Radiotherapy and no cervical lymph node dissection were associated with worse HRQoL in pediatric patients with malignancy. The surgical approach of parotid is not a factor influencing HRQoL. Factors associated with HRQoL in children and adolescents with parotid gland tumors include pathological types, permanent facial palsy, and Frey syndrome. In addition, factors affecting patients with malignancy include lateral lymph node dissection and radiotherapy.

Percutaneous injection of minocycline in postoperative sialocele following condylar fracture

Sialocele is a common complication of parotid tumour surgery. Aspiration and pressure dressing are the most common conservative treatments for sialoceles. However, they occasionally exhibit a refractory nature. In this case report, a minocycline injection was administered for refractory sialocele following a condylar fracture treated using the retromandibular anterior transparotid approach. Aspiration of the sialocele and the same amount of minocycline injection using three-way stopcocks were performed four weeks after surgery. After the injection, the buccal swelling completely disappeared without complications, including facial palsy. Percutaneous injection of minocycline might be the first choice for postoperative refractory sialocele following condylar fracture.

Bell's palsy and COVID-19: A cohort study with historical rate comparison

IntroductionDuring the SARS-CoV-2 pandemic, immune-mediated neurological events have been described in patients vaccinated against the virus or who have overcome the disease. Among these events is Idiopathic peripheral facial palsy or Bell’s palsy. ObjectivesTo study the incidence of Bell's Palsy in the ENT emergency department of a tertiary hospital in Catalonia during the SARS-CoV-2 pandemic. MethodsRetrospective historical cohort comparison study of patients diagnosed with Bell's palsy between January 2018 and December 2021. Crude incidence rates were calculated as the total number of events divided by person time at risk per 100.000 person-years. Observed (2020, 2021) and historical (2018, 2019) rates were compared using standardized incidence rates with corresponding 95% confidence intervals. ResultsOf the total number of ENT emergency department visits from 2018 to 2021 (22.658), there were 247 cases of Bell's palsy. The incidence rate of Bell's palsy in the pre-pandemic group was 12,2 and 10,9 per 100.000 person-years for 2018 and 2019, respectively. The 2020 standardized incidence rate of Bell's palsy was 0,70 [95% CI 0,49–1,01] and 1,25 [95% CI 0,93–1,67] for 2021. No significant differences were evident between the two groups. ConclusionIn our cohort, no association was found between vaccination or COVID-19 infection and the development of Bell's Palsy.

Prevention and Treatment of Post-Paralytic Synkinesis: Critical Changes Following Severe Facial Palsy

Prevention and Treatment of Post-Paralytic Synkinesis: Critical Changes Following Severe Facial Palsy

"Muscle foreshortening after free gracilis transfer for smile: Where, when, why?"

Gracilis free muscle transfer (GFMT) remains the standard for smile restoration in patients with long-standing facial palsy. Resting oral commissure lateralization (ROCL) following GFMT is aesthetically unappealing and can cause functional problems including dysarthria and oral incompetence. The risk factors for ROCL following GFMT are poorly understood. Of all patients who underwent GFMT for smile restoration from 2003 - 2021, patients with subsequent ROCL were identified from a facial nerve database using pre-determined search criteria. Medical records were reviewed to identify potential risk factors for muscle foreshortening. Of 412 patients who underwent successful GFMT since 2003, we identified 41 (10%) patients who subsequently developed ROCL. ROCL rates varied significantly based on gracilis innervation source, with ipsilateral CN VII innervation and dual-innervation (cross-facial nerve graft (CFNG) plus ipsilateral nerve-to-masseter (NTM)) demonstrating the highest foreshortening rates (27.3% and 15.4%, respectively), compared to the lowest rates of foreshortening when gracilis was innervated by CNFG alone (3.2%), p=0.005. Patients with a history of radiation to the surgical field were significantly more likely to develop ROCL (22%) compared to those without a history of radiation (8.6%), p<0.001. Furthermore, the rate of ROCL was significantly higher among patients who underwent concurrent stabilization of the nasolabial fold using a wide band of fascia lata (20.8%) compared to those who did not (6.6%), p<0.001. Herein we report potential risk factors for ROCL following GFMT for smile restoration, including innervation source, radiation history, and concurrent fascia lata static suspension.

Overview of Unilateral and Bilateral Pediatric Facial Paralysis: Workup, Treatment, and Frontiers.

Pediatric facial nerve paralysis can present significant challenges based on its various etiologies, unique approach to treatment options, and overall outcomes. It can impact both the child and parent when regarding function, appearance, and psychosocial implications. The etiology of facial nerve palsy can include congenital, traumatic, iatrogenic, and idiopathic causes. In some, the paralysis is transient while others have permanent loss of function. A thorough evaluation and differential diagnosis are essential to guide treatment planning. The purpose of this paper is to review facial paralysis in children with a focus on surgical management.

Long-Term Outcomes of Modified Endoscopic Transcanal Approach to Small Acoustic Tumors.

The management options for small acoustic tumors are still controversial, and surgery is indicated in a select number of patients only. This is to avoid unnecessary extensive operations and risk of complications. Endoscopic transcanal approach, which was recently introduced, can be an alternative option to overcome these challenges. We have developed a modified technique for endoscopic transcanal removal of small acoustic tumors with tympanoplasty using tragal cartilage and without the need to harvest abdominal fat for obliteration. There was also no need to do an ear cul-de-sac procedure compared with the previous method. We report the long-term outcomes of this approach. Retrospective review. Tertiary hospital. Those who were diagnosed with small acoustic tumors between June 2016 and June 2022 were enrolled. Tumor removal via a Modified Endoscopic Transcanal Transpromontorial Approach (mETTA). Tumor control rate, closure rate of tympanic membrane, and complications such as cerebrospinal fluid (CSF) leakage and facial palsy were analyzed. Operation time and hospital stay were also analyzed. Twenty-two patients with a mean age of 55.5 ± 9.4 years were enrolled. Eighteen were vestibular schwannomas (VS), two were intracochlear schwannomas (ICS), and two were with intravestibulocochlear schwannomas (IVCS). Gross total removal was achieved in 21 cases. One had developed significant CSF leakage, and the other patient complicated with permanent facial palsy. The tympanic membrane healed well in all patients, but three patients showed delayed healing until several months and treated conservatively. Mean operation time was 149.6 ± 48.4 minutes, mean hospital stay was 8.9 ± 4.5 days, and mean postoperative follow-up period was 42.0 ± 15.7 months. Long-term results of modified endoscopic transcanal approach to small acoustic tumors are acceptable and comparable to classical treatments such as translabyrinthine approach or gamma knife radiation. This is an alternative option for smaller tumors warranting surgical removal and maintained cosmetic advantages.

Beyond the smile: a systematic review of diagnostic tools for peripheral facial paralysis.

Effective rehabilitation of peripheral facial paralysis (PFP) requires reliable assessment tools. This systematic review aimed to identify and validate instruments used in PFP rehabilitation, categorizing them according to the ICF framework. A comprehensive search was conducted across PubMed, Cinahl, Web of Science, and Scopus up to April 2024. Observational analytical studies and one non-randomized controlled trial that validated tools for assessing PFP were included. Thirty-three studies were included, covering twenty different tools. Seventeen tools were related to the "Structure and Function" domain, while three addressed "Activity and Participation." The Sunnybrook and House-Brackmann scales were the most extensively studied. The Sunnybrook scale exhibited excellent intra- and inter-rater reproducibility and internal validity, making it suitable for clinical use. The House-Brackmann scale was user-friendly but had limitations in reproducibility and sensitivity to subtle differences, which newer versions like the FNGS 2.0 aimed to address. The FAME scale showed promise by reducing subjective scoring. Computerized tools, such as eFACE and A-FPG, and instruments for lip asymmetry and ocular involvement demonstrated potential but require further validation. The Facial Disability Index and the FaCE Scale were validated for assessing disability and participation restrictions. This review identified several validated tools for PFP assessment, with the Sunnybrook and House-Brackmann scales being the most reliable. While emerging tools and computerized programs show promise, they need further validation for routine clinical use. Integrating validated tools into clinical practice is essential for comprehensive assessment and effective rehabilitation of PFP.

The Role of Botulinum Toxin A Neuromodulator in the Management of Synkinesis in Facial Palsy.

Facial palsy describes the denervation of the facial nerve leading to difficulty in facial animation and expression. Facial synkinesis is the result of complex pathological nerve regeneration following damage to the facial nerve axons. Synkinesis in facial palsy can be managed using facial neuromuscular rehabilitation, botulinum toxin neuromodulators, and surgical treatment options. Botulinum toxin A can be used as an adjunct to other treatment options to manage synkinesis. This article will explore the role of botulinum toxin A in the management of synkinesis in facial palsy including the clinical assessment, injection location (muscles targeted), dosages, treatment interval, and long-term results. It will also include surgical management options.

Granulomatous cheilitis: a rare case report

Granulomatous cheilitis is a rare granulomatous disorder characterized by a recurrent firm swelling of one or both lips. This is called the cheilitis granulomatosa of Miescher (CGM) when it occurs in isolation. It is called Melkersson-Rosenthal syndrome (MRS) if the classical triad of recurrent or persistent orofacial edema, plicated or fissured tongue (lingua plicata), and relapsing peripheral facial nerve paralysis is present. A 40-year-old female patient came to the Dermatology Department with persistent painless swelling of both lips and perioral area for the last one year. On histopathological examination there was a nodular tuberculoid granulomatous inflammation in patchy pattern present throughout the submucosa. The granuloma consists of lymphocytes, histiocytes and occasional plasma cells. AFB stain and PAS stain were negative. Diagnosis of granulomatous cheilitis was made and patient was put on tab clofazimine and intralesional corticosteroids. The case is being reported due to its rarity and the role of dermatopathologist to make a diagnosis.

Exposure of the facial nerve within the facial canal: A technical report

BackgroundThe facial canal lies in the petrous part of the temporal bone and contains the facial nerve. The facial canal and nerve are divided into three segments: the labyrinthine, tympanic and mastoid segments, which travel in different planes. These segments are closely related to the structures of the middle- and inner-ear, so pathology of the intracranial facial nerve is often evident in cochlear implant users. The facial canal and nerve are of great concern to otologists during electrode placement for a cochlear implant, as any damage to the nerve may result in untreatable facial paralysis. Few studies have been conducted on a cadaveric population, with most carried out on CT images of the cochlea and facial nerve. Thus, there is no standard or straightforward methodology to visualise the facial canal and nerve directly. We propose a detailed dissection technique to bridge this gap in research. MethodFour cadavers were used, and both the left and right facial canals were dissected. After the exposure of the cranial floor, the internal acoustic meatus and the facial canal were dissected out using drilling tools to remove the surrounding temporal bone and expose the facial nerve within the facial canal. ResultsThis technique allowed for morphometric analyses and observations of the facial canal in relation to the middle- and inner-ear. ConclusionKnowledge of the facial canal may assist otosurgeons in safely dissecting the region without injuring vital structures within this area.

Risk Factors Associated with Bell's Palsy in Faisalabad: A Retrospective Study

Background: Bell's palsy is a common neurological disorder characterized by sudden facial paralysis, leading to significant distress and reduced quality of life. Despite extensive research, the exact etiology remains unclear, with various factors such as age, gender, and comorbid conditions like hypertension and diabetes implicated.Objective: This study aimed to identify the risk factors associated with Bell's palsy in a specific population, focusing on demographic and clinical variables.Methods: A retrospective study was conducted on 98 patients diagnosed with Bell's palsy in Faisalabad, Pakistan. Data were collected from multiple healthcare settings, including government and private hospitals, polyclinics, and independent medical practitioners. Variables such as age, gender, BMI, comorbidities, and history of exposure to cold were analyzed. Statistical analysis was performed using SPSS version 25.Results: Of the 98 patients, 56.12% were female, and 43.88% were male. The right side of the face was affected in 67.3% of patients, while 32.7% had left-side involvement. Significant associations were found between Bell's palsy and hypertension (p &lt; 0.05), diabetes mellitus (p &lt; 0.05), and exposure to cold (p &lt; 0.05).Conclusion: Bell's palsy was more prevalent in females and younger individuals. Hypertension, diabetes, and cold exposure were identified as significant risk factors. These findings contribute to understanding the potential causes and risk factors for Bell's palsy, informing clinical management and prevention strategies.

Static reanimation of the paralyzed face using non-absorbable polypropylene mesh.

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; There are 2 methods for correcting facial deformities resulting from facial nerve paralysis - dynamic and static. Although dynamic methods are the standard approach in selected patient groups, static facial suspension using synthetic material provides a minimally invasive alternative for those who do not qualify for them.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;b&gt; Presenting experiences with the use of non-absorbable polypropylene mesh in the Department of Plastic Surgery in Polanica-Zdrój and reviewing the literature related to static facial reanimation methods.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; Fourteen patients underwent static facial tissue suspension using non-absorbable polypropylene mesh and 12 patients underwent surgery using classical autologous tissue techniques between 2019 and 2023. Indications for surgical treatment were analyzed, and preliminary results of treatment using both methods were compared.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Compared to autologous tissue methods, surgeries using synthetic mesh were associated with shorter hospitalization times. No long-term postoperative complications were observed in any patient. There were no differences in treatment outcomes between autologous tissue and synthetic mesh techniques, and all patients assessed the outcome as favorable.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Discussion:&lt;/b&gt; Treatment of facial nerve paralysis sequelae using static techniques should be considered for patients not qualifying for surgery with dynamic methods and/or not consenting to such procedures. Using synthetic material as an alternative to autologous material reduces surgical time and avoids donor-site injuries and prolonged recovery.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Facial suspension with synthetic material is an effective, low-risk procedure for static correction of facial nerve paralysis sequelae.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Study significance:&lt;/b&gt; Emphasizing the importance of static methods in facial reanimation.&lt;/br&gt.