Peripheral Facial Palsy Patients Research Articles

The Effects of Telerehabilitation-Based Exercise Therapy on Motor and Non-Motor Clinical Outcomes in Adults With Facial Palsy: A Randomized Controlled Trial.

Recent case reports have emphasized the essential clinical contribution of telerehabilitation in the treatment of facial palsy. However, no randomized controlled trial has yet demonstrated the effects of telerehabilitation-based facial exercise therapy. Thus, we aimed to investigate the effectiveness of video exercise-based telerehabilitation on motor and non-motor clinical outcomes in adults with facial palsy. We conducted a randomized controlled trial with 40 peripheral facial palsy patients. Those in the experimental group (EG) received four weeks of telerehabilitation-based video exercises and routine care. Those in the control group (CG) received only routine care. All participants were evaluated with the Facial Disability Index (FDI), the Facial Clinimetric Evaluation Scale (FaCE), Short Form-12 (SF-12), the Hospital Anxiety and Depression Scale (HADS), the House-Brackmann Scale (H-B) and the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ), both before and after the interventions. Both groups demonstrated a significant improvement in FDI, FaCE, and SF-12 PCS scores (p < .05). In addition, there was a significant improvement only in EG on the SF-12 MCS score (p < .05), and there was a significant gain only in CG on the HADS-Depression score (p < .05). While these results provide a further contribution to our understanding of telerehabilitation benefits in mental health variables related to quality of life for facial palsy patients, we found no EG and CG differences on the physical components of treatment.

Comparison of the Reliability of the House- Brackmann, Facial Nerve Grading System 2.0, and Sunnybrook Facial Grading System for the Evaluation of Patients with Peripheral Facial Paralysis.

To compare the reliability of the House-Brackmann (HB), Facial Nerve Grading System 2.0 (FNGS 2.0), and Sunnybrook Facial Grading System (SB) which are widely used in the evaluation of peripheral facial paralysis (PFP) patients. Thirty-five video-recorded adult PFP patients were included in the study. The evaluators comprised 6 physicians. Evaluations were conducted twice independently, utilizing video recordings. Simultaneously, the evaluators were asked to keep time during the evaluation. For the analysis of reliability, Fleiss' kappa coefficient was used for the HB, and the intraclass correlation coefficient (ICC) was used for the FNGS 2.0 and SB. The mean evaluation time of 1 patient was found to be 1.06 ± 0.24, 1.47 ± 0.23, and 2.32 ± 0.41 minutes for the HB, FNGS 2.0, and SB, respectively. For interrater reliability, Fleiss' kappa for the HB was 0.495 and 0.403; ICC for the FNGS 2.0 was 0.966 and 0.958; ICC for the SB was 0.960 and 0.967 for the first and second measurements, respectively. For intrarater reliability, Fleiss' kappa for the HB was 0.391, 0.446, 0.564, 0.502, 0.626, and 0.455; ICC for the FNGS 2.0 was 0.87, 0.982, 0.966, 0.929, 0.933, and 0.948; ICC for the SB was 0.935, 0.96, 0.895, 0.941, 0.96, and 0.94 for the 6 raters, respectively. In the present study, statistically high intra- and interrater correlations were found for the FNGS 2.0 and SB, while a moderate correlation was found for the HB. Although the HB seems to be more practical, it has been concluded that the FNGS 2.0 and SB are more reliable.

Psychological counselling in patients with a peripheral facial palsy: initial experience from an expert centre

The aims of this pilot study were to evaluate the psychologist's role on the multidisciplinary team during peripheral facial palsy (PFP) patient care and to identify the potential predictors of anxiety and depressive symptoms/disorders in PFP patients. Using the prospective non-controlled study design, PFP patients aged 18-75 years who presented to the Radboud Facial Palsy Expert Centre, the Netherlands, were enrolled during a 1-year interval. The main outcome variables were 1) anxiety and depression in relation to PFP using the Hospital Anxiety and Depression Scale (HADS) and 2) the outcome of psychological counselling in patients with a HADS score ≥ 8. A sample comprised 25 patients (68% females, 56% right-side PFP, 16% House-Brackmann scale I-II) with a mean age of 50 ± 14 years were referred to a psychologist. The proportion of patients with a HADS score ≥8, were 16 (64%) and 13 (52%), respectively. Especially, coping (in general or coping with the disease, 48%) and/or help with the choice of possible surgery (8.0%) were important reasons for counselling. In one case, a patient had chronic fatigue syndrome and was therefore referred to a psychological specialist centre. One patient was treated with acceptance and commitment therapy (ACT) with good results. Despite a small sample size and limited statistical analyses, the results of this study suggest that one-eighth of the PFP patients require psychological evaluation and treatments. This pilot study emphasises the important role of psychological screening and counselling in PFP patient care.

Validation of the Turkish Translation of the Facial Clinimetric Evaluation Scale in Patients with Peripheral Facial Paralysis

Objective: To transcribe and validate the Facial Clinimetric Evaluation (FaCE) scale to be able to use it in a Turkish-speaking patient population with peripheral facial paralysis (PFP). Material and Methods: The original English FaCE scale was translated according to international guidelines. Then a validation study was conducted on 37 patients with facial paralysis. The patients completed the scale twice at a 1-week interval. Internal consistency was evaluated with the Cronbach alpha coefficient. The correlations between the FaCE scale and the House-Brackmann Grading System (HBGS), the Sunnybrook Grading System (SBGS), and the Facial Disability Index (FDI) scores and structure validity were evaluated by calculating the Spearman rho correlation coefficient. Results: The FaCE scale showed internal consistency with an excellent Cronbach α value of 0.828. Test-retest reliability was shown with an Intraclass Correlation Coefficient (ICC) in the range of 0.51-0.95. The FaCE scale was determined to be well correlated with the HBGS and SBGS points (r=-0.51, r=0.65, respectively). The FaCE scale face movement score showed the highest correlation with HBGS (r=-0.61). SBGS had the highest correlation with the oral function score (r=0.61). The study determined there to be a good correlation between the FaCE scale and the social/well-being function and physical function of the FDI (r=0.69, r=0.66, respectively). Conclusion: The FaCE scale is a reliable and valid tool for assessing the quality of life of PFP patients. The Turkısh version of the FaCE Scale showed good psychometric properties. By showing high validity and reliability, the Turkish FaCE scale can be used in Turkish-speaking patients with peripheral facial paralysis.

Clinical observation on acupoint sticking therapy plus electroacupuncture for treating peripheral facial paralysis

To observe the clinical effect of acupoint sticking therapy with Mian Tan Gao (facial paralysis paste) plus electroacupuncture (EA) for treating peripheral facial paralysis and its influence on patients’ facial nerve functions, facial disability index and clinical symptoms and signs. A total of 96 peripheral facial paralysis patients were allocated into an observation group, a medicine group and an EA group by simple randomization, with 32 cases in each group. Patients in the medicine group were treated with oral mecobalamine and prednisone acetate; patients in the EA group were treated with EA on the basis of the medicine treatment; while patients in the observation group were treated with acupoint sticking therapy with Mian Tan Gao (facial paralysis paste) plus EA. After 4-week treatment, the clinical efficacy, the adverse events, and the scores of House-Brackmann (H-B) facial nerve function grading scale, visual analog scale (VAS), clinical symptoms and signs, and facial disability index (FDI) were compared. After 4-week treatment, the total effective rate was 96.9% in the observation group, higher than 68.7% in the medicine group and 75.0% in the EA group (both P 0.05). The between-group comparison of the adverse event across the three groups showed no statistical significance (P>0.05). Acupoint sticking therapy with Mian Tan Gao (facial paralysis paste) plus EA can decrease H-B grade, reduce pain severity and improve clinical symptoms and signs as well as the facial disability condition in peripheral facial paralysis patients. This method produced more significant efficacy compared with oral medicine and medicine plus EA.

French Translation and Validation of the Synkinesis Assessment Questionnaire.

Synkinesis is a distressing sequela of peripheral facial palsy (PFP). This study aimed to translate and validate the Synkinesis Assessment Questionnaire (SAQ), a reliable patient-reported outcome evaluation tool for synkinesis, in French. The SAQ was translated following a standard forward-backward translation procedure. After a cognitive debriefing with 10 PFP patients, the SAQ-F was assessed amongst 50 patients for internal consistency, known-group validity, construct validity, criterion validity, and test-retest reliability. Results demonstrated that the SAQ-F was valid, reliable, and had a unidimensional structure. The SAQ-F should be accompanied by clinician-based scales, to provide valuable additional information on the severity of synkinesis.

Altered brain language network in idiopathic peripheral facial paralysis patients with dysarthria.

BackgroundDysarthria is one of the common symptoms of facial paralysis (FP). This study aimed to investigate functional alterations in the brain language network in early idiopathic peripheral FP patients with dysarthria using resting-state functional magnetic resonance imaging (fMRI).MethodsA total of 45 cases of FP (left 22, right 23) and 34 cases of healthy control (HC) were recruited into this study. The data of patients with left-side FP and matched controls (17 cases) were flipped from left to right, and the brain regions were defined as ipsilateral and contralateral regions. The FC of 16 ROIs in classical language centers and regions that may be involved in language function were calculated. After identifying the differences of FC between the two groups, the correlation analysis between altered FC and TFGS score of oral muscle movement in FP group were analyzed.ResultsThe FC between bilateral language regions has a significantly decreased trend in FP group compared with HC group (P<0.05). The ipsilateral inferior frontal gyrus, superior temporal gyrus, and middle temporal gyrus exhibited significantly decreased FC with multiple brain regions. In addition, we found that thalamus and cerebellum also with a significant alteration in FC in FP patients indicating that these two regions may also be involved in the mechanism of dysarthria in FP. The correlation analysis results indicated that the decrease of FC was positively correlated with the severity of oral paralysis.ConclusionsIdiopathic peripheral FP with dysarthria induces several FC alterations in the brain language network. The severity of oral paralysis is associated with these functional alterations.

Nerve Integrity Monitor Responses to Direct Facial Nerve Stimulation During Facial Nerve Decompression Surgery Can Predict Postoperative Outcomes.

To test whether the threshold of nerve integrity monitor (NIM) responses during facial nerve decompression surgery can predict the postoperative outcome. Retrospective study. University hospital. Twenty peripheral facial palsy patients who underwent transmastoid decompression surgery. During decompression surgery, thresholds of NIM responses were measured via direct facial nerve stimulation at three sites: the geniculate ganglion (GG), the second genu (2 G), and the stylomastoid foramen. Facial nerve function was evaluated before and 6 months after surgery using the Yanagihara grading score (maximum score = 40 points). Complete recovery was defined as an improvement of the grading score to ≥ 36 points without synkinesis. Variables including age, sex, disease (Bell's palsy or Ramsay Hunt syndrome), time after onset, Yanagihara grading score, and electroneurography before surgery, and the thresholds of NIM responses during surgery were compared in the complete and incomplete recovery groups. NIM responders were defined as those exhibiting a NIM response of < 1.5 mA at any site. Postoperative Yanagihara grading scores in NIM responders and NIM nonresponders were compared. No variables differed significantly in the complete and incomplete recovery groups before surgery. NIM response thresholds in the complete recovery group at the GG and the 2nd G were significantly lower than the corresponding thresholds in the incomplete recovery group. The postoperative Yanagihara grading scores of NIM responders were significantly better than those of NIM nonresponders. NIM responses to intraoperative direct facial nerve stimulation were useful for predicting outcomes after decompression surgery.

Acupuncture combined with herbal-cake partitioned moxibustion is superior to routine acupuncture in the treatment of peripheral facial paralysis

To observe the clinical effect of acupuncture combined with herbal-cake (Qianzhengsan) partitioned moxibustion at Xiaguan (ST7), Qianzheng (EX-HN), etc. for patients with peripheral facial paralysis. Seventy-eight patients with peripheral facial paralysis (within 7 days) were divided into acupuncture plus moxibustion (Acu-Moxi) group and routine acupuncture (control) group (n＝38 cases in each). Patients of the control group were treated by routine acupuncture of unilateral or bilateral Yangbai (GB14), Sibai (ST2), Taiyang (EX-HN5), Quanliao (SI18), Jiache (ST6), Dicang (ST4), Yifeng (SJ17), Hegu (LI4) and Zusanli (ST36), and those of the Acu-Moxi group were treated by routine acupuncture of the above-mentioned acupoints in combination with herbal-cake-partitioned moxibustion at ST7 and EX-HN. The treatment was conducted once daily for 20 days. The House-Brackmann facial grading scale (H-B FGS) was used to assess the degree of facial nerve palsy (Ⅰ－Ⅵ grades), the modified Portmann scale used to assess the severity of facial paralysis including the situations of movement of eyebrow raising, eye closing, cheek bulging, pouting, teeth showing and nostril widening, and symmetry during resting state (20 points in total) and the facial disability index (FDI) used to rate the physical function (FDIP) and social life function (FDIS) (5－30 points in total). The clinical efficacy of each group was evaluated after the treatment. After the treatment, the number of patients with H-B FGS grade IV and V and FDIS scores were significantly decreased, and patients' number of H-B FGS grade I and II , Portmann scale and FDIP scores were significantly increased in both control and Acu-Moxi groups in comparison with their own pre-treatment (P<0.01), suggesting an improvement of facial nerve function after treatment. The patients' number of H-B FGS grade I and II and Portmann scores of the Acu-Moxi group was significantly higher than those of the control group (P<0.05, P<0.01), but no significant differences were found between two groups in the FDIP and FDIS scores (P>0.05). Of the two 38 patients in the control group and Acu-Moxi group, 8 (21.05%) and 15 (39.47%) were cured, 7 (18.42%) and 8 (21.05%) experienced marked improvement, 14 (36.84%) and 13 (34.21%) were effective, and 9 (23.68%) and 2 (5.26%) invalid, with the effective rates being 76.32% and 94.74%, respectively. The therapeutic effect of the Acu-Moxi group was evidently superior to that of the control group (P<0.05). The acupuncture combined with Qianzhengsan-partitioned moxibustion is considerably superior to routine acupuncture in improving clinical symptoms and signs of peripheral facial paralysis patients.

Validation of French versions of the Facial Disability Index and the Facial Clinimetric Evaluation Scale, specific quality of life scales for peripheral facial palsy patients.

To translate and validate French versions of two health-related quality of life questionnaires for patients with peripheral facial palsy: Facial Disability Index (FDI) and Facial Clinimetric Evaluation (FaCE) scale. Prospective cohort study. University tertiary referral centre. A pilot test was performed on 10 subjects (5 patients with facial palsy of more than 1-month duration and 5 normal subjects), and then 67 adult patients with facial palsy were enrolled in the validation study. Translation of the original questionnaires has followed international guidelines using a forward-backward translation method. A pilot test and a validation study based on the translated questionnaires were performed. Internal consistency, test-retest reliability, validity and responsiveness were assessed. Validity was assessed by comparing to SF-36 and Sunnybrook/House-Brackmann grading systems. Subjects answered scales twice within a one-week interval. Sixty-seven patients were enrolled, among which 63 completed scales one week later (retest). For physical and social functions of FDI and FaCE scores, Cronbach's α representing internal consistency was 0.88, 0.70 and 0.89, and test-retest reliability by intra-class correlation coefficients was 0.81, 0.86 and 0.89, respectively. The correlation of facial movement score of FaCE scale was good with Sunnybrook/House-Brackmann grading systems (0.73 and -0.75, P<0.01). The correlation of social function of FaCE scale was excellent with social function of SF-36 (0.8, P<0.01). French versions of FDI and FaCE scale are psychometrically valid. Both questionnaires can be used for clinical studies to assess the quality of life of patients with peripheral facial palsy.

A controlled study on the therapeutic effect of acupuncture and acupuncture combined with drugs on peripheral facial paralysis with normal result of facial nerve magnetic resonance examination

To explore whether a combination of drugs is needed when acupuncture is used to treat peripheral facial paralysis with normal result of facial nerve magnetic resonance examination. A total of 48 normal facial nerve magnetic resonance examination of peripheral facial paralysis patients were randomly divided into an acupuncture combined with drugs group and an acupuncture group, 24 cases in each group. Acupuncture combined with prednisone were applied in the acupuncture combined with drugs group, and simple acupuncture was given in the acupuncture group. The acupuncture treatment methods were the same. Acupuncture mainly applied at Yifeng (TE 17), Quanliao (SI 18), Taiyang (EX-HN 5), Sibai (ST 2), Jiache (ST 6), Dicang (ST 4) on the affected side, Hegu (LI 4, opposite side) for 30 min a day, once every other day. Electroacupuncture was added at Yifeng (TE 17) and Quanliao (SI 18), Jiache (ST 6) and Dicang (ST 4) on the affected side after the acute phase until it was cured. Prednisone was taken orally once a day, with an initial dose of 30 mg, decrease 10 mg every 3 days for 9 days. After 3 and 8 weeks of treatment, the effect was observed by Portmann score. After 3 and 8 weeks of treatment, the cured rates were 50.0% (12/24) and 83.3% (20/24) in the acupuncture group, which were slightly lower than 58.3% (14/24) and 87.5% (21/24) in the acupuncture combined with drugs group，there was no significant difference between the two groups (both P>0.05); the course of treatment in the acupuncture group was (31.2±17.0) d, slightly longer than (29.5±12.8) d in the acupuncture combined with drugs group , but there was no significant difference between the two groups (P>0.05). Simple acupuncture treatment on peripheral facial paralysis with normal result of facial nerve magnetic resonance examination can achieve the same effect of acupuncture combined with drugs, and avoid drug-related adverse reactions.

Childhood peripheral facial palsy.

The objectives of this study were to evaluate the demographic and clinical characteristics, causes, treatment patterns, outcome, and recurrence of childhood peripheral facial palsy. We performed a retrospective study of 144 peripheral facial palsy patients, under 18years old in a tertiary care pediatric hospital. Medical charts were reviewed to analyze the age, gender, side of facial nerve paralysis, family history, cause, grading by the House-Brackmann Facial Nerve Grading Scale (HBS), results of diagnostic tests, therapies, outcomes, and recurrence. Causes were as follows: 115 idiopathic (Bell's palsy) facial palsy (79.9%), 17 infections (11.8%) (9 otitis media, 4 varicella zoster virus (VZV) infection, 3 tooth abscess, and 1 group A β-hemolytic streptococcus infection), 7 trauma (4.9%), 4 congenital-syndrome (2.8%), and 1 (0.7%) arterial hypertension. There was no difference in age, sex, family history, grading, or outcome between idiopathic and cause-defined facial palsy. At the end of the first year, our recovery rates were 98.3%. No significant difference in recovery outcome was detected between the patients who were treated with and without steroid treatment. Thirteen (9%) patients had recurrent attacks, and no differences in the outcomes of patients with recurrent facial palsy were observed. Recurrence time ranged from 6months to 6years. The results of this study indicate that both Bell's palsy and cause-defined facial palsy in children have a very good prognosis. Medical treatment based on corticosteroids is not certainly effective in improving outcomes in children. Recurrent attacks occurred in 6years from the onset which leads to the conclusion that we should have a long-term follow-up of patients diagnosed with Bell's palsy.

Study of fraction amplitude of low frequency fluctuation on resting-state functional magnetic resonance imaging in adultperipheral facial paralysis

Objective: To analysis the change of brain functional activity in the left and right peripheral facial paralysis by using resting-state functional magnetic resonance imaging (R-fMRI) of fraction amplitude of low frequency fluctuation(fALFF) measurement technique, and research the abnormal brain region with different side patients whether there are differences. Methods: A total of 43 patients with peripheral facial paralysis patients (patient groups, divided into left / right two subgroups) and 21 healthy volunteers (control group) in this study.Resting-state fMRI were acquired for each volunteer and patient. The fALFF approach was used to compare the peripheral facial paralysis groups to healthy group.Functional analysis was performed with brain function analysis software REST and DPARSFA , and then analysis the difference of two groups of patients and control group in two sample t test.At the same time, the correlation analysis between fALFF parameters map of the left and right side of two groups of patients and corresponding facial nerve grading TFGS score.Ultimately obtain a statistically significant brain regions. Results: Compared to healthy group, the decreased fALFF areas in the left side facial paralysis were showed in the right superior temporal gyrus , the pole of the right temporal, right middle temporal gyrus, the left occipital gyrus, and left medial cingulate gyrus, left paracentral lobule, and the left supplementary motor area; while the increased brain regions have the right superior frontal gyrus, right middle frontal gyrus, the right precentral gyrus, bilateral inferior temporal gyrus and middle temporal gyrus.Compared to healthy group, the decreased fALFF areas in the right side facial paralysis were showed in the right inferior temporal gyrus and fusiform gyrus, the left inferior occipital gyrus, the left superior parietalgyrus, the left inferior parietalgyrus, left precuneus, left paracentral lobule, the left supplementary motor area; while the increased brain regions have the left Calcarine, right lingual gyrus, corpus callosum, right medial cingulum gyrus.In the left facial paralysis group TFGS score was positively correlated with brain regions have left middle frontal gyrus, left precuneus and left cuneus, while the negatively related brain area on the right lingual gyrus.In the right facial paralysis groups TFGS score was positively correlated with brain areas have right inferior temporal gyrus and middle temporal gyrus, left inferior parietalgyrus; while the negatively correlated brain area on the left superior temporal gyrus, the right medial frontal gyrus. Conclusion: The left and right side facial paralysis patient's mood and motor function integration mechanism may be different, and the patient's emotional and psychological changes may be associated with disease severity.

Peripheral Facial Palsy: Does Patients' Religiousness Matter for the Otorhinolaryngologist?

In order to deal with the suffering, a frequent strategy employed by patients is the use of religious beliefs and behaviors. Nevertheless, few studies in otorhinolaryngology have investigated this dimension. Therefore, the present study aims to investigate the role of religiousness on quality of life, mental health, self-esteem and appearance in 116 patients with peripheral facial palsy (PFP). A cross-sectional, single-center study was carried out between 2010 and 2012 in PFP outpatients. We assessed socio-demographic data, PFP characteristics, depression, anxiety, quality of life, self-esteem, appearance and religiosity. A linear regression (adjusted for confounders) was performed to investigate whether religiosity was associated with any outcomes. The present study found that religious attendance, but not other types of religiousness, was related to quality of life and mental health on PFP patients. In addition, ENT patients would like their doctors to ask them about their faith and religion as part of their medical care. These findings give further support to the importance of religious and spiritual beliefs on ENT patients. Otorhinolaryngologists should be aware of the positive and negative aspects of religion and be prepared to address these issues in clinical practice.

Somatosensory-evoked blink reflex in peripheral facial palsy

Somatosensory-evoked blink reflex (SBR) is an eye blink response obtained from electrical stimulation of peripheral nerves or the skin area of the body away from the face. The aim of this study was to investigate the presence of SBR in peripheral facial palsy (PFP) and its relation with clinical and electrophysiological changes occurring in PFP as compared with postfacial syndrome (PFS). This was a single-center, public hospital-based electromyography laboratory study. It was designed as a cross-sectional examination of consecutive patients with PFP and PFS and apparently healthy volunteers. The study included 25 patients with PFP, 25 patients with PFS, and 31 healthy volunteers. Facial nerve motor conduction, trigeminal blink reflex, and SBR were studied. Quantitative data were compared using the Mann–Whitney test and the Kruskal–Wallis test. Qualitative data were analyzed using Pearson’s Chi-square test. SBR was elicited in 67.7% of controls, in 68% of PFS patients, and in 32% of PFP patients. In the PFP group, SBR was found on the nonparalytic side in 28% of patients with paralyzed side stimulation and in 24% of patients with healthy side stimulation. For the PFS group, SBR was found on the nonparalytic side in 48%. Bilateral SBR elicitability was higher than its unilateral elicitability. SBR occurs in patients with PFP and PFS and in healthy individuals. It has no relation with the clinical and electrophysiological changes occurring in PFP and PFS. Increased brainstem interneurons excitability is not essential to generate SBR. The hypothetical sensory-motor gating mechanism could be responsible for SBR generation.

Retrospective Study on Factors Influencing Facial Nerve Damage of Acute Peripheral Facial Palsy Patients: by Electromyography

Objectives : This research was conducted to investigate the factors that affect the level of facial nerve damage. Methods : From October 2009 to September 2013, the total number of 581 patients of Bell’s palsy and Ramsay-Hunt syndrome visited Facial Palsy Center in Kyung Hee University Hospital at Gangdong for Traditional Korean and Western combined medical treatment. Of these, 453 patients of peripheral facial nerve palsy were selected for the research. After reviewing the medical records that have details of age, gender, diagnosis(Bell’s palsy and Ramsay-Hunt syndrome), onset, underlying diseases(DM, HTN), and HbAlc value, the analysis on the influence factors on the level of facial nerve damage was drew out. Results : The axonal loss rate of oris branch and nasal branch were significantly higher than the axonal loss rate of frontal branch and oculi branch. In addition, the frequency of becoming a major damaged branch was also high in the oris branch nasal branch. The factors by month, weather, smoking, and alcohol did not influence EMG axonal loss rate. Male rather than female and patient with Rasmay-Hut syndrome rather than Bell’s palsy had a higher axonal loss rate in all branches. Of those, front of branch of male was remarkably higher than female. Patient with DM as P/H had high axonal loss rate in all branches. Patient with HTN as P/H had high axonal loss rate in all branches except for oris branches. Patients with DM and HTN group had significantly higher value from the average of axonal loss rate than patients who are only with HTN and without DM/HTN. DM alone group had significantly higher value than patients who are without DM/HTN. However, HTN alone was not significantly high. By analysing HbAlc of the patients who were hospitalised regardless DM, axonal loss rate was high in the order of DM group, preDM group, normal group. Nevertheless, only DM group showed higher axonal rate statistically than normal group. Considering DM and HbA1c value, the patients can be divided into 4 different groups of hkDM, lkDM, hfDM and nDM. By analysing those groups, the average damaged value of the groups with diagnosis followed by treatment(lkDM, hkDM) were higher than the average rate of hfDM and statistically higher than the rate of the nDM. Conclusions : The influential factors of increasing the level of EMG damage are male(only for the frontal branch), age above sixties, HTN, DM, and HbAlc value above 6.5. Besides, the negligible factors are month, season, diagnosis, alcohol, and smoking. Further research including clinical prognosis should be conducted.

Comparison of efficacy and the safety evaluation of electroacupuncture with different waveforms for peripheral facial paralysis patients

ObjectiveTo use different waveforms of electroacupuncture (EA) to treat peripheral facial paralysis and assess the clinical efficacy of three kinds of EA waveforms (continuous wave, disperse-dense wave and intermittent wave). MethodsOne hundred and twenty nine patients of Bell's palsy were randomly divided into a continuous wave group (45 cases), a disperse-dense wave group (40 cases) and an intermittent wave group (44 cases). The acupoints selected were Dìcāng (▪ ST 4), Jiáchē (▪ ST 6), Tàiyáng (▪ EX-HN 5), Xiàguān (▪ ST 7), Hégŭ (▪ LI 4), etc. The House-Brackmann (HB) scale was used in assessment on the day of inclusion, after the 1st, 2nd, 3rd and 4th courses of treatment and the 1st and 3rd months after the end of treatment during the follow-up visit respectively. ResultsThe cured rates were 68.9% (31/45), 60.0% (24/40) and 65.9% (29/44) respectively in the continuous wave group, the disperse-dense wave group and the intermittent wave group. The results of the rank sum test showed that the efficacy comparison among three groups did not show statistically significant difference (P>0.05). ConclusionEA achieved the significant clinical efficacy on peripheral facial paralysis and there is no significant difference in the efficacy among different waveforms. It is suggested that the clinical efficacy of EA on the disease had no significant correlation with the waveforms.

Validation of a Swedish version of the Facial Disability Index (FDI) and the Facial Clinimetric Evaluation (FaCE) scale

Conclusion: Swedish versions of the Facial Disability Index (FDI) and Facial Clinimetric Evaluation (FaCE) scale are psychometrically valid. Both questionnaires can be used for clinical studies on peripheral facial palsy patients, and provide important information on quality of life. Objectives: To translate and validate Swedish versions of the FDI and FaCE scale in patients with peripheral facial palsy. Methods: Translation of the original questionnaires followed international guidelines. Internal consistency and test–retest stability were assessed in adult patients with stable peripheral facial palsy. Facial function was examined with the Sunnybrook and House-Brackmann scales. Subjects answered the questionnaires twice with a 2-week interval. Validity was assessed by comparing FDI and FaCE scale scores to SF-36 and Sunnybrook/House-Brackmann scores. Results: Ninety-three patients were included, 53% women and 47% men, mean age 56.9 years and mean duration of palsy 51.9 months. The questionnaires showed good/excellent psychometric properties with Cronbach's α scores between 0.76 and 0.92. In the test–retest analysis, intra-class correlation coefficients were very good for both questionnaires with scores of 0.83–0.97. Both questionnaires showed good sensitivity to discriminate between patients with varying degrees of facial dysfunction. Moderate to strong correlation was found between the social domains in the questionnaires when compared with the equivalent domains in SF-36.

Effect of Bloodletting Therapeutics Complex Therapy on Peripheral Facial Paralysis Patients with Back of the Affected Ear Pain※

Objectives : This study was done for reporting the effect of bloodletting therapeutics on peripheral facial paralysis patients with back of the affected ear pain. Methods : We investigated 37 cases of peripheral facial paralysis patients with postauricular pain, and devided patients into two groups : We treated one group by complex oriental medical treatment with bloodletting therapeutics, and did the other group by complex oriental medical treatment without bloodletting therapeutics. Visual analogue scale(VAS) and gross grading system of House-Brackmann(H-B grade) and at baseline and final were used for evaluating the effect of the treatment. Results : 1. In bloodletting therapeutics group and non-bloodletting therapeutics group, compared with baseline, at final, VAS and H-B grade was significantly decreased. 2. At final, bloodletting therapeutics group showed significant decrease on VAS and H-B grade compared with non-bloodletting therapeutics group. Conclusions : Bloodletting therapeutics showed significant improvement in peripheral facial palsy with postauricular pain.

Clinical research of the efficacy and the safety of dioscoreae rhizoma (sanyak) pharmacopuncture therapy for peripheral facial paralysis patients.

Objectives:The aim of this study is to evaluate the efficacy and the safety of Sanyak pharmacopuncture therapy for the treatment of peripheral facial paralysis patients.Methods:This study was a retrospective investigation of a total of 70 patients who were inpatients of the Oriental Hospital of Daejeon University between January 1, 2011, and May 31, 2012, and who were diagnosed as having peripheral facial paralysis by physical examination, the patients received three different interventions. Eleven (11) patients were treated with acupuncture and alcohol Dioscorea rhizoma pharmacopuncture (ADG), 25 patients with acupuncture and distillation Dioscorea rhizoma pharmacopuncture (DDG), and 34 patients with acupuncture and non-Dioscorea rhizoma pharmacopuncture (NDG). The resulting data were analyzed.Results:The changed H-B grades indicated significant improvements in all three groups, and the ADG and the DDG groups showed significant results after two weeks of treatment when compared to the NDG group. The changed y-Scores indicated significant improvements in all three groups, and the ADG group showed significant results after 10 and 15 days of treatment when compared to the NDG group. Dioscorea rhizoma pharmacopuncture may be safe for the human body because in most cases, the only abnormal finding was the pain could by the application of pharmacopuncture.Conclusions:The results of this study suggest that Oriental medical treatment with dioscoreae Rhizoma (Sanyak) pharmacopuncture complex therapy may be effective and safe in patient with peripheral facial paralysis