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PubMedDate not supplied

Functional profile in patients with facial paralysis treated in a myofunctional approach.

BACKGROUND: Clinical rehabilitation of peripheral facial paralysis (PFP). AIM: To delineate the contributions of myofunctional exercises during the flaccid phase of the disorder, before any sequelae. METHOD: 147 promptuaries of patients with facial paralysis were analyzed and divided in two groups according to the period in which rehabilitation began. For the analysis of development, the classifications proposed by House and Brackmann (1985) and Ross et al. (1994) were used. RESULTS: According to the classification of House and Brackmann (1985), all of the individuals who had sequelae reached level III. However, it was observed that even in cases of severe nerve lesion, cases in which the sequelae were non-acceptable, patients who started treatment at an early stage, revealed a better functional result when evaluated according to the classification of Ross et al. (1994). CONCLUSION: The myofunctional approach demonstrated to be an effective method for the functional reestablishment in cases of facial paralysis.

Age of Onset↗
PubMed2003

[Comparative evaluation of speech disorders and verbal and non verbal communication within two groups of patients: patients with facial paralysis (FP) and those who had undergone hypoglosso-facial anastomosis (HFA)].

INTRODUCTION: Speech disorders were often allotted to hypoglossal-facial anastomosis (HFA) without being clearly shown. We have compared patients with a peripheral facial paralysis at those with HFA. AIMS OF THE STUDY: Retrospective study comparing verbal communication (articulation) and non-verbal within two groups of patients: patients with patient FP versus with HFA. PATIENTS AND METHODS: 10 patients with idiopathic FP versus 7 patients with HFA took part in this study. The series of tests includes an evaluation of the motor possibilities, bilabial pressure measurement (for the patients with FP), speech capacities and finally an evaluation of the verbal and non-verbal communication from a scale of satisfaction. RESULTS: The results highlight: the presence of real speech disorders (permanent) among patients with FP and their absence among patients having profited from HFA; a real satisfaction of the HFA versus FP on the quality of life compared to daily tasks, more specifically concerning verbal and food skills. CONCLUSION: The HFA is not responsible for speech disorders, and makes undeniable improvements confirmed subsequently by the patients.

Anastomosis, Surgical↗
PubMedDate not supplied

[Recent developments in electrical tests applied to the study of facial paralysis].

We have already shown the spontaneous development over a period of time of idiopathic facial paralysis, in relation to the extent of the resulting disfigurement, by means of analytical clinical measurement representing the sum of 19 factors constituting the force of contraction, tonus, coordination and hemispasm. This spontaneous development takes place in 3 stages: --an initial period up to the 15th day; --an intermediate period during which there is clinically total facial paralysis; --a period of recuperation. The duration of this development in relation to the extent of sequelae enables a rough distinction to be made between: a) benign facial paralysis in which disfigurement is nil or very slight (1 to 6 p. 100), incomplete paralysis or complete paralysis in which recuperation starts about the 15th day at the earliest, or at about the 4th month at the latest; c) very serious facial paralysis with moderate (38 to 66 p. 100), or considerable (66 to 100 p. 100) disfigurement and in which recuperation starts at the end of the 3rd month at the earliest. The authors have attempted to indicate how effective very prompt quantitative electrical procedures are in helping to assess the seriousness of ultimate permanent disfigurement (see article).

Electrodiagnosis↗
PubMed2003

[Effects of L-nitroarginine on the recovery of traumatic facial paralysis].

OBJECTIVE: To study the effects of constitutive nitric oxide synthase inhibitor L-nitroarginine on the recovery of traumatic facial paralysis in rats and the changes of the expression of cNOS and OX42 in the facial nucleus. METHODS: L-nitroarginine was intraperitoneally injected into rats and the recovery of facial paralysis was observed at different time point. and the changes of cNOS and OX42 positive neurons were studied in facial nucleus. RESULTS: Treatment of L-nitroarginine could remarkably inhibit the recovery of traumatic facial paralysis. The cNOS immunoactivity was obvious inhibited in facial nucleus, while the OX42 immunoactivity was obvious increased. CONCLUSION: Endogenous nitric oxide may play an important mediator role on the recovery of traumatic facial paralysis.

Animals↗
PubMed2001

Clinical and experimental study on facial paralysis in temporal bone fracture.

OBJECTIVE: To study the main prognostic factors and significance of facial nerve decompression for facial paralysis in temporal bone fracture. METHODS: The main relative prognostic factors of 64 patients with facial paralysis were analyzed. An experimental model of facial paralysis was made. The expansion rates of facial nerve in the facial canal opening group and the facial canal non-opening group were measured and observed under electron microscope. RESULTS: The main factors affecting the prognosis were facial nerve decompression and selection of surgery time. The expansion rate of facial nerve in the facial canal opening group was significantly higher than that of the facial canal non-opening group (t=7.53, P<0.01). The injury degree of the nerve fiber in the facial canal non-opening group was severe. CONCLUSIONS: Early facial nerve decompression is beneficial to restoration of the facial nerve function.

Animals↗
PubMed2000

Restoration of lower eyelid support in facial paralysis.

Lower eyelid dysfunction in the patient with facial paralysis is frequently the result of several deleterious factors, including the loss of orbicularis tone, involutional changes in the canthal ligaments, the effect of aging on the midfacial soft tissue structures, and malposition of the lower eyelid punctum. This dysfunction is manifested as lagophthalmos, ectropion, and epiphora. Fortunately, there are several surgical methods by which the various abnormalities can be corrected or compensated for. This article addresses the management of the lower eyelid and several of the current methods available to the surgeon for management of the lower eyelid in facial paralysis.

Ear Cartilage↗
PubMed1987

Effects of facial paralysis after acoustic neuroma surgery in Norway.

This survey investigated how individuals with facial paralysis resulting from acoustic neuroma surgery manage self-care needs of daily living. Facial paralysis was defined to include damage from surgery to other cranial nerves located in the same area as the facial nerve. The 40 patients surveyed had surgery performed at the Neurosurgical Department, National Hospital of Norway, Oslo, during a four-year period. The instrument used was a questionnaire based on Orem's universal self-care requisites. Results showed that problems related to eating and drinking and certain physiological problems were accepted over time, while pain, eye problems, and hearing loss remained difficult for patients to cope with. Social and psychological problems related to the facial paralysis were ongoing for many patients and seemed to be mitigated by self-acceptance and acceptance by others.

Activities of Daily Living↗
PubMed2006

One-stage reconstruction of facial paralysis associated with skin/soft tissue defects using latissimus dorsi compound flap.

Neurovascular free muscle transfer is now the mainstay for smile reconstruction in the treatment of established facial paralysis. Since facial paralysis due to ablative surgery or some specific disease sometimes accompanies defects of the facial skin and soft tissue, simultaneous reconstruction of defective tissues with facial reanimation is required. The present paper reports results for 16 patients who underwent reconstruction by simultaneous soft tissue flap transfer with latissimus dorsi muscle for smile reconstruction of the paralysed face. Soft tissue flaps comprised skin paddle overlying the latissimus dorsi muscle (n=6), serratus anterior musculocutaneous flap (n=5), serratus anterior muscle flap (n=2), and latissimus dorsi perforator-based flap with a small muscle cuff (n=3). The latissimus dorsi muscle can be elevated as a compound flap of various types, and thus offers the best option as a donor muscle for facial reanimation when soft tissue defects require simultaneous reconstruction.

Adolescent↗
PubMedDate not supplied

[Facial paralysis and tuberculous otitis. Significance of early neural decompression].

Facial paralyses associated with tuberculous otitis have consistently had a bad prognosis. This is bound up with delay in diagnosing the tuberculous nature of the lesions and with slow-acting medical treatment. The facial nerve must be decompressed immediately and not delayed until medical treatment has failed. This attitude is particularly necessary in two types of circumstances in which the tuberculous origin should be under suspicion as a matter of routine / firstly when facial paralysis appears in the secondary sequelae of ear surgery and, secondly, when facial paralysis is a complication in chronic otitis without cholesteatoma.

Adult↗
PubMed1985

Facial paralysis and Bell's palsy: a protocol for differential diagnosis.

In the past, most cases of facial paralysis have been erroneously labeled Bell's palsy. Bell's palsy has been synonymous with and defined as idiopathic facial paralysis affecting only the facial nerve within the confines of the temporal bone. In the last ten years, Bell's palsy has been redefined as viral polyneuritis, probably caused by herpes simplex reactivation, and its diagnosis is no longer reached by exclusion. This article discusses the signs, symptoms, and testing necessary to confidently and accurately differentiate Bell's palsy from other forms of facial paralysis. The nonspecificity of topographic diagnosis is discussed and statistical analysis of factors affecting prognosis are included.

Cranial Nerve Diseases↗
PubMed1990

Otogenic facial paralysis. A histopathological study.

The histopathological changes of the facial canal and nerve in facial paralysis due to chronic suppurative otitis madia are described in six temporal bones. Bony destruction of the facial canal was found in its tympanic segment and in its upper mastoid part in all cases, but it was particularly notable in the labyrinthine segment as well. The pathological process, cholesteatoma or granulation tissue surrounding the exposed facial nerve was inflamed in all cases. The affected facial nerve showed degenerative and inflammatory changes throughout its tympanic segment in all cases, but its mastoid segment appeared to be relatively normal. Our findings suggest that facial paralysis occurs us chronic suppurative otitis when the inflammatory process specifically involves the facial nerve trunk.

Chronic Disease↗
PubMedDate not supplied

[Peripheral facial paralysis and HIV infection].

Two cases of peripheral facial paralysis associated with infection by the human immunodeficiency virus in young intravenous drug abuser patients are reported. One patient manifested AIDS-related complex (ARC) and the other fulfilled the Center for Disease Control (CDC) criteria for AIDS. Clinical symptoms and signs occurred as facial paralysis and headache. One patient presented progressive motor slowing and the computerized tomography (CT) of the brain showed a wide hypodense lesion in the left temporal-anterior region and the involvement of the left basal ganglia. In this patient the impairment of the facial nerve was associated with a HIV-related encephalitis. In the second patient the CT did not show cerebral lesions and the etiology of the paralysis was unknown.

AIDS Dementia Complex↗
PubMed1990

Simultaneous 'dual system' rehabilitation in the treatment of facial paralysis.

Simultaneous dual system rehabilitation of facial paralysis involves using two independent reanimation techniques to optimize facial movement in both a quantitative and qualitative manner. These techniques involve the use of nerve grafting or crossover procedures combined with a dynamic muscle transfer. A group of 37 patients who underwent five different combinations of reanimation was analyzed. The techniques were evaluated using a standard rating scheme for judging success of reanimation procedures. The combination of a masseter muscle transfer to the lower region of the face and a cable graft of the upper facial nerve division appeared to offer excellent results in terms of independent motion of the upper and lower regions of the face and good eye closure, while allowing spontaneous mimetic function in 50% of cases. The advantages and disadvantages of the other techniques are described. The clinical situations in which these techniques have advantage over single reanimation techniques are outlined.

Facial Nerve↗
PubMed1988

Prognostic value of blink test in patients with facial paralysis.

In order to gain an early estimate of a prognosis for facial paralysis, the vertical eye movements associated with eyeblinks (Bell's phenomenon) in 39 patients with acute unilateral Bell's paralysis and Hunt's syndrome and of 21 normal subjects were recorded by electronystagmography. These data were then analysed with a small digital computer (PDP 11/34). The results were compared with electroneurography (ENoG) and nerve excitability test (NET) results and can be summarized as follows: 1. Difference in velocity and amplitude between left and right eye movement during eyeblink (called blink index), diminished in inverse proportion to any improvement of lagophthalmos. 2. All the 5 patients showing more than 80% in maximum blink index (MBI) proved to have a poor prognosis, whereas 18 of 19 patients having a MBI of 40% or less proved to have a good prognosis. The blink test was deemed to be of equal clinical significance to ENoG and NET for predicting facial paralysis. 3. The blink test does not require needle electrodes for electrical stimulus, nor any special equipment other than electronystagmography, and yet this test can provide a quantitative analysis of a degeneration profile in facial paralysis.

Blinking↗
PubMed1999

Physical therapy for facial paralysis: a tailored treatment approach.

BACKGROUND AND PURPOSE: Bell palsy is an acute facial paralysis of unknown etiology. Although recovery from Bell palsy is expected without intervention, clinical experience suggests that recovery is often incomplete. This case report describes a classification system used to guide treatment and to monitor recovery of an individual with facial paralysis. CASE DESCRIPTION: The patient was a 71-year-old woman with complete left facial paralysis secondary to Bell palsy. Signs and symptoms were assessed using a standardized measure of facial impairment (Facial Grading System [FGS]) and questions regarding functional limitations. A treatment-based category was assigned based on signs and symptoms. Rehabilitation involved muscle re-education exercises tailored to the treatment-based category. OUTCOMES: In 14 physical therapy sessions over 13 months, the patient had improved facial impairments (initial FGS score= 17/100, final FGS score= 68/100) and no reported functional limitations. DISCUSSION: Recovery from Bell palsy can be a complicated and lengthy process. The use of a classification system may help simplify the rehabilitation process.

Aged↗
PubMed2002

[Transposition of pedicled sternocleidomastoid muscle for repair of facial paralysis in late stage].

OBJECTIVE: To explore a new surgical approach to repair facial paralysis in late stage, using regional transposition of pedicled sternocleidomastoid muscle for the dynamic reanimation of the paralyzed face. METHODS: Seven cases with facial paralysis in late stage from December 1999 were treated and followed up for 10 months before clinical evaluation. In all of the cases, the sternal and clavicular branches of the sternocleidomastoid muscle were both elevated from their bony attachments, with the mastoid insertion left in situ as the pedicle for blood supply and accessory nerve maintained in it. The muscle strips were transposed and sutured to the orbicularis oris around the mouth corner on the paralyzed side. RESULTS: Static asymmetry of nose and oral commissure on the paralyzed side were corrected immediately after operation, and the movement of the oral commissure recovered one week after operation. Symmetric smiling was observed in one month and all of the oral movements recovered in 10 months postoperatively. CONCLUSION: The new approach to repair facial paralysis in late stage by regional transposition of pedicled sternocleidomastoid muscle is effective in restoration of both static and dynamic symmetry of nose and mouth, and in recovery of the facial expression and the oral commissure.

Adult↗
PubMedDate not supplied

Use of the endoscopic forehead-lift to improve brow position in persistent facial paralysis.

Traditionally, the asymmetrical brow in facial paralysis has been treated with open procedures. There are few data that support the use of endoscopic procedures to treat patients with facial palsy or paralysis. We sought to evaluate a single surgeon's experience with the use of endoscopic forehead-lifts to treat asymmetrical brow positioning resulting from facial nerve disorders. All cases involving patients who underwent endoscopic brow-lifts by the senior author (Y.D.) from 1997 through 2003 with a minimum follow-up of 12 months were retrospectively reviewed. Demographic data were collected, and patient satisfaction was determined from postoperative interviews conducted at follow-up visits. Standard photographs were used to measure the degree of preoperative and postoperative brow asymmetry. A total of 31 cases were available for review. The average age of our patient population was 47 years (age range, 22-76 years), with a male-female ratio of almost 1.5:1. Twenty-three patients had a complete paralysis, and 8 patients had a palsy. The average preoperative difference in height at the desired apex of brow was 5.9 mm, with a range of 3.0 to 9.0 mm. The average postoperative difference (as measured at 12 months) in brow position was only 1.3 mm, with a range of 0 to 3 mm. Adjunctive periorbital procedures were performed in the majority of patients (90%) at the time of endoscopic brow-lifting. All patients felt that their brow position was much improved after surgery. No major complications were encountered. A single patient underwent a secondary open direct browpexy to optimize his result. Endoscopic brow-lifting may be associated with favorable outcomes in the majority of patients with facial nerve palsy or paralysis. Performing concurrent adjunctive periorbital procedures as deemed necessary to optimize lower eyelid position, eyelid closure, and upper eyelid symmetry appears to be safe and reliable.

Endoscopy↗