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Journal of Korean Medical Science Aug 2020This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest.
METHODS
An electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms "Bell's palsy," "Ramsay-Hunt syndrome," "Facial palsy," "Facial paralysis," "Facial paresis," "Guideline," "Meta-analysis," "Systematic review," and "Randomized controlled trial." Only studies written in English were used.
RESULTS
The characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised.
CONCLUSION
For peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.
Topics: Acupuncture Therapy; Acute Disease; Decompression, Surgical; Facial Nerve; Facial Paralysis; Humans; Practice Guidelines as Topic
PubMed: 32743989
DOI: 10.3346/jkms.2020.35.e245 -
Tidsskrift For Den Norske Laegeforening... Nov 2018Facial paralysis can be a stigmatising condition, and in many cases it may affect the closing function of the eye, facial expression, the nasal airway passage, language... (Review)
Review
Facial paralysis can be a stigmatising condition, and in many cases it may affect the closing function of the eye, facial expression, the nasal airway passage, language and nutritional intake to varying degrees. For the majority of patients, treatment methods exist that may improve function and quality of life. This article aims to provide a review of relevant surgical reconstruction methods and treatment options for patients with facial paralysis.
Topics: Botulinum Toxins; Facial Paralysis; Humans; Neurotoxins; Plastic Surgery Procedures
PubMed: 30421736
DOI: 10.4045/tidsskr.17.1023 -
Acta Medica Portuguesa Dec 2011Peripheral facial paralysis (PFP) is a consequence of the peripheral neuronal lesion of the facial nerve (FN). It can be either primary (Bell`s Palsy) or secondary. The... (Review)
Review
Peripheral facial paralysis (PFP) is a consequence of the peripheral neuronal lesion of the facial nerve (FN). It can be either primary (Bell`s Palsy) or secondary. The classical clinical presentation typically involves both stages of the hemiface. However, there may be other symptoms (ex. xerophthalmia, hyperacusis, phonation and deglutition changes) that one should recall. Clinical evaluation includes rigorous muscle tonus and sensibility search in the FN territory. Some useful instruments allow better objectivity in the patients' evaluation (House-Brackmann System, Facial Grading System, Functional Evaluation). There are clear referral criteria to Physical Medicine and Rehabilitation. Treatment of Bell`s Palsy may include pharmacotherapy, neuromuscular training (NMT), physical methods and surgery. In the NMT field the several treatment techniques are systematized. Therapeutic strategies should be problem-oriented and adjusted to the patient's symptoms and signs. Physical methods are reviewed. In about 15-20 % of patients permanent sequelae subside after 3 months of evolution. PFP is commonly a multidisciplinary condition. Therefore, it is important to review strategies that Physical Medicine and Rehabilitation may offer.
Topics: Facial Paralysis; Humans; Physical Therapy Modalities
PubMed: 22863499
DOI: No ID Found -
Brazilian Journal of Physical Therapy 2022Facial palsy (FP) is defined as an injury of the seventh cranial nerve pair, partial or total, which can be classified as central or peripheral. Proprioceptive... (Review)
Review
BACKGROUND
Facial palsy (FP) is defined as an injury of the seventh cranial nerve pair, partial or total, which can be classified as central or peripheral. Proprioceptive neuromuscular facilitation (PNF) is primarily used in the functional recovery of upper and lower limb conditions, however the technique has also been used for FP.
OBJECTIVE
To analyze the effect of PNF in the treatment of dysfunctions in FP.
METHODS
Ten databases including BVS, CENTRAL Cochrane, CINAHL, PEDro, PubMed, Scielo, ScienceDirect, SCOPUS, Web of Science, and Google Scholar were comprehensively searched for dates prior to April 2021. Randomized controlled trials of PNF in individuals with dysfunctions caused by facial paralysis were eligible. Outcomes measures were recovery rate and clinical recovery, both measured by using the House Brackmann Scale. Recovery time was measured in days and synkinesis assessed with the Synkinesis Assessment Questionnaire.
RESULTS
A total of 184 patients were included. In general, the included studies have low methodological quality. None of the five studies used PNF as the sole intervention. In all of the included studies PNF was used in combination with other interventions. Our findings show very low evidence that PNF is more effective than minimal intervention for treating FP.
CONCLUSION
We conclude that given the limited number of studies included and the low methodological quality presented, recommendations based on these studies should be interpreted with caution. The effects of PNF on facial paralysis are not clear.
Topics: Humans; Facial Paralysis; Muscle Stretching Exercises; Synkinesis; Recovery of Function
PubMed: 36279766
DOI: 10.1016/j.bjpt.2022.100454 -
European Journal of Physical and... Feb 2020Peripheral facial nerve palsy (FNP) can have various causes, such as Bell's palsy or after surgery for acoustic neuroma. Rehabilitation is often required but there is no... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Peripheral facial nerve palsy (FNP) can have various causes, such as Bell's palsy or after surgery for acoustic neuroma. Rehabilitation is often required but there is no evidence that any rehabilitation approach is more efficacious than another.
AIM
The purpose of this research was to determine the effects of neurocognitive-rehabilitative approach through mirror-therapy (MT) and motor-imagery (MI), integrated into the traditional rehabilitation with mime-therapy and myofascial-approach.
DESIGN
This study was designed as a double-blind, randomized, controlled trial.
SETTING
This study took place from January 2016 to June 2018 at the Unit of Physical Medicine and Rehabilitation of Umberto I Polyclinic Hospital, Rome, Italy.
POPULATION
Twenty-two patients were randomized into two groups: the mirror therapy group (N.=11, MT and MI) and the traditional rehabilitation group (N.=11, mime-therapy and a myofascial-approach).
METHODS
Outcome assessments were performed before treatment (T0), after one month (T1=10 session, twice/week), after the second and third months (T2=10 twice/week + 5 of MT+MI one/week and T3=10 twice/week + 5 of MT+MI 1/week), and at the 4-week follow-up (T4=2 months follow-up).
RESULTS
The analysis of the functional evaluations show that both groups experienced progressive improvement T0 to T3, with stabilization of the results at the follow-up. There was a significant difference in House-Brackmann-Scale scores between T0 and follow-up in favor of the experimental group. In terms of quality of life (FaCE scale), total scores and social function items improved in both groups from T0 to T3. The experimental group obtained better results with regard to quality of life and emotional depression.
CONCLUSIONS
The integrated use of MT and MI is efficacious in the rehabilitation of FNP, improving facial physical function. Further studies are needed to determine the predictive factors of the recovery of facial mimic.
CLINICAL REHABILITATION IMPACT
The ability of patients with unilateral facial paralysis to recognize and appropriately judge facial expressions and perceive the judgments of others remains underexplored. The likelihood of recovering near-normal facial-function after grade VI facial paralysis is low. Procedures, such as the immediate repair of the facial nerve with an interposed donor graft, might improve facial function in patients with partially injured facial nerves.
Topics: Adult; Aged; Disability Evaluation; Double-Blind Method; Facial Nerve; Facial Paralysis; Female; Humans; Imagery, Psychotherapy; Male; Middle Aged; Neuropsychological Tests; Physical Therapy Modalities
PubMed: 30916916
DOI: 10.23736/S1973-9087.19.05757-5 -
JAMA Otolaryngology-- Head & Neck... Nov 2020Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the...
IMPORTANCE
Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the expectation of facial function recovery. A potential treatment is physical therapy (PT).
OBJECTIVE
To investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP.
EVIDENCE REVIEW
Patients with noniatrogenic FP, facial reanimation surgery, and invasive adjunctive treatments (acupuncture or botulinum toxin injection) were excluded. A systematic review was conducted for records discussing iatrogenic FP and PT; a search for these records was performed using Ovid MEDLINE (1946-2019), Embase (1947-2019), Scopus (1823-2019), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform (2004-2019), and ClinicalTrials.gov (1997-2019). The references of all the included articles were also assessed for eligible studies. All human participant, English-language study designs with at least 2 cases were included. Quality assessment was performed using the Methodological Index for Non-randomized Studies (MINORS) and the revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. All search strategies were completed on May 16, 2019, and again on October 1, 2019.
FINDINGS
Fifteen studies (7 of which were retrospective cohort studies) and 313 patients with iatrogenic FP were included in the systematic review. Most iatrogenic FP (166 patients [53%]) was associated with parotidectomy; traditional PT (ie, facial massage) was the most common intervention (196 patients [63%]). The use of various facial grading systems and inconsistent reporting of outcomes prevented direct comparison of PT types.
CONCLUSIONS AND RELEVANCE
Because of heterogeneity in reported outcomes of facial nerve recovery, definitive conclusions were unable to be made regarding the association between PT and outcomes of iatrogenic FP. Physical therapy probably has benefit and is associated with no harm in patients with iatrogenic FP.
Topics: Facial Paralysis; Humans; Iatrogenic Disease; Physical Therapy Modalities
PubMed: 32970128
DOI: 10.1001/jamaoto.2020.3049 -
European Archives of... Jul 2008Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell's palsy). Three quarters of peripheral FNP are primary and one quarter... (Review)
Review
Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell's palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell's palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell's palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell's palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell's palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae.
Topics: Anti-Inflammatory Agents; Antiviral Agents; Botulinum Toxins, Type A; Decompression, Surgical; Facial Nerve; Facial Paralysis; Gold Compounds; Humans; Magnetic Resonance Imaging; Neuromuscular Agents; Pentoxifylline; Prospective Studies; Severity of Illness Index; Skull; Tomography, X-Ray Computed; Vasodilator Agents
PubMed: 18368417
DOI: 10.1007/s00405-008-0646-4 -
Revista de NeurologiaTo make a review and analysis of articles that used physical therapy methods for peripheral facial paralysis (PFP). (Review)
Review
AIM
To make a review and analysis of articles that used physical therapy methods for peripheral facial paralysis (PFP).
MATERIALS AND METHODS
The articles were searched in MEDLINE, EMBASE, PEDro y CINAHL data bases. The inclusion criteria used for the selection of the articles were: randomized controlled trials, studies in which patients suffered from PFP, studies in which physical therapy interventions were used for PFP treatment, studies published in periodic journals in between the years of 1970 and 2007, studies published in English. There were two independently reviewers that assessed the quality of the studies thanks to the Jadad scale and finally selected six randomized controlled trials.
RESULTS
Four of six selected articles showed acceptable methodological quality and five of them described movement and facial symmetry improvements, as so as prevention and decrease of synkinesis.
CONCLUSIONS
The results of our systematic review study can be very helpful for clinical decision purposes and further clinical trials. However, we consider that it's necessary to reproduce all of the studies selected but with certain methodological adjustments. We recommend that further studies investigate the most effective treatment parameters for adequate PFP treatment.
Topics: Facial Paralysis; Humans; Physical Therapy Modalities
PubMed: 18543196
DOI: No ID Found -
Indian Journal of Ophthalmology Jun 2022Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of...
BACKGROUND
Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of the jaw following a peripheral facial nerve palsy. The increased orbicularis tone due to aberrant connections between the cranial nerve (CN) V and CN VII results in an undesirable wink with major psychosocial impact.
PURPOSE
Most cases in literature were either observed or administered botulinum toxin injection to the orbicularis muscle. There are few sporadic reports of surgical interventions with successful outcomes.Hence there was a need to generate awareness regarding various modes of management of this rare entity.
SYNOPSIS
We present a video on the clinical presentation and management of six such patients, of whom one was bilateral. Five patients were females. Traumatic facial nerve paralysis and Bell's palsy was previously diagnosed in one and five patients respectively. The mean age was 52 ± 9.48 years. The mean MRD (margin reflex distance) 1 and MRD 2 was 3.17 ± 0.60 and 5.33± 0.65 mm respectively. On smiling or on movement of the jaw the MRD 1 and 2 was reduced by 2. 50±0.40 and 1.50+/-0.40 mm respectively. Of the six patients four patients opted for nil intervention.
HIGHLIGHTS
Botulinum toxin injection and preseptal orbicularis resection in the upper and lower eyelid along with blepharoplasty was performed in 1 patient each. Satisfactory reduction in the synkinetic movement was achieved in both. Marin-Amat syndrome is a rare often underdiagnosed synkinetic disorder following peripheral facial nerve palsy. Botulinum toxin injection and preseptal orbicularis resection are viable management options.
VIDEO LINK
https://youtu.be/YQbRecp449w.
Topics: Adult; Blinking; Botulinum Toxins; Facial Nerve; Facial Paralysis; Female; Humans; Male; Middle Aged; Syndrome; Synkinesis
PubMed: 35648031
DOI: 10.4103/ijo.IJO_1262_22 -
BMC Neurology Sep 2023Paralysis of the facial nerve (CN VII) is one of the most debilitating issues that any patient can encounter. Bell's palsy is the most commonly seen mononeuropathy....
BACKGROUND
Paralysis of the facial nerve (CN VII) is one of the most debilitating issues that any patient can encounter. Bell's palsy is the most commonly seen mononeuropathy. Although usually self-limited, symptomatology can persist for decades in persistent cases. The non-surgical alternative therapies discussed in this study are successful without reconstruction and are regenerative.
OBJECTIVE AND DESIGN
We sought to determine a safe new treatment could be developed to restore facial nerve function using extracellular vesicles (EVs) in patients who have been unable to return to normal under a variety of conditions. We performed a pilot safety study of 7 patients with idiopathic and secondary facial paralysis to determine if any functional restoration was possible. Each patient had symptomology for varying periods of time, with diverse House-Brackmann scores. They were all treated with the same protocol of extracellular vesicles (EVs) over a 4-week period of time and were evaluated both before and after treatment.
CASE PRESENTATIONS
All patients in this study received treatment by their private physicians prior to entering the study. A record review was completed, with independent physical examinations. House-Brackmann scores and Facial Disability Indices were obtained prior to, and after completing the study. EVs were injected into the area of the main trunk of the facial nerve on the affected side, and an intravenous drip of EVs on visits during weeks 1, 2, and 4.
CONCLUSIONS
All seven patients enrolled in the study improved with this treatment protocol. After the second week of treatment, we saw a progression of independent motion of the affected eyelid, brow motion, and commissure. Although all patients began at different House-Brackman starting points, almost all ended at the same endpoint on the scale over the same period of time - four weeks. No adverse effects were encountered. Clearly, the duration of the treatment protocol needs to be longer than one month. The pathomechanism is still unknown. But it appears that the mechanism is reversible. At last, these patients can have hope.
TRIAL REGISTRATION
The Institute of Regenerative and Cellular Medicine IRB approval number: IRCM-2021-304.
Topics: Humans; Bell Palsy; Facial Paralysis; Facial Nerve; Acupuncture Therapy; Extracellular Vesicles
PubMed: 37770834
DOI: 10.1186/s12883-023-03400-6