Treatment Of Facial Paralysis 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.

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.

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

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

Etiology and Management of 800 Patients With Facial Palsy at a Private Practice Setting Over a 5-Year Period.

Very few papers investigated the etiologic breakdown and demographic characteristics of patients with facial nerve (FN) palsy. Our paper aims to present the etiologic breakdown and demographic characteristics of patients with FN palsy, presenting at a private care center between 2014 and 2019, along with the treatment modalities that were offered to them. Charts of 800 patients with facial palsy (FP) were reviewed. Data included the etiology of their diagnosis, family history, recurrent FP, demographic information, and treatment provided before and after presentation. Seventy-five percent of our study population were females. The average period between diagnosis with FP and presentation at our center was 10.8 years. The most commonly identified etiology was Bell's palsy, followed by acoustic neuroma. Eighty-one percent of the study subjects were prescribed steroids and/or antivirals. Facial neuromuscular retraining, electrical stimulation, chemodenervation, and surgical intervention were also part of some treatment plans for our population. Recommendations for the treatment of idiopathic FP include steroids with adjuvant antiviral medications. Data remains uncertain whether the combination therapy of steroids and antivirals has better results compared to steroids alone. Electrical stimulation is still a controversial therapeutic tool for facial paralysis with a potential role in exacerbating synkinesis. The difference in referral patterns between tertiary and private care centers can explain the disparity in the ranking of the etiologies between our study and what has been published. Management of FP is a complex process. The FN community must develop a common database to improve its understanding of the different presentations.

Problems of treating facial nerve paresis after removal of vestibulocochlear neurinoma

Surgical treatment of facial paralysis after removal of tumors of the posterior cranial fossa and lateral part of the base of the skull remains a relevant issue and one of the most difficult problems in modern medicine and neurosurgery. Severe dysfunction of the facial nerve, accompanied by cosmetic, functional, and psychological disorders, is the cause of social maladjustment of patients. Based on current literature, the article provides an overview of various methods of surgical treatment of this pathology aimed at restoring facial expressions and symmetry.

Needles, Herbs, and Electricity: A Meta-Analysis of Traditional Eastern Medicine in the Management of Facial Paralysis.

In Eastern nations, interventions like acupuncture and herbal medicine are often first-line for patients presenting with facial paralysis. Despite the rising popularity of Eastern medicine in Western nations, the literature assessing whether Eastern medicine interventions should be recommended for patients with facial paralysis is lacking. This meta-analysis aims to define what Eastern medicine interventions exist for the management of facial paralysis and assess whether current research supports these approaches as safe and effective. The PubMed and Cochrane databases were reviewed in accordance with PRISMA guidelines. Inclusion criteria consisted of peer-reviewed studies published between 2000 and 2023 that reported on Eastern medicine, also described as, "complementary" or "alternative" interventions for facial paralysis. Effective and cured rates were the primary outcomes extracted from the literature. Interventions within these studies were categorized into six groups: (1) standard acupuncture, (2) special needle therapies, (3) needle therapy + other alternative treatments, (4) herbal medicine, (5) alternative treatments + Western medicine, and (6) Western medicine alone. A multiple-treatment meta-analysis was performed to assess differences in effective and cured rates. Fifteen studies involving Eastern medicine for the treatment of facial paralysis met the inclusion criteria. No significant differences were found in effective and cured rates across groups. Multiple quality concerns were noted, such as the lack of control groups, blinding, and randomization noted in several studies. Many studies failed to report complications, preventing conclusions from being drawn on the safety of these Eastern medicine interventions. This meta-analysis was unable to support the recommendation of Eastern medicine approaches for patients with facial paralysis. No Eastern medicine treatments, combination of Eastern medicine treatments, or Eastern medicine treatments given with Western medicine were seen to be more effective than Western medicine alone.

Investigation of Parotid Cancer Cases Diagnosed as Bell's Palsy at Initial Presentation: The 23 Year Experience of a Single Institution.

Objective: Facial nerve paralysis due to parotid carcinoma is sometimes misdiagnosed as Bell's palsy. This study aimed to compare patients with parotid carcinoma with and without accompanying facial nerve paralysis and to capture the features of patients misdiagnosed with Bell's palsy. Methods: Among 209 patients, 42 (20%) had facial nerve paralysis. Of these 42 patients, 14 had received treatment for facial nerve paralysis without being diagnosed with parotid carcinoma (pretreatment group); the remaining 28 patients had not received any pretreatment and were diagnosed with parotid carcinoma at the initial visit to our hospital (no pretreatment group). This study compared patients with and without facial nerve paralysis and the pretreatment and no pretreatment groups. Results: The 42 patients with facial nerve paralysis had a significantly higher frequency of pain/tenderness and adhesion with surrounding tissues, significantly higher proportions of deep lobe tumors, and a significantly higher proportion of high-grade malignancy. In addition, the disease-specific and disease-free 5 year survival rates were significantly poorer in patients with than in those without facial nerve paralysis. The comparison between the pretreatment and no pretreatment groups revealed no significant differences in any factors nor survival rate. Five patients in the pretreatment group complained of palpable masses or pain/tenderness at the time of their initial treatment for paralysis. Conclusion: Patients with parotid carcinoma who present with facial nerve paralysis at the initial visit have a significantly poorer prognosis. The number of cases in the pretreatment group can be reduced by performing a detailed examination, which can potentially improve the prognosis.

Facial Paralysis Treatment Using Selective Neurectomy: A Comprehensive Review.

Facial paralysis can affect patients undergoing full mouth rehabilitation, regardless of what caused their paralysis. A procedure known as modified selective neurectomy of the facial nerve can enhance the movement of facial muscles in individuals with facial synkinesis safely and effectively. This approach is proposed as an alternative to more invasive surgical options when used independently as a treatment for incomplete facial palsy. Selective neurectomy offers a promising surgical option for managing nonflaccid facial paralysis and synkinesis, enhancing patients' quality of life. However, treatment plans should be individually tailored considering the complexity of facial paralysis and the unique needs of each patient, taking into account the timing and type of treatment. The objective of this review is to explore the use of selective neurectomy as a treatment for facial paralysis based on previously published papers.

Use of athletic tape in the speech-language-hearing treatment of post-stroke facial paralysis in the acute phase.

To verify the efficacy of using athletic tape associated with myofunctional therapy in the speech-language-hearing treatment of facial palsy after stroke in the acute phase. Randomized controlled clinical study with 88 patients with facial palsy in the acute phase of stroke. The sample was allocated in: Group 1: rehabilitation with orofacial myofunctional therapy and use of athletic tape on the paralyzed zygomaticus major and minor muscles; Group 2: rehabilitation alone with orofacial myofunctional therapy on the paralyzed face; Group 3: no speech-language-hearing intervention for facial paralysis. In the evaluation, facial expression movements were requested, and the degree of impairment was determined according to the House and Brackmann scale. Movement incompetence was obtained from measurements of the face with a digital caliper. After the evaluation, the intervention was carried out as determined for groups 1 and 2. The participants of the three groups were reassessed after 15 days. The statistical analysis used was the generalized equations. The groups were homogeneous in terms of age, measure of disability and functioning, severity of neurological impairment and pre-intervention facial paralysis. Group 1 had a significant improvement in the measure from the lateral canthus to the corner of the mouth, with better results than groups 2 and 3. The athletic tape associated with orofacial myofunctional therapy had better results in the treatment of facial paralysis after stroke in the place where it was applied.

面神经麻痹的治疗现状

面神经麻痹的治疗现状

针灸治疗中风后遗面瘫症 的研究进展

针灸治疗中风后遗面瘫症 的研究进展

Assessment of deep plane facelift combined with fascia lata graft for the static treatment of facial palsy: A preliminary report

Addressing facial palsy (FP) presents intricate challenges in achieving natural expressions.While free functional muscle transfers (FFMT) offer effective smile restoration, age impacts their efficacy.The optimal FFMT age range of 5-55 is limited by physical fitness, which extends beyond age boundaries. Unilateral FP demands vary; younger patients require dynamic solutions like FFMT, whereas older individuals prioritize public appearance due to baseline distortion. The aim of this study is to describe and to assess a new static technique combining deep plane facelift and fascia lata graft (FLG) for FP treatment. We conducted a prospective pilot study enrolling unilateral FP patients aged >55 and declining FFMT. Exclusions encompassed prior FP surgery, recent injections, uncontrolled diabetes cognitive deficits and Patients unable to quit smoking.To evaluate this technique, the Glasgow Benefit Inventory (GBI), along with two objective scales: the Face and Neck-Lift Objective Photo-Numerical Assessment Scale and the eFACE scale, were used. Interrater reliability and Intrarater reliability were assessed. Fifteen patients (mean age: 60.9 years) underwent the procedure. Both static and dynamic symmetry significantly improved (p<0.05), including check volume and position, oral commissure, and jawline. Notably, eye closure enhancement was observed. GBI scores also significantly increased (p<0.05). Interrater reliability and Intrarater reliability were minimal (p=0.12 and p=0.13).This combined approach offers a static FP treatment option, especially for the elderly or FFMT-ineligible patients. The relatively brief procedure yields immediate and satisfactory results, suggesting its potential value in FP management. Further comprehensive studies are encouraged to validate the technique's long-term efficacy and applicability across larger populations.

A conceptual study of Arditam and its Chikitsa mentioned in Brihatrayis along with its modern correlation (Facial Paralysis)

Ardita is considered as one among the 80 types of Vata Nanatmaja Vyadhi described in our Ayurvedic classics. Ardita with special reference to facial palsy is a disease affecting all ages and more common in the present day scenario which causes distortion of face and associated with the impairment of motor and sensory functions of the affected side of the face, Effective treatment has been highlighted by contemporary science for this crippling disease, by the virtue of targeting the Dosha involved and there by curing the disease through Ayurveda is successful key in the treatment of facial palsy. Various Ayurvedic herbal formulations and Panchakarma procedures have been so far found effective in reversing the condition.

Chronologically Change and Importance of Acupuncture Points Used in Bell’s Palsy in Classical Literature

Objectives: Many acupuncture points have been suggested for the treatment of Bell's palsy, but information on which acupuncture points are more important in treatment is not provided. This study was conducted to investigate the importance of acupuncture points currently used clinically in Bell's palsy.Methods: By reviewing the full text of 11 books that recorded acupuncture prescriptions from the Qin Dynasty to the Qing Dynasty, the frequency of use of acupuncture points, their meridians, and their location were investigated.Results: The average number of acupuncture points used for local, adjacent and distal points selection was 10.5, 2, 4 respectively. The number of acupuncture points increased from the Qin Dynasty to the Ming Dynasty 《Bojaebang》 and then decreased, but the proportion of local points has been still high. From the Ming Dynasty, ST4, ST6, GV26, and GV24 were mainly have been used as the local points. Except for the GB12, the use of the rest of the acupuncture points gradually decreased in the adjacent points. In the distal acupuncture points, it was summarized to point of lung and large intestine channel until the Ming Dynasty, and LI4 was mainly used in the Qing Dynasty. Yangming meridian has been most often used at the local and distal area except for the adjacent area.Conclusions: In the treatment of facial paralysis, the lower part of the face had the highest proportion among local acupuncture points, and the Yangming had the highest proportion by meridian.

1288 Animated Patient Information Videos to Enhance Understanding of Free Functional Muscle Transfer Surgery for Dynamic Treatment of Facial Palsy

Abstract Aim Facial palsy affects approximately 25-30 per 100,000 people a year causing physical and psychological symptoms including facial asymmetry, a lack of facial expression, oral incompetence, difficulties in articulation and reduced quality of life. The treatment of choice for many patients is free functional muscle transfer (FFMT), a highly complex surgery. Due to the complexity, patients’ ability to understand and retain information during traditional consultations poses a barrier to truly informed consent. Our study aims to utilise animated patient videos and integrated messaging platform to improve patients’ understanding of FFMT surgery, its potential complications, and recovery period. Method We developed a new electronic adjunct for patients undergoing FFMT surgery to complement the traditional consent process. The platform employs narrated animations and secure integrated messaging service for patients to directly communicate with their surgeon. A multilingual narrative script, suitable for all ages, complements the animations outlining the details of FFMT surgery in multiple subcategories including scar placement, wound care and signs to identify complications. Results We will present a series of patient information videos from 7 subcategories covering all portions of FFMT surgery, demonstrate the ease of use of the messaging platform and summarise the feedback collected. Conclusions We have successfully developed an electronic patient information platform to support the traditional informed consent process for FFMT as a treatment of facial palsy which increases patients’ understanding and engagement. Patients can review every step of their journey, from first entering the hospital until the end of rehabilitation, at their own pace, and as frequently as required.

Efficacy of Laser Therapy on Paralysis and Disability in Patients with Facial Palsy: A Systematic Review of Randomized Controlled Trials.

(1) Background: Facial palsy is a common health issue which leads to sequelae and disability. This systematic review aimed to assess the efficacy of laser therapy for the treatment of facial palsy. (2) Methods: Only randomized controlled trials comparing the effectiveness of laser therapy to non-laser intervention, no intervention, or placebo were searched for. Relevant studies were searched in seven electronic databases. Studies that examined the use of laser modalities for facial palsy management, with or without acupuncture, were also included. Two authors independently read and scored the methodological quality of the selected texts, and any disagreement was resolved by discussion or by intervention from the third author. (3) Results and conclusions: With five full-text articles, a methodological quality for each included study was assessed (kappa coefficient = 0.75). The laser therapy group in the mean difference measuring FDI showed an effect size of 8.15 compared to the control group; while measuring the paralysis score, an advantage was disclosed with an effect size of 0.22 compared to the control group.

Transmastoid Facial Nerve Decompression for Craniometaphyseal Dysplasia.

We document the first successful transmastoid surgical treatment of facial nerve palsy for a patient with craniometaphyseal dysplasia (CMD), a rare genetic disease. A 9-month-old girl with bilateral facial nerve palsies and conductive hearing loss. Genetic testing made a diagnosis of CMD, and imaging showed narrowing of the facial nerve canals and ossicular fixation. Right transmastoid facial nerve decompression and ossicular chain reconstruction. Facial nerve function (House-Brackmann grade). Facial nerve function initially worsened, then improved within 12 months from House-Brackmann grade IV-V to grade III. Surgical cranial nerve decompression of and ossicular chain reconstruction may be effective treatments for patients with CMD.

Real-time actuation of a dielectric elastomer actuator neuroprosthesis for facial paralysis

Facial paralysis is a highly burdening condition, resulting in a patient's inability to move his mimic musculature on one or both sides of his face. This condition compromises the patient's communication and facial expressions, and thus dramatically reduces his quality of life. The current treatment for chronic facial paralysis relies on a complex reconstructive surgery. This publication proposes a novel, less invasive approach for dynamic facial reanimation. The use of a smart material, namely a Dielectric Elastomer Actuator (DEA) is proposed for facial motion restoration, thus avoiding the traditional two-stage free muscle transfer procedure and allowing for a faster recovery of the patient. DEAs are a type of electroactive polymers, showing promising properties similar to natural muscles such as the fact that they are soft, lightweight and allow for large displacements. As a result, a study of the facial muscles and neural interfaces, notably the ones responsible for mouth movement, was performed, in order to implement a realistic setup. In this paper, a non-invasive neural interface based on myoelectric signal is used in order to establish a real-time control of the actuator. Visible motion of a skin model is produced in real time, by synchronizing the actuator to the activity of a healthy muscle, with a maximal delay of 108 ​ms resulting from the signal processing and a delay of less than 30 ​ms related to the actuation of the DEA. This shows that the usage of DEA combined with a neural interface presents a promising approach for treatment of facial paralysis.

Effects of Electrical Stimulation on Facial Paralysis Recovery after Facial Nerve Injury: A Review on Preclinical and Clinical Studies.

Various methods have been used to improve function and manage facial nerve injury. Although electrical stimulation therapy is frequently used to treat facial paralysis, its effects have been found to vary and no clear standards have been developed. The current review describes the results of preclinical and clinical studies evaluating the effectiveness of electrical stimulation therapy in promoting the recovery of a peripheral facial nerve injury. Evidence is presented showing the efficacy of electrical stimulation in promoting nerve regeneration after peripheral nerve injuries in both animal models and human patients. The ability of electrical stimulation to promote the recovery of facial paralysis was found to depend on the type of injury (compression or transection), the species of animal tested, the type of disease, the frequency and method of electrical stimulation, and the duration of the follow-up. Electrical stimulation, however, can also have potential negative outcomes, such as reinforcing synkinesis, including mistargeted axonal regrowth via inappropriate routes; excessive collateral axonal branching at the lesion site; and multiple innervations at neuromuscular junctions. Because of the inconsistencies among studies and the low quality of evidence, electrical stimulation therapy is not currently regarded as a primary treatment of facial paralysis in patients. However, understanding the effects of electrical stimulation, as determined in preclinical and clinical studies, is important for the potential validity of future research on electrical stimulation.

Detailed anatomical study of the peripheral motor branches of the facial nerve in the swine model: A novel investigative approach for facial paralysis research

IntroductionLarge animal models aid in innovating surgical approaches and developing medical devices for the treatment of facial paralysis. However, there is a lack of information on facial nerve anatomy in swine. This study aimed to investigate the branching pattern and histologic characteristics of the swine facial nerve, thereby establishing the anatomical patterns of preclinical models in facial paralysis research. Material and methodsThe five peripheral motor branches of the facial nerve were dissected in 30 hemifaces of fresh swine cadavers. Starting at the stylomastoid foramen, the course, branching pattern, and diameter of each motor branch was recorded. Samples were taken at the start of each branch for epoxy embedding, toluidine blue staining, and histomorphologic analysis. ResultsThe dissections demonstrated consistent anatomy of the buccal and marginal mandibular branches in contrast to the temporal and zygomatic branches, which showed more variation in branching patterns. The buccal branch had the largest mean diameter of 1.34 mm (± 0.26 mm), whereas the marginal mandibular branch had the largest fascicular area of 0.558 mm2 (± 0.12 mm2) and highest axon count of 3636.35 (± 526.36). The zygomatic branch had both the smallest diameter of 0.74 mm (± 0.25 mm) and fascicular area of 0.187 mm2 (± 0.14 mm2). ConclusionsThe swine facial nerve is anatomically similar to the human facial nerve, making the pig a suitable large animal model. Detailed anatomical and histological information is crucial for developing preclinical models of novel facial nerve reconstruction approaches.