-
Journal of Plastic, Reconstructive &... Nov 2023The purpose of this review is to provide an overview of the available literature assessing the treatment of botulinum toxin injections for the treatment of synkinesis of... (Review)
Review
BACKGROUND
The purpose of this review is to provide an overview of the available literature assessing the treatment of botulinum toxin injections for the treatment of synkinesis of the buccinator muscle in patients with peripheral facial palsy (PFP).
MATERIALS AND METHODS
A multi database search was performed, including the following databases: Pubmed, Medline, Embase, and the Cochrane Library. Each database was searched from its earliest date until 8 June 2023. The following outcome measures were extracted from the articles when available: subjective, somatic, and psychological effects on the patients and objective outcomes such as the House-Brackmann, Sunnybrook and Sydney scores. The methodological quality of the included studies was rated using the Newcastle-Ottawa scale for nonrandomised trials.
RESULTS
The primary literature search generated 37 articles. After removing duplicates, 25 articles remained for abstract appraisal, of which 20 underwent full-text appraisal, resulting in 3 studies for analysis. All of these studies showed (significant) improvement in synkinesis either measured using the Synkinesis Assessment Questionnaire or subjectively measured by asking treated patients.
CONCLUSION
The available literature supports the finding that botulinum toxin treatment of the buccinator muscle could be a welcome addition to facial synkinesis treatment and could significantly improve patient outcomes. In future studies, the efficacy of EMG-guided buccinator injections, optimal dose, and a validated measuring method could be beneficial in optimising treatment for patients with a PFP and synkinesis.
Topics: Humans; Botulinum Toxins, Type A; Neuromuscular Agents; Synkinesis; Face; Facial Muscles; Facial Paralysis
PubMed: 37716254
DOI: 10.1016/j.bjps.2023.08.006 -
Facial Plastic Surgery & Aesthetic... 2024Coronavirus disease 2019 (COVID-19) has been linked to Bell's palsy and facial paralysis. Studies have also shown increased risk of Bell's palsy in unvaccinated...
Coronavirus disease 2019 (COVID-19) has been linked to Bell's palsy and facial paralysis. Studies have also shown increased risk of Bell's palsy in unvaccinated COVID-19 patients. To compare the relationship between Bell's palsy and COVID-19 infection and vaccination. This is a retrospective longitudinal study. The COVID-19 research network was used to identify patients with facial palsy presenting to 70 health care organizations in the United States. The incidence of Bell's palsy was measured within an 8-week window after COVID-19 test or vaccination event in identified patients. Incidence of facial palsy diagnosis (0.99%) was higher than the background rate within 2 months of COVID-19 infection. When compared with their negative counterparts, patients with COVID-19 infection had significantly higher risk of Bell's palsy (risk ratio [RR] = 1.77, < 0.01) and facial weakness (RR = 2.28, < 0.01). Risk ratio was also amplified when evaluating Bell's palsy (RR = 12.57, < 0.01) and facial palsy (RR = 44.43; < 0.01) in COVID-19-infected patients against patients who received COVID-19 vaccination. In our patient population, there is a higher risk of developing facial palsy within 2 months of COVID-19 infection versus vaccination. Vaccinated patients are not at higher risk of developing facial palsy.
Topics: Humans; United States; Bell Palsy; Facial Paralysis; Longitudinal Studies; Retrospective Studies; COVID-19 Vaccines; COVID-19
PubMed: 37751178
DOI: 10.1089/fpsam.2022.0394 -
Journal of AAPOS : the Official... Oct 2023To analyze the surgical results of patients treated for superior oblique palsy with coexisting exotropia.
PURPOSE
To analyze the surgical results of patients treated for superior oblique palsy with coexisting exotropia.
METHODS
The medical records of patients with superior oblique palsy and exotropia who underwent inferior oblique weakening and simultaneous lateral rectus recession by a single surgeon from 1996 to 2022 were reviewed retrospectively. Demographics, pre- and postoperative vertical and horizontal deviation, and presence of diplopia were recorded. Surgical success was defined as horizontal deviation <10 and vertical deviation ≤4 without overcorrection or diplopia. The decision to operate for the horizontal deviation was made based on fusion in free space when the vertical deviation was offset with a prism.
RESULTS
A total of 27 patients were included. Mean age was 26.1 ± 22 years (range, 26 months to 78 years). Preoperatively, mean vertical deviation was 15.2 ± 7.5 (range, 4-30); mean exodeviation, 17 ± 5.5 (range, 10-35). Of the 27 patients, 25 underwent unilateral and 2 underwent bilateral lateral rectus recession, according to the magnitude of the horizontal deviation. Mean follow-up was 3 ± 3.8 months (range, 2 weeks to 17 months). Postoperative mean vertical alignment was 3.0 ± 5.9, and horizontal alignment was 3.4 ± 5.2 (esotropia of 7 to exotropia of 12; P < 0.0001). Nineteen patients (70%) had a successful result; 2 patients had residual exotropia of >10, 2 had vertical overcorrection (range, 3-4), and 6 had residual vertical deviation ≥4 (range, 5-20). None had secondary esotropia >10. Horizontal deviation was corrected successfully with no consecutive esotropia in 25 patients.
CONCLUSIONS
In our study cohort, patients with superior oblique palsy and exotropia in whom fusion required both horizontal and vertical prism correction had a high likelihood of successful horizontal alignment after lateral rectus weakening in combination with inferior oblique surgery.
Topics: Humans; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Exotropia; Esotropia; Retrospective Studies; Diplopia; Oculomotor Muscles; Trochlear Nerve Diseases; Ophthalmologic Surgical Procedures; Paralysis; Treatment Outcome; Follow-Up Studies
PubMed: 37716432
DOI: 10.1016/j.jaapos.2023.08.002 -
Journal of Shoulder and Elbow Surgery Oct 2023Impairment of both shoulder extension and behind-the-back function are common in patients with residual neonatal brachial plexus injury (NBPI), but have scarcely been...
BACKGROUND
Impairment of both shoulder extension and behind-the-back function are common in patients with residual neonatal brachial plexus injury (NBPI), but have scarcely been studied or reported in the literature. Behind-the-back function is classically evaluated using the hand-to-spine task used for the Mallet score. Angular measurements of shoulder extension with residual NBPI have generally been studied utilizing kinematic motion laboratories. To date, no validated clinical examination method for this has been described.
METHODS
Intraobserver and interobserver reliability analyses of 2 shoulder extension angles-passive glenohumeral extension (PGE) and active shoulder extension (ASE)-were performed. Afterwards, a retrospective clinical study was conducted on prospectively collected data on 245 children with residual BPI treated from January 2019 through August 2022. Demographic characteristics, level of palsy, previous surgical procedures, modified Mallet score, and bilateral PGE and ASE data were analyzed.
RESULTS
All inter- and intraobserver agreements were excellent, ranging from 0.82 to 0.86. The median patient age was 8.1 years (3.5-21). Among the 245 children, 57.6% had Erb's palsy, 28.6% extended Erb's palsy, and 13.9% global palsy. One hundred sixty-eight (66%) of the children could not touch their lumbar spine, among whom 26.2% (n = 44) had to swing the arm to reach it. Both the degrees of ASE and PGE achieved correlation significantly with the hand-to-spine score, the ASE strongly (r = 0.705) and the PGE weakly (r = 0.372) (both P < .0001). Significant correlations also were found between lesion level and the hand-to-spine Mallet score (r = -0.339; P < .0001) and ASE (r = -0.299; P < .0001), and between patient age and the PGE (P = .0416, r = -0.130). A statistically significant decrease in PGE and incapacity to reach the spine were found in patients who underwent glenohumeral reduction, shoulder tendon transfer, or humeral osteotomy, relative to those who had microsurgery or no surgery. Receiver operating curves showed that, for both PGE and ASE, the minimum extension angle required to successfully perform the hand-to-spine task was 10°, with sensitivity levels of 69.9 and 82.2, and specificity levels of 69.5 and 87.8 (both P < .0001), respectively.
CONCLUSIONS
Glenohumeral flexion contracture and lost ASE are extremely common in children with residual NBPI. Both the PGE and ASE angles can be measured reliably with a clinical exam, with at least 10° of PGE and ASE necessary to perform the hand-to-spine Mallet task.
Topics: Infant, Newborn; Humans; Child; Shoulder; Retrospective Studies; Shoulder Joint; Reproducibility of Results; Treatment Outcome; Brachial Plexus Neuropathies; Brachial Plexus; Paralysis; Range of Motion, Articular; Birth Injuries
PubMed: 37178959
DOI: 10.1016/j.jse.2023.03.036 -
The Annals of Otology, Rhinology, and... Sep 2023To report a case of alternobaric facial palsy (AFP) with a hyperpneumatized temporal bone and to review the relevant literature in order to propose a new facet of AFP... (Review)
Review
OBJECTIVE
To report a case of alternobaric facial palsy (AFP) with a hyperpneumatized temporal bone and to review the relevant literature in order to propose a new facet of AFP pathogenesis.
METHODS
A patient with a hyperpneumatized temporal bone was found to have recurrent episodes of facial palsy associated with air travel. Systematic review of PubMed, Cochrane Library, and Embase characterized all articles related to transient facial palsy associated with altitude changes or diving with a focus on demographics and imaging findings.
RESULTS
A 25 year-old male was referred for recurrent facial palsy associated with commercial air travel. Imaging demonstrated a hyperpneumatized and well-aerated temporal bone. Total air cell volume was calculated to be 8.59 cc on the affected side. A systematic review of the literature identified 49 cases of AFP. Mean age was 34 years old and 80% were male. Twelve cases had imaging of the temporal bone for evaluation, of which 85% demonstrated at least 1 area of hyperpneumatization. Hyperpneumatization was most frequently encountered in the mastoid, zygomatic root, and inferior petrous apex.
CONCLUSION
Hyperpneumatization of the temporal bone is critical to AFP etiology as it predicts higher middle ear pressure, if atmospheric pressure changes cannot be equilibrated, via reduced efficacy of normal tympanic membrane pressure buffering. This hypothesis helps to better account for the rarity of the condition and male preponderance.
Topics: Humans; Male; Adult; Female; Facial Paralysis; alpha-Fetoproteins; Bell Palsy; Diagnostic Imaging; Petrous Bone; Temporal Bone
PubMed: 36278328
DOI: 10.1177/00034894221127499 -
Complementary Therapies in Medicine Dec 2023This study aimed to employ bibliometric approaches to assess the worldwide scientific achievements in acupuncture for facial paralysis research from 2013 to 2023, and... (Review)
Review
OBJECTIVE
This study aimed to employ bibliometric approaches to assess the worldwide scientific achievements in acupuncture for facial paralysis research from 2013 to 2023, and explore the hotspots and frontiers.
METHODS
Articles related to acupuncture facial paralysis were retrieved from the Web of Science Core Collection (WoSCC). CiteSpace was utilized to examine journals, publication year, country, institution, cited authors, as well as authors.Research hotspots and trends were analyzed by mapping co-citation networks and keywords.
RESULTS
The period from January 1, 2013, to July 31, 2023, yielded nearly 145 research records on acupuncture treatment for facial paralysis, with a steady increase in the number of annual publications.In terms of the number of publications, OTOLARYNGOLOGY HEAD NECK had the highest publication count, while AM J CHINESE MED exhibited the highest centrality and citation frequency among the cited journals. Further, 54.4 % of publications originated from China, followed by USA (8.2 %) and Germany (8.2 %). Guangzhou University of Chinese Medicine stood out with the highest publication volume among institutions. Guntinas-lichius, Orlando was the most prolific author, and PEITERSEN E was the most cited author. The keywords "Randomized controlled trials" and "multicenter" displayed high frequency and centrality, indicating that clinical trials with a randomized controlled design and multicenter studies were prevalent research methods, likely to remain a future trend.
CONCLUSION
Acupuncture's potential in the treatment of facial paralysis merits further research. Authors from different countries/regions and organizations need to eliminate language and academic barriers and strengthen collaboration and communication. Current research hotspots focus on "brain", "nerve", "electrical stimulation", "RCT" and "guidelines". The study of acupuncture mechanisms, especially based on the central nervous system mechanism, may be the future research hotspot.
Topics: Humans; Facial Paralysis; Acupuncture Therapy; Asian People; Bibliometrics; Brain
PubMed: 37972694
DOI: 10.1016/j.ctim.2023.103006 -
Journal of Neurology Nov 2023Information regarding frequency, details of neurological signs and recovery patterns of patients with secondary hypokalaemic paralysis (HP) is limited. This study aimed...
PURPOSE
Information regarding frequency, details of neurological signs and recovery patterns of patients with secondary hypokalaemic paralysis (HP) is limited. This study aimed to analyse the frequency, aetiology, clinical features and recovery patterns of patients with secondary HP.
METHODS
The clinical and laboratory records of 18 consecutive patients with secondary HP aged ≥ 18 years admitted to our hospital between April 2011 and March 2022 were reviewed. Patients with inherited hypokalaemic periodic paralysis were excluded.
RESULTS
Of the 18 patients, 16 had a common aetiology: chronic alcoholism, diarrhoea or an imbalanced diet. Initial symptoms, such as fatigue, were often atypical. Three patients had prominent asymmetric limb weakness and four had predominant upper limb weakness. On admission, the mean serum potassium and creatine kinase (CK) levels of the patients were 1.90 mmol/L and 4488 U/mL, respectively. Ten patients (56%) had decreased potassium levels after admission, despite potassium replacement treatment (rebound hypokalaemia). Twelve patients presented with increased CK levels even after 2-5 days (delayed hyperCKaemia). Low serum magnesium levels significantly correlated with rebound hypokalaemia.
CONCLUSIONS
Secondary HP can be caused by a variety of conditions, but mainly occurs due to lifestyle conditions/disorders. Secondary HP often presents with atypical symptoms, and the initial symptoms can be non-specific. Rebound hypokalaemia and delayed hyperCKaemia are common in secondary HP, despite potassium replacement. As such, careful serial monitoring is needed for patients with secondary HP.
Topics: Humans; Hypokalemia; Hypokalemic Periodic Paralysis; Potassium; Paralysis; Fatigue
PubMed: 37542171
DOI: 10.1007/s00415-023-11923-8 -
Acta Oto-laryngologica 2023Several studies point out the association of facial palsy with psychiatric distress such as depression and anxiety. However, there have been few studies on this...
BACKGROUND
Several studies point out the association of facial palsy with psychiatric distress such as depression and anxiety. However, there have been few studies on this association based on population-based data.
OBJECTIVES
To investigate the risk for depression and anxiety disorders in patients with Bell's palsy and in those with Ramsay Hunt syndrome.
MATERIALS AND METHODS
This retrospective study included data from the Korean National Health Insurance Service National Sample Cohort. From 2006 to 2015, patients with Bell's palsy and those with Ramsay Hunt syndrome were defined using diagnostic and medication claim codes. Patients with depression or anxiety were defined using diagnostic and medication claim codes. Occurrences of depression and anxiety were included in analyses.
RESULTS
There were significantly higher risks for depressive and anxiety disorders in the group of patients with Bell's palsy than in the control group, as well as in the group of patients with Ramsay Hunt syndrome than in the control group.
CONCLUSIONS AND SIGNIFICANCE
There were significantly higher risks for depression and anxiety in patients with facial palsy including Bell's palsy and Ramsay Hunt syndrome based on population-based data from Korea.
Topics: Humans; Facial Paralysis; Bell Palsy; Herpes Zoster Oticus; Retrospective Studies; Depression; Anxiety Disorders; Anxiety; Republic of Korea
PubMed: 38240110
DOI: 10.1080/00016489.2024.2302899 -
Otolaryngology--head and Neck Surgery :... Mar 2024To review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP). (Review)
Review
OBJECTIVE
To review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP).
DATA SOURCES
PubMED, Scopus, and Cochrane Library.
REVIEW METHODS
A systematic review of the literature on epidemiology, etiologies, and management of adult patients with BVFP was conducted through preferred reporting items for systematic reviews and meta-analyses statements by 2 investigators.
RESULTS
Of the 360 identified papers, 245 were screened, and of these 55 were considered for review. The majority (76.6%) of BVFP cases are iatrogenic. BVFP requires immediate tracheotomy in 36.2% of cases. Laterofixation of the vocal fold was described in 9 studies and is a cost-effective alternative procedure to tracheotomy while awaiting potential recovery. Unilateral and bilateral posterior transverse cordotomy outcomes were reported in 9 and 7 studies, respectively. Both approaches are associated with a 95.1% decannulation rate, adequate airway volume, but voice quality worsening. Unilateral/bilateral partial arytenoidectomy data were described in 4 studies, which reported lower decannulation rate (83%) and better voice quality outcome than cordotomy. Revision rates and complications vary across studies, with complications mainly involving edema, granuloma, fibrosis, and scarring. Selective posterior cricoarytenoid reinnervation is being performed by more surgeons and should be a promising addition to the BVFP surgical armamentarium.
CONCLUSION
Depending on techniques, the management of BVFP may be associated with several degrees of airway improvements while worsened or unchanged voice quality. The heterogeneity between studies, the lack of large-cohort controlled randomized studies and the confusion with posterior glottic stenosis limit the draw of clear conclusion about the superiority of some techniques over others.
Topics: Adult; Humans; Vocal Cords; Treatment Outcome; Vocal Cord Paralysis; Voice Quality; Tracheotomy
PubMed: 38123531
DOI: 10.1002/ohn.616 -
EBioMedicine Nov 2023Progressive supranuclear palsy (PSP) is a primary 4-repeat tauopathy with diverse clinical phenotypes. Previous post-mortem studies examined tau deposition sequences in...
BACKGROUND
Progressive supranuclear palsy (PSP) is a primary 4-repeat tauopathy with diverse clinical phenotypes. Previous post-mortem studies examined tau deposition sequences in PSP, but in vivo scrutiny is lacking.
METHODS
We conducted [F]Florzolotau tau positron emission tomography (PET) scans on 148 patients who were clinically diagnosed with PSP and 20 healthy controls. We employed the Subtype and Stage Inference (SuStaIn) algorithm to identify PSP subtype/stage and related tau patterns, comparing clinical features across subtypes and assessing PSP stage-clinical severity association. We also evaluated functional connectivity differences among subtypes through resting-state functional magnetic resonance imaging.
FINDINGS
We identified two distinct subtypes of PSP: Subtype1 and Subtype2. Subtype1 typically exhibits a sequential progression of the disease, starting from subcortical and gradually moving to cortical regions. Conversely, Subtype2 is characterized by an early, simultaneous onset in both regions. Interestingly, once the disease is initiated, Subtype1 tends to spread more rapidly within each region compared to Subtype2. Individuals categorized as Subtype2 are generally older and exhibit less severe dysfunctions in areas such as cognition, bulbar, limb motor, and general motor functions compared to those with Subtype1. Moreover, they have a more favorable prognosis in terms of limb motor function. We found significant correlations between several clinical variables and the identified PSP SuStaIn stages. Furthermore, Subtype2 displayed a remarkable reduction in functional connectivity compared to Subtype1.
INTERPRETATION
We present the evidence of distinct in vivo spatiotemporal tau trajectories in PSP. Our findings can contribute to precision medicine advancements for PSP.
FUNDING
This work was supported by grants from the National Natural Science Foundation of China (number 82272039, 81971641, 82021002, and 92249302); Swiss National Science Foundation (number 188350); the STI2030-Major Project of China (number 2022ZD0211600); the Clinical Research Plan of Shanghai Hospital Development Center of China (number SHDC2020CR1038B); and the National Key R&D Program of China (number 2022YFC2009902, 2022YFC2009900), the China Scholarship Council (number 202006100181); the Deutsche Forschungsgemeinschaft (DFG) under Germany's Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy, ID 390857198).
Topics: Humans; Supranuclear Palsy, Progressive; tau Proteins; China; Positron-Emission Tomography
PubMed: 37839135
DOI: 10.1016/j.ebiom.2023.104835