Management Of Facial Paralysis Research Articles

The Impact of the COVID-19 Pandemic on Bell's Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study.

This article presents a comprehensive review of data on the impact of facial palsy during the coronavirus disease 2019 (COVID-19) pandemic. The possible causes and pathophysiological mechanisms of changes in the epidemiology of facial palsy during the COVID-19 pandemic are also discussed. This multicenter retrospective cohort study included 943 patients diagnosed with Bell's palsy or Ramsay Hunt syndrome. This study compared patient demographics, comorbidities, symptoms, and treatments before the COVID-19 pandemic (from 2017 to 2019) and during the COVID-19 pandemic, from 2020 to 2022). Following the COVID-19 outbreak, there has been a significant increase in the number of cases of Bell's palsy, particularly among elderly individuals with diabetes. Bell's palsy increased after the COVID-19 outbreak, rising from 75.3% in the pre-COVID-19 era to 83.6% after the COVID-19 outbreak. The complete recovery rate decreased from 88.2% to 73.9%, and the rate of recurrence increased from 2.9% to 7.5% in patients with Bell's palsy. Ramsay Hunt syndrome showed fewer changes in clinical outcomes. This study highlights the impact of the COVID-19 pandemic on the presentation and management of facial palsy, and suggests potential associations with COVID-19. Notably, the observed increase in Bell's palsy cases among elderly individuals with diabetes emphasizes the impact of the pandemic. Identifying the epidemiological changes in facial palsy during the COVID-19 pandemic has important implications for assessing its etiology and pathological mechanisms of facial palsy disease.

Facial Palsy Treatment After Cranial Base Fracture : A Systematic Review

Facial nerve paralysis is a common event in cases of cranial base trauma. Especially facial nerve paralysis due to trauma or fracture of the temporal bone accounts for around 7-10% of cases. Analysis of studies related to the management of facial nerve paralysis due to skull base fractures still needs to be studied. The aim of this paper is to examine in more depth the management of facial nerve paralysis due to traumatic skull base fractures. This research analyzes studies through the PubMed, Google Scholar, and Proquest databases. After searching, 729 articles were found. Seven articles were found that were suitable and discussed the management of facial nerve paralysis due to cranial base trauma. Based on the results of the investigation, it was found that the management carried out was based on the severity scale of facial paralysis where medical or surgical treatment could be carried out according to the required indications.

Patient Perception of Education, Care Coordination, and Psychological Distress After Developing Facial Paralysis

The management of vestibular schwannoma may include observation, microsurgical resection, or radiation of a tumor near the facial nerve. Injury to the facial nerve can result in facial paralysis with major functional, social, and psychological sequelae, and the experiences of patients after paralysis are not well studied. To (1) identify patient preparedness for developing facial paralysis and how well their care is coordinated following its development and (2) present in their own words outcomes of facial paralysis in terms of physical health, emotional health, self-perception, and social interactions. A qualitative observational study was performed using semistructured interviews at a tertiary care academic medical center. Semistructured interviews were conducted between January 1, 2018, and June 30, 2019, with adults aged 25 to 70 years who developed facial paralysis after treatment for vestibular schwannoma. Data were analyzed from July 2019 to June 2020. Perceptions of the educational and emotional experiences of individuals who developed complete facial paralysis after surgical treatment of vestibular schwannoma. Overall, 12 participants were interviewed (median age, 54 years [range, 25-70 years]; 11 were female). Saturation was achieved after 12 interviews, indicating that no further information could be elicited from additional interviews. Four major themes were identified: (1) lack of sufficient patient education about the diagnosis of facial paralysis; (2) lack of appropriate care coordination related to facial paralysis; (3) changes in physical and emotional health following facial paralysis; and (4) changes in social interactions and external support following facial paralysis. It is well-known that patients with facial paralysis have reduced quality of life, severe psychological and emotional sequelae. However, little is currently done to help prepare patients for this undesirable outcome. In this qualitative study of facial paralysis, patients express, in their own words, their feeling that the education and management of facial paralysis by their clinicians was inadequate. Before patients undergo surgery, and certainly after injury to the facial nerve, clinicians should consider the patient's goals, preferences, and values to ensure that a comprehensive educational program and psychosocial support system are implemented. Facial reanimation research has not adequately captured these key patient factors associated with the quality of communication.

Study of Palmaris Longus Tendon among the Undergraduate Medical Students

Palmaris longus is a thin fusiform shaped muscle which terminates as a long slender tendon and enters the palmar aponeurosis of the hand. It is also one of the most variable muscles in the body. The main objective of this study was to detect its tendon in both hands and to compare and analyse it in relation to gender and hand dominance. An observational, descriptive study was conducted over a period of 11 months from October 2021 – August 2022 in the Department of Human Anatomy of Nepal Medical College and Teaching hospital, Gokarneshwor – 8, Kathmandu, Nepal. Following tests were conducted for its detection. 1. Schaeffer’s, 2. Thompson’s, 3. Mishra’s test I, 4. Mishra’s test II and Pushpakumar’s test. The results obtained showed that presence of left palmaris longus was more in left handed individuals which was statistically significant with p – value of 0.025. Similarly, presence of right palmaris longus was more in right hand dominant participants. Among the left hand dominant participants, left palmaris longus agenesis was more common in female which was also found to be statistically significant with p-value of 0.009. The knowledge regarding the palmaris longus tendon is of growing interest to surgeons these days for its augmentation, ptosis correction and in facial paralysis management. It gains its importance for autograft as it fulfills the requirement of length, diameter and availability. Hence the study regarding the palmaris longus tendon in relation to its hand dominance and gender can be helpful to surgeons working in various fields.

New trends in management of facial nerve paralysis

New trends in management of facial nerve paralysis

Incidence and Management of Facial Paralysis After Skull Base Trauma, an Administrative Database Study.

Report the incidence of and treatment patterns for facial nerve palsy after skull base fracture. Retrospective cohort study. IBM MarketScan Commercial Database (2006-2019). Human subjects with skull base fracture, per International Classification of Diseases-9th and 10th Revisions-Clinical Modification diagnosis codes. The primary outcomes were the incidence and median time to facial nerve palsy diagnosis within 30 days of skull base fracture. Secondary outcomes were treatments (corticosteroids, antivirals, facial nerve decompression, botulinum toxin, and facial reanimation), demographics, and rates of hearing loss, vertigo, tympanic membrane rupture, cerebrospinal fluid leak, comorbidities, and loss of consciousness. The 30-day incidence of facial nerve palsy after skull base trauma was 1.0% (738 of 72,273 patients). The median (95% confidence interval [CI]) time to diagnosis was 6 (6-7) days, and only 22.9% were diagnosed within 1 day. There were significantly higher rates (risk difference, 95% CI) of hearing loss (26%, 22-29%), tympanic membrane rupture (6.3%, 4.5-8.1%), cerebrospinal fluid leak (6.4%, 4.5-8.3%), comorbidity (14%, 10.4-17.6%), and loss of consciousness (24.3%, 20.7-27.9%). Loss of consciousness was associated with longer median (95% CI) time to facial nerve palsy diagnosis: 10 (9-10) days. Corticosteroids were the most common treatment but only reported for less than one-third of patients. Only eight patients underwent facial nerve decompression. Facial nerve palsy after skull base fracture is associated with higher comorbidity, and the diagnosis is often delayed. Few patients were treated with surgery, and there are inconsistencies in the types and timing of treatments.

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.

Trends in Facial Paralysis Management: A National Survey Study.

Advances in operative management, minimally invasive procedures, and physical therapy have allowed for dramatic improvements in functional and cosmetic outcomes in patients with facial paralysis. Our goal was to evaluate the current trends and practice patterns in the diagnosis and management of facial paralysis by provider demographics. An electronic questionnaire was distributed to members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Practice patterns in the diagnosis and treatment were compared by level of training (fellowship-trained facial plastic and reconstructive surgeon versus non-fellowship trained), practice type (academic and private), practice length, patient volume, and presence of a dedicated facial nerve clinic. The bivariate associations of the outcome variables and the stratification factors were analyzed using 2-way contingency tables and Fisher's exact tests. The survey was sent to 1129 members of the AAFPRS. The response rate was 11.7% (n=132). Most respondents were fellowship-trained surgeons (79%) in the academic setting (55%), and most have been in practice for more than 10 years (53%). Practice setting and patient volume were the factors most associated with significant variations in management, including the use of facial paralysis grading scales, photography/videography, patient-reported outcome metrics, as well as differences in both noninvasive and surgical management. Based on the present study, several physician demographic factors may play a role in choosing which diagnostic and treatment options are employed for facial paralysis, with practice setting and patient volume appearing to be the 2 variables associated with the most significant differences.

A Historical Perspective on the Management of Facial Paralysis: From Ancient Civilizations to the Modern Era.

Documented evidence of facial nerve paralysis (FNP) and its treatment have been discovered in many early civilizations dating back centuries. Early records are present in art and scripts across ancient civilizations and have laid the groundwork for the implementation of many managements used in modern practice. Although the current management of FNP is still evolving, it includes a complex and multimodal spectrum of options ranging from pharmacologic therapy to facial physical therapy and neuromuscular training, and surgical facial reanimation interventions via static and dynamic procedures. The aim of this review is not to provide an up-to-date glossary of modern management options but rather to discuss the historical evidence of FNP and treatments leading up to current techniques and practices.

A CASE REPORT: AYURVEDIC MANAGEMENT OF ARDITAVATA (FACIAL PALSY)

Arditavata is a disease in which both facial expressions and communication are disabled. It is a VataVyadhi with an increased prevalence in present day scenario is due to exposure to Vatavrddhikara Ahara and Vihara. Ardita (facial palsy) is a disease that presents with deviation of half of the face, associated with impairment of motor and sensory functions of affected side of the face. This disease affects all the age groups, and it is need of the hour to curb the disease through effective treatment. The present study mainly focuses on management of facial palsy(LMN type) through Ayurvedic medicines like Ekangaveeraras, Kanchanara Guggulu, Aswagandhachurna (Internally),Kukkutanda Nimbuka sweda and Ksheera bala taila Nasyam. Targeting the dosha involved, and there by curing the disease is successful key tool in treating Arditavata(Facial Palsy) through Ayurveda

Facial Nerve Paralysis as A Complication of Acute Otitis Media

Background:Facial nerve paralysis is not a very frequent association with acute otitis media (AOM). The pathophysiology and treatment of this condition still under debate. Aim of the Work:to review the treatment strategies and extent of recovery in patients with facial nerve paralysis after AOM. Patients and Methods:The study was a retrospective study. Authors reviewed a total of 4710 cases of AOM seen during the period form 2010 to 2020. Fourty cases developed facial nerve paralysis. All were reviewed for epidemiological data and clinical assessment. Facial palsy was graded by House-Brackmann scale. All patients were treated with antibiotics combined with oral or intravenous corticosteroids. Myringotomy with or without application of a ventilation and mastoidectomy without decompression of the facial nerve were performed in selected cases. Result:Normal facial function was resumed to normal in all patients. The paralysis was mainly of acute onset (90.0%) and otorrhea reported among 12.5%. The initial paralysis grade was mainly grade IV (41.3%) followed by grade III (26.3%). The topography was mainly infrageniculate (86.3%). A collected material for bacteriology was reported for 40.0%, and 53.1% of them had negative culture. The most common detected organism was staphylococcus aureus (18.8%). Myringotomy was done for 7.5%, aspiration for 10.0% and Mastoidectomy for 10.0%. The overall outcome was good among 90.0% and bad among 10.0%. The duration for complete cure in cases with good outcome not exceeded 3 months. Only lower initial grade on House-Brackmann scale and infrageniculate topography were associated with favorable outcome. Conclusion: The management of facial nerve paralysis due to acute otitis media could be conservative by antibiotics with corticosteroids.

The Experience of a Facial Nerve Unit in the Treatment of Patients With Facial Paralysis Following Skull Base Surgery.

: The management of facial paralysis following skull base surgery is complex and requires multidisciplinary intervention. This review shows the experience of a facial nerve (FN) unit in a tertiary university referral center. A multidisciplinary approach has led to the breaking of some old treatment paradigms. An overview of five FN scenarios is presented. For each setting a contemporary approach is proposed in contrast to the established approach. 1) For patients with an anatomically preserved FN with no electrical response at the end of surgery for vestibular schwannoma, watchful waiting is usually advocated. In these cases, reinforcement with an interposed nerve graft is recommended. 2) In cases of epineural FN repair, with or without grafting, and a poor expected prognosis, an additional masseter-to-facial transfer is recommended. 3) FN transfer, mainly hypoglossal-to-facial and masseter-to facial, are usually chosen based on the surgeons' preference. The choice should be based on clinical factors. A combination of techniques improves the outcome in selected patients. 4) FN reconstruction following malignant tumors requires a combination of parotid and temporal bone surgery, involving different specialists. This collaboration is not always consistent. Exposure of the mastoid FN is recommended for lesions involving the stylomastoid foramen, as well as intraoperative FN reconstruction. 5) In patients with incomplete facial paralysis and a skull base tumor requiring additional surgery, consider an alternative reinnervation procedure, "take the FN out of the equation" before tumor resection. In summary, to achieve the best results in complex cases of facial paralysis, a multidisciplinary approach is recommended.

Management of facial paralysis following treatment of neurosurgical tumours

The purpose of this study is to present our experience on improving the quality of life of patients with facial paralysis due to an operated intracranial tumour, by performing minimally invasive static reanimation procedures. We reviewed the clinical information pertaining to neurosurgical patients with facial paralysis that underwent static reanimation. The study included 11 patients with complete facial nerve paralysis of all nerve branches, that reported different primary complaints upon presentation. The performed procedures consisted of gold plate insertion into the superior eyelid, inferior eyelid ectropion correction or suture suspension. The functional results were favourable in all cases and the resulting appearance was acceptable. The choice of the different techniques used is discussed. Good outcomes are possible using static reanimation with an adequate adaptation of the techniques to the main patient complaint.

Effects of self-designed facial muscle exercise in facial paralysis nursing among patients after acoustic neurinoma surgery

Objective To explore the effects of self-designed facial muscle exercise in facial paralysis nursing among patients after acoustic neurinoma surgery. Methods From May 2018 to February 2019, we selected 90 cerebellopontine angle (CPA) patients after acoustic neurinoma surgery of the Cancer Ward of Neurosurgery Department at a Class Ⅲ Grade A hospital in Beijing. All of the patients were randomly divided into experimental group (n=50) and control group (n=40) . Control group carried out routine facial paralysis management. On the basis of routine nursing, experimental group implemented the self-designed facial muscle exercise directed by researchers from 10: 00 to 11: 00 in the morning and from 16: 00 to 17: 00 in the afternoon. The grades of facial paralysis after facial paralysis were assessed with the House-Brackmann facial nerve grading system, and statistical analysis was used to the recovery effects of facial paralysis and anxiety of patients between two groups. Results A total of 30 days after surgery, the total effective rate of experimental group was higher than that of control group with a statistical difference (P 0.05) . The scores of SAS of experimental group were lower than those of control group 7, 30 and 90 days after surgery with statistical differences (P<0.01) . Conclusions The self-designed facial muscle exercise can promote the recovery of facial paralysis after acoustic neurinoma surgery and improve anxiety of patients. Key words: Rehabilitation nursing; Acoustic neurinoma; Postoperative period; Facial paralysis; Self-designed facial muscle exercise; Anxiety

Impact of increasing age on functioning free muscle transplantation for facial palsy reconstruction.

Management of facial paralysis in older patients is controversial. The purpose of this study is to evaluate the impact of increasing age on functioning free muscle transplantation (FFMT). Twenty-nine facial paralysis patients over 50 years old received FFMT. A separate group of patients aged 41-50 years old were included as control. Outcome assessments included use of the SMILE evaluation system for excursion, a cortical adaptation scoring system for brain plasticity, and a subjective satisfaction assessment score. Meta-analysis of literature over the past 50 years was also performed to examine the impact of older age. The mean change in excursion movement was 13.39 ± 5.49 mm. Weakest excursion was found in the oldest age group (11.74 ± 4.84 mm, p = .097), in concordance with the meta-analysis. There was significant difference between the three different neurotizers (p = .036). Excursion and satisfaction score were significantly worse in the older cohort with the cross face-nerve graft FFMT. FFMT is a viable option in the elderly patient group but performs weaker in excursion. The choice of neurotizer is dependent on the patient's goals and the suitable age at which the benefits outweigh the risks.

A Static Facial Sling Technique Restoring Nasolabial Sulcus in Facial Paralysis.

Static facial sling techniques are useful rehabilitation modalities where dynamic rehabilitation methods are not feasible in the management of facial paralysis. The authors present their technique as an alternative static sling method, which may give the patient a more natural nasolabial sulcus restoration in addition to suspension of the oral commisure.

Evaluation and management of facial nerve paralysis in MGM medical college

Evaluation and management of facial nerve paralysis in MGM medical college

Management of facial nerve paralysis in children

Management of facial nerve paralysis in children

A Study of Etiopathology and Management of Facial Palsy at a Tertiary Care Institute

A Study of Etiopathology and Management of Facial Palsy at a Tertiary Care Institute

Facial nerve paralysis grade V managed with combined medical and alternative therapy: a case report with literature review

AbstractBackgroundVery few studies are available in the management of facial nerve paralysis with alternative therapies.MethodsA medical case is reported with facial nerve paralysis grade V (FNPV) managed with combined medical and alternative therapy, a relatively new modality in management options.ResultsA 23‐years old Saudi woman presented with FNPV according to the House–Brackmann grading system. The patient was immediately offered management with combined drug therapy and alternative therapy for 3 months.ConclusionIn spite of the current debate regarding the application of alternative therapies in treating patients with medical conditions, this 23‐year old woman with FNPV recovered significantly after 3 months’ treatment using a combination of medical and alternative therapies. We conclude that offering alternative therapy, specifically wet cupping, or Hijama, in treating difficult medical conditions like FNPV can aid in the complete recovery of the condition.