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Cirugia Y Cirujanos 2021Facial paralysis is a frequent disabling entity that causes a negative impact on the cosmetic, functional, social, psychological and economic aspects of the patient....
BACKGROUND
Facial paralysis is a frequent disabling entity that causes a negative impact on the cosmetic, functional, social, psychological and economic aspects of the patient. Surgical treatment aims to restore the patient to her previous life with the fewest possible sequelae.
OBJECTIVE
Describe the experience of surgical management and propose a treatment algorithm.
METHOD
A retrospective study was carried out from 2017 to 2019 of the records of patients with facial nerve involvement. The variables were age, sex, etiology, affected side and procedures performed.
RESULTS
108 patients were obtained. The most frequent cause was development facial paralysis (41,8%), followed by resection of intracranial tumors (29%). A total of 225 procedures were performed, average per patient of 2.7. The most performed dynamic procedure was the gracilis-free flap (59%). The most frequent static procedures were the placement of a gold weight (24%) and the recreation of the nasogenian sulcus (13%).
CONCLUSIONS
The surgical treatment algorithm will depend on the evolution time, etiology, donor nerves and state of the facial musculature. The gracilis-free flap continues to be the gold standard procedure in facial paralysis reconstruction. Static procedures are additionally required to achieve a satisfactory aesthetic and functional result.
Topics: Facial Paralysis; Female; Free Tissue Flaps; Humans; Mexico; Plastic Surgery Procedures; Retrospective Studies; Tertiary Care Centers
PubMed: 34851577
DOI: 10.24875/CIRU.20000916 -
Ear, Nose, & Throat Journal Jun 2024Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with... (Review)
Review
INTRODUCTION
Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with enduring facial paralysis, there is still a lack of complete understanding of this debilitating condition, leading to functional limitations and decreased quality of life. This article reviews the diagnostic assessment, etiology, pathophysiology, rehabilitation, and nonsurgical and surgical treatments for facial synkinesis.
METHODS
A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "facial," "synkinesis," "palsy," and various combinations of the terms.
RESULTS
The resultant inability to control the full extent of one's facial movements has functional and psychosocial consequences and may result in social withdrawal with a significant decrease in quality of life. An understanding of facial mimetic musculature is imperative in guiding appropriate intervention. While chemodenervation with botulinum toxin and neurorehabilitation have continued to be the primary treatment strategy for facial synkinesis, novel techniques such as selective myectomy, selective neurolysis, free-functioning muscle transfer, and nerve grafting techniques are becoming increasingly utilized in treatment regimens. Facial rehabilitation, including neuromuscular retraining, soft tissue massage, and relaxation therapy in addition to chemodenervation with botulinum toxin, remains the cornerstone of treatment. In cases of severe, intractable synkinesis and non-flaccid facial paralysis, surgical interventions, including selective neurectomy, selective myectomy, nerve grafting, or free muscle transfer, may play a more significant role in alleviating symptoms.
DISCUSSION
A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes. Ultimately, therapy should be tailored to the severity and pattern of synkinesis, and each patient approached on a case-by-case basis. A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes.
Topics: Humans; Synkinesis; Facial Paralysis; Facial Muscles; Quality of Life; Botulinum Toxins; Neuromuscular Agents; Denervation
PubMed: 34836457
DOI: 10.1177/01455613211054627 -
Clinical Neurophysiology : Official... Jan 2023Epileptiform activity is common in critically ill patients, but movement-related artifacts-including electromyography (EMG) and myoclonus-can obscure EEG, limiting...
OBJECTIVE
Epileptiform activity is common in critically ill patients, but movement-related artifacts-including electromyography (EMG) and myoclonus-can obscure EEG, limiting detection of epileptiform activity. We sought to determine the ability of pharmacologic paralysis and quantitative artifact reduction (AR) to improve epileptiform discharge detection.
METHODS
Retrospective analysis of patients who underwent continuous EEG monitoring with pharmacologic paralysis. Four reviewers read each patient's EEG pre- and post- both paralysis and AR, and indicated the presence of epileptiform discharges. We compared the interrater reliability (IRR) of identifying discharges at baseline, post-AR, and post-paralysis, and compared the performance of AR and paralysis according to artifact type.
RESULTS
IRR of identifying epileptiform discharges at baseline was slight (N = 30; κ = 0.10) with a trend toward increase post-AR (κ = 0.26, p = 0.053) and a significant increase post-paralysis (κ = 0.51, p = 0.001). AR was as effective as paralysis at improving IRR of identifying discharges in those with high EMG artifact (N = 15; post-AR κ = 0.63, p = 0.009; post-paralysis κ = 0.62, p = 0.006) but not with primarily myoclonus artifact (N = 15).
CONCLUSIONS
Paralysis improves detection of epileptiform activity in critically ill patients when movement-related artifact obscures EEG features. AR improves detection as much as paralysis when EMG artifact is high, but is ineffective when the primary source of artifact is myoclonus.
SIGNIFICANCE
In the appropriate setting, both AR and paralysis facilitate identification of epileptiform activity in critically ill patients.
Topics: Humans; Electroencephalography; Artifacts; Critical Illness; Retrospective Studies; Myoclonus; Reproducibility of Results; Paralysis
PubMed: 36462473
DOI: 10.1016/j.clinph.2022.11.007 -
BMJ Case Reports Sep 2021Eight-and-a-half syndrome is a rare entity characterised by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia and ipsilateral lower motor neuron...
Eight-and-a-half syndrome is a rare entity characterised by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia and ipsilateral lower motor neuron type facial palsy. It is due to a lesion affecting median longitudinal fasciculus, paramedian pontine reticular formation and facial nerve fascicle on the same side at the level of pons. The diagnosis is easily missed as it needs detailed ocular movement examination. It is mainly caused due to infarction or demyelinating conditions. We are reporting an interesting case of a 54-year-old man with right-side eight-and-a-half syndrome due to acute ischaemic stroke and ST-elevation myocardial infarction of the inferior wall.
Topics: Brain Ischemia; Facial Paralysis; Humans; Male; Middle Aged; Ocular Motility Disorders; Ophthalmoplegia; Pons; Stroke
PubMed: 34479896
DOI: 10.1136/bcr-2021-244338 -
Cold Spring Harbor Perspectives in... Nov 2019Bioelectronic medicine is a rapidly growing field that explores targeted neuromodulation in new treatment options addressing both disease and injury. New bioelectronic... (Review)
Review
Bioelectronic medicine is a rapidly growing field that explores targeted neuromodulation in new treatment options addressing both disease and injury. New bioelectronic methods are being developed to monitor and modulate neural activity directly. The therapeutic benefit of these approaches has been validated in recent clinical studies in various conditions, including paralysis. By using decoding and modulation strategies together, it is possible to restore lost function to those living with paralysis and other debilitating conditions by interpreting and rerouting signals around the affected portion of the nervous system. This, in effect, creates a bioelectronic "neural bypass" to serve the function of the damaged/degenerated network. By learning the language of neurons and using neural interface technology to tap into critical networks, new approaches to repairing or restoring function in areas impacted by disease or injury may become a reality.
Topics: Biosensing Techniques; Brain; Electric Stimulation Therapy; Electronics, Medical; Forecasting; Humans; Neurons; Paralysis; Synaptic Transmission
PubMed: 30745288
DOI: 10.1101/cshperspect.a034306 -
Tidsskrift For Den Norske Laegeforening... Sep 2018
Topics: Diagnosis, Differential; Headache; Humans; Paralysis
PubMed: 30180483
DOI: 10.4045/tidsskr.18.0598 -
Journal of the American Veterinary... Sep 2016
Topics: Animals; Animals, Newborn; Autopsy; Cattle; Cattle Diseases; Diagnosis, Differential; Granuloma; Injections, Intramuscular; Paralysis; Spinal Cord Compression; Viral Vaccines
PubMed: 27556260
DOI: 10.2460/javma.249.5.483 -
HNO Apr 2023Handling of the facial nerve during surgery for parotid cancer is relevant for the patient's long-term quality of life. In about two thirds of cases, the facial nerve is... (Review)
Review
Handling of the facial nerve during surgery for parotid cancer is relevant for the patient's long-term quality of life. In about two thirds of cases, the facial nerve is not affected by the tumor. In these cases, in addition to complete tumor resection, identification and preservation of the facial nerve are important components of a successful operation. If the nerve is infiltrated by the tumor, the affected part must be resected during radical parotidectomy. When possible, primary nerve reconstruction leads to the best long-term cosmetic and functional outcomes. Individual selection of the optimal treatment concept is based on clinical examination of facial muscle mobility, preoperative imaging to understand the positional relationship between tumor and nerve, and on the basis of an electrophysiological examination of nerve function. Intraoperatively, standardized dissection helps to identify and preserve the facial nerve. If radical parotidectomy is indicated, in addition to one-step reconstruction, preoperative diagnostic tests can help to plan postoperative adjuvant therapy. The aim of rehabilitation is restoration of facial tone, facial symmetry, and movement of the paralyzed face. Restoration of eye closure is of high importance. The surgical treatment of facial paralysis has seen many improvements in recent years. The present work provides an overview of the most recent advances in diagnostics, surgical techniques, and further possibilities for preventing damage to the normal facial nerve during parotid cancer treatment. Furthermore, the options for rehabilitation of the tumor-infiltrated facial nerve in the context of treatment of salivary gland malignancies are described.
Topics: Humans; Facial Nerve; Parotid Neoplasms; Quality of Life; Facial Paralysis; Parotid Gland; Postoperative Complications
PubMed: 35288765
DOI: 10.1007/s00106-022-01148-y -
Neurobiology of Disease Nov 2015Loss of the ability to move, as a consequence of spinal cord injury or neuromuscular disorder, has devastating consequences for the paralyzed individual, and great... (Review)
Review
Loss of the ability to move, as a consequence of spinal cord injury or neuromuscular disorder, has devastating consequences for the paralyzed individual, and great economic consequences for society. Functional electrical stimulation (FES) offers one means to restore some mobility to these individuals, improving not only their autonomy, but potentially their general health and well-being as well. FES uses electrical stimulation to cause the paralyzed muscles to contract. Existing clinical systems require the stimulation to be preprogrammed, with the patient typically using residual voluntary movement of another body part to trigger and control the patterned stimulation. The rapid development of neural interfacing in the past decade offers the promise of dramatically improved control for these patients, potentially allowing continuous control of FES through signals recorded from motor cortex, as the patient attempts to control the paralyzed body part. While application of these 'brain-machine interfaces' (BMIs) has undergone dramatic development for control of computer cursors and even robotic limbs, their use as an interface for FES has been much more limited. In this review, we consider both FES and BMI technologies and discuss the prospect for combining the two to provide important new options for paralyzed individuals.
Topics: Brain; Brain-Computer Interfaces; Electric Stimulation Therapy; Electrocorticography; Electroencephalography; Humans; Motor Cortex; Muscle, Skeletal; Neurons; Paralysis; Psychomotor Performance; Recovery of Function; Spinal Cord Injuries
PubMed: 25447224
DOI: 10.1016/j.nbd.2014.10.014 -
Scientific Reports Jul 2020Walking speed is strongly influenced by the severity of motor paralysis in post-stroke patients. Nevertheless, some patients with mild motor paralysis still walk slowly....
Walking speed is strongly influenced by the severity of motor paralysis in post-stroke patients. Nevertheless, some patients with mild motor paralysis still walk slowly. Factors associated with this difference in walking speed have not been elucidated. To confirm walking characteristics of patients with mild motor paralysis and slow walking speed, this study identified patient subgroups based on the association between the severity of motor paralysis and walking speed. Fugl-Meyer assessment synergy score (FMS) and the walking speed were measured (n = 42), and cluster analysis was performed based on the association between FMS and walking speed to identify the subgroups. FMS and walking speed were associated (ρ = 0.50); however, some patients walked slowly despite only mild motor paralysis. Cluster analysis using FMS and walking speed as the main variables classified patients into subgroups. Patients with mild motor paralysis (FMS: 18.4 ± 2.09 points) and slow walking speed (0.28 ± 0.14 m/s) exhibited poorer trunk stability, increased co-contraction of the shank muscle, and increased intramuscular coherence in walking compared to other clusters. This group was identified by their inability to fully utilize the residual potential of motor function. In walking training, intervention in instability and excessive cortical control may be effective.
Topics: Aged; Female; Humans; Male; Middle Aged; Paralysis; Psychomotor Performance; Stroke; Stroke Rehabilitation; Walking; Walking Speed
PubMed: 32678273
DOI: 10.1038/s41598-020-68905-3