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Background: The degree of distress caused by the sequelae of peripheral facial nerve palsy usually depends on the severity of synkinesis.Objective: To clarify whether electroneurography (ENoG) can ...

The researchers analyzed facial patterns in subjects with facial synkinesis after facial paralysis and evaluated the involved muscles to aid in the development of effective treatments for facial synkinesis.A total of 142 subjects were included in the study, the primary measure for synkinesis was determined by video analysis involving the strongest combination of two muscle groups that contributed to facial expression. The secondary measure of synkinesis was the analysis of its severity using the SB grading system, while observing the number of facial synkinetic movements.The most common type of facial synkinesis was oral-ocular synkinesis (n = 137). Other synkinesis such as ocular-oral, ocular-nasal, ocular-chin, ocular-stapedial, chin-ocular and chin-oral synkinesis continued to coexist together with oral-ocular synkinesis. The results of BTX-A treatment are assessed based on the number of facial synkinetic movements observed and the evaluation of initial facial function.The effectiveness of botulinum toxin A (BTX-A) treatment should be considered on an individual basis, according to the initial state of facial function. A patient with mild facial synkinesis restricted to the oral-ocular area and with a high score on the Sunnybrook (SB) facial nerve grading system would be the best candidate for BTX-A treatment.

To establish a rat model with paradoxical vocal fold movement to understand the detailed etiology and physiology of laryngeal synkinesis by evaluating vocal fold movement and by electromyography.Adult Wistar rats were used. The recurrent laryngeal nerve was transected, anastomosed, and the anastomotic portion was placed in a silicone tube. At 2, 4, and 10 weeks after the treatment (n = 30), we performed laryngoscopy and electromyography. The vocal fold movement was recorded, the hemiglottal area was measured, and the Δarea was calculated by subtracting the area during expiration from that during inhalation. We evaluated the ratio of the Δarea on the treated side to that of the normal side. After laryngoscopy, electromyography of the thyroarytenoid and posterior cricoarytenoid muscles was performed.The mean Δareas were 1.5 ± 3.4%, 2.3 ± 21.5%, and 0.7 ± 31.8% at 2, 4, and 10 weeks after anastomosis, respectively. Eighteen of 18 rats indicated synkinetic reinnervation at 4 and 10 weeks. Regarding vocal fold mobility, 8 of 18 animals showed paradoxical movement, and 5 of 18 exhibited impaired mobility.We have established an animal model of paradoxical movement following recurrent laryngeal nerve injury. This model may be useful in studying laryngeal synkinesis.

Rehabilitation was significantly efficient in both groups of patients with synkinesis, especially in those in whom treatment with botulinum toxin type A (BTX-A) preceded physical rehabilitation.To determine the influence of preventive treatment with BTX-A on synkinesis when physical rehabilitation is planned.Twenty patients, who recovered from facial palsy with final House-Brackmann (HB) grade II and III, were randomized to assess the efficacy of preventive BTX-A treatment on final synkinesis score after physical rehabilitation. Synkinesis was graded according to the four-point scale derived from the SunnyBrook Facial Grading System (FGS). Physical rehabilitation was carried out using NeuroMuscular Retraining Therapy (NMRT). In the randomized groups, NMRT was administered with (group a) or without pre-BTX-A treatment (group b).Patients who were preliminarily treated with BTX-A in the affected area showed a 2.1 improvement of score on the SunnyBrook scale (p0.001), with significantly better results in comparison to the non-BTX-A group.

We investigated coordinated saccadic eye and head movements following predictive horizontal visual targets at +/- 30 degrees by applying transcranial magnetic stimulation (TMS) over the cerebellum before the start of the gaze movement in 10 young subjects. We found three effects of TMS on eye-head movements: 1. Saccadic latency effect. When stimulation took place shortly before movements commenced (75-25 ms before), significantly shorter latencies were found between predictive target presentation and initiation of saccades. Eye latencies were significantly decreased by 45 ms on average, but head latencies were not. 2. Gaze amplitude effect. Without TMS, for the 60 degrees target amplitudes, head movements usually preceded eye movements, as expected (predictive gaze type 3). With TMS 5-75 ms before the gaze movement, the number of eye movements preceding head movements by 20-50 ms was significantly increased (p0.001) and the delay between eye and head movements was reversed (p0.001), i.e. we found eye-predictive gaze type 1. 3. Saccadic peak velocity effect. For TMS 5-25 s before the start of head movement, mean peak velocity of synkinetic eye saccades increased by 20-30% up to 600 degrees/s, compared to 350-400 degrees/s without TMS. We conclude that transient functional cerebellar deficits exerted by means of TMS can change the central synkinesis of eye-head coordination, including the preprogramming of the saccadic pulse and step of a coordinated gaze movement.

A simple measuring box to determine lip-shift angle and eye-width narrowing offered simultaneous and objective data on outcome dysfunction. The method is as easy as visual approaches. The method is objective and as easy as visual access. It is practical for routine clinical use in any clinic.The outcome dysfunction after facial paralysis is commonly evaluated by subjective visual access. This paper introduces a new method for simple objective evaluation and grading with documentation of lip-shift and eye-width changes.Thirty adult controls were used to determine standard deviations (SDs) for angular shift of the lip at rest and eye-width narrowing at maximum lip protrusion. Thirty patients with facial paralysis more than 6 months after onset were studied for outcomes in terms of synkinesis, contracture, and lip deviation to the healthy side. Abnormalities were read with a simple measuring box.Among the controls, mean lip shift at rest and its SD were 0° and 1.2. Mean eye narrowing at maximum lip protrusion effort and its SD were -0.6 mm and 1.6. This paper proposes a new grading system that relies simply on the sum of evaluating items exceeding 2 SDs, or residual lip deviation to the healthy side.

A pattern of sound-induced paroxysms of the eye and head and other spinal motor neuron synkinesis (Tullio's phenomenon) in human subjects always implies either a pathological contiguity of the tympano-ossicular chain and membranous labyrinth or a dehiscence of the bone overlying the superior semicircular canal. However, it has become clear in the last decade that sound-evoked vestibular stimulation is not only a sign of disease but also a physiological phenomenon, The examination of such physiologically sound-induced vestibular (saccular) responses contributes today to the clinical testing of the vestibular organ, mainly in the form of vestibular-evoked myogenic potentials. In this study it was observed that, in a group of 20 normal subjects, a 500 Hz tonal stimulus of high intensity (105 dB HL = 118.5 dB SPL), applied monoaurally, elicited postural responses. Each subject was studied under 4 different conditions: (i) head facing forwards, eyes open; (ii) head facing forwards, eyes closed; (iii) head rotated approximately 90 degrees to the right, eyes closed: and (iv) head rotated approximately 90 degrees to the left, eyes closed. Body sway, measured using a force platform, was recorded in all subjects, with eyes either open or closed. Postural responses, which were also elicited with a 250 Hz tonal stimulus, were not observed with a tone of 2000 Hz, with legs slightly flexed or with binaural stimulation. The postural sway (head facing forwards, eyes open or closed) was in a lateral direction towards the stimulated ear: with the stimulus applied to the right ear the subject had postural sway towards the right, with the stimulus applied to the left ear towards the left. When the head was rotated approximately 90 degrees sideways and the stimulus was given facing forwards (i.e. head rotated contralaterally to stimulated ear) the postural sway was in a forward direction; when the head was rotated approximately 90 degrees sideways and the stimulus was given facing backwards (i.e. head rotated ipsilaterally to stimulated ear) the postural sway was in a backward direction. The mean values (mm) of body sway obtained with the head facing forwards and the eyes closed were higher than those with the eyes open (21.7 and 22.8 vs 15.7 and 14.7 for the right and left ears, respectively); higher mean values were obtained with the head turned to the side contralateral to the ear stimulated and the eyes closed (29.3 and 24.8 for the right and left ears, respectively). Under this condition the body sway was mainly in a forward direction. The sound-evoked vestibulopostural reflex seems to be a useful test for exploring the saccular function and, as a click-evoked vestibulocollic reflex, can be considered a physiological Tullio phenomenon.

The occurrence of sequelae in 330 patients with Bell's palsy followed up for more than 6 months was investigated. At least one of five kinds of sequelae (synkinesis, crocodile tears syndrome, spasm, contracture, tinnitus and/or hearing loss during facial movement) was observed in 30 of the 330 cases (9.1 %). Sequelae occurred at 23.9–39.0 weeks (mean) after onset of palsy and at scores of 30–34 points (mean; full score 40 points). The incidence of sequelae was correlated to the degree of facial nerve dysfunction.