Search

Objective: The aim of this observational retrospective study was to report quality of life (QoL) in patients with postoperative facial nerve (FN) palsy after vestibular schwannoma (VS) surgery, investigating clinical factors related to functional outcomes. Methods: Forty-eight consecutive patients (M:F 25:23; median age: 52.5 years) with facial palsy following surgery for sporadic VS were considered retrospectively. FN palsy was graded by using the Sunnybrook facial grading system (SBFGS), while postoperative QoL and subjective functional aspects were assessed by using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale, the Synkinesis Assessment Questionnaire, and questions on eating and drinking. Results: A significant correlation emerged between all Sunnybrook scores and median PANQOL domain regarding facial function. Increasing overall SBFGS scores were associated with reduced risk of slow chewing on the affected side (p = 0.004), lack of masticatory strength (p = 0.025), masticatory fatigue (p < 0.001), accumulation of food in the oral vestibule (p < 0.001), difficulty in drinking from a glass (p = 0.019), and fluid spillage while drinking (p = 0.016). Conclusions: This study suggests that the clinical evaluation of patients with FN palsy after VS surgery should be integrated with patient reports about functional outcomes and perceived QoL to help clinicians guide rehabilitation choices. [ABSTRACT FROM AUTHOR]

Background Muscles affected by postparetic synkinesis have imbalanced tonicity that limit perioral mimetic movement and inhibit the ability to smile. The depressor anguli oris (DAO) muscle has been a common myectomy target for the treatment of perioral synkinesis. While addition of buccinator myectomies to DAO myectomies has risen, no studies have analyzed the effects of buccinator myectomies. The goal of this study was to evaluate and compare the effects of a DAO myectomy with and without concomitant buccinator myectomy through objective facial metrics and subjective patient-reported outcomes. Methods This study is a retrospective review of patients with postparetic synkinesis who underwent DAO myectomy (DAO myectomy group) or DAO myectomy with buccinator myectomy (DAO + Buccinator myectomies group). Outcomes included postoperative differences in objective smile measures (smile angle, excursion, and dental show) using validated software and patient-reported outcomes using the Facial Disability Index (FDI) questionnaire and a myectomy-specific questionnaire. Results After chart review, 18 patients were included in the DAO myectomy group and 19 in the DAO + Buccinator myectomies group. There were no significant postoperative differences between the groups in (1) smile excursion, angle, or dental show at resting, closed smile, or open smile (p > 0.05), (2) FDI physical and social scores, p = 0.198 and 0.932, respectively, or (3) myectomy-specific questionnaire responses (p > 0.05). Conclusion The addition of a buccinator myectomy to a DAO myectomy does not provide significant clinical benefit when compared with an isolated DAO myectomy, based on objective measures and subjective patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the prevalence of mental health disorders in individuals with facial synkinesis, facial paralysis alone, and the general population. Study Design: Retrospective cohort. Setting: Eighty‐two health care organizations across the United States. Methods: The TriNetX Research Network was queried from 2011 to 2021 for patients with facial paralysis without synkinesis, facial paralysis and documented synkinesis, and controls, matched for age, sex, race, and ethnicity. Cases included infectious, iatrogenic, or idiopathic facial paralysis. Patients with pre‐existing depression or anxiety were excluded. Two‐year rates of newly diagnosed depression, anxiety, and mental health prescriptions were compared. Results: Among 127,573 patients with facial paralysis, 92.5% (n = 117,976) had facial paralysis alone, and 7.5% (n = 9597) also had documented synkinesis. Compared to controls, patients with facial paralysis alone had increased risks of new depression (8.9% vs 7.3%, P <.001) and anxiety (10.1% vs 9.6%, P <.001), with higher mental health medication rates (16.6% vs 13.1%, P <.001). Patients with documented synkinesis, in comparison to controls, had the highest risks of depression (19.8% vs 8.6%, P <.001), anxiety (20.5% vs 10.5%, P <.001), and prescriptions (28.1% vs 15.8%, P <.001). The 27.8% (n = 2669) of synkinetic patients treated with chemodenervation had lower rates of depression (8.5% vs 23.5%, P <.001), anxiety (9.0% vs 23.8%, P <.001), and prescriptions (21.6% vs 30.0%, P <.001) compared to synkinetic patients who were not. Conclusion: Facial paralysis, particularly synkinesis, is linked to increased mental health disorders. Integrating mental health screening and treatment into a comprehensive approach is crucial. Chemodenervation is associated with decreased mental health disorders in synkinesis, highlighting its therapeutic potential. [ABSTRACT FROM AUTHOR]

Background: Facial palsy causes severe functional disorders and impairs quality of life. Disturbing challenges for patients with acute facial palsy, but also with those with chronic facial palsy with synkinesis, are the loss of the ability to smile and insufficient eyelid closure. A potential treatment for these conditions could be a closed-loop electro-stimulation system that stimulates the facial muscles on the paretic side as needed to elicit eye closure, eye blink and smile in a manner similar to the healthy side. Methods: This study focuses on the development and evaluation of such a system. An artificial intelligence (AI)-based auricular-triggered algorithm is used to classify the intended facial movements. This classification is based on surface electromyography (EMG) recordings of the extrinsic auricular muscles, specifically the anterior, superior, and posterior auricular muscle on the paretic side. The system then delivers targeted surface electrical stimulation to contract the appropriate facial muscles. Results: The evaluation of the system was conducted with 17 patients with facial synkinesis, who performed various facial movements according to a paradigm video. The system's performance was evaluated through a simulation, using previously captured data as the inputs. The performance was evaluated by means of the median macro F1-score, which was calculated based on the stimulation signal (output of the system) and the actual movements the patients performed. Conclusions: This study showed that such a system, using an AI-based auricular-triggered algorithm, can support with a median macro F1-score of 0.602 for the facial movements on the synkinetic side in patients with unilateral chronic facial palsy with synkinesis. [ABSTRACT FROM AUTHOR]

Background: Facial synkinesis (FS) is a distressing sequela of facial palsy (FP) characterized by involuntary, simultaneous movements of facial muscles occurring during voluntary facial expressions. Treatment of synkinesis is challenging, and preventive methods are needed. Aim: This study evaluated the efficacy of physical facial nerve rehabilitation (PFNR) therapy alone vs. PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis. Methods: Twenty five outpatients were randomized to receive either PFNR alone (neuromuscular retraining and Kabat proprioceptive neuromuscular facilitation) or PNFR and early (90 days after FP onset) eyelid surgery (involving a conservative oculoplastic correction for lagophthalmos with epiphora or ectropion). Comprehensive otolaryngological assessments and Magnetic Resonance Imaging (MRI) were conducted. Synkinesis progression was measured using Another Disease Scale (ADS) at baseline, 3-, 6-, 12-, and 24-months post-treatment. The data were analyzed with ANOVA, τ-test, Chi-Square analyses. Results: Patients undergoing eyelid surgery with PFNR showed faster (p < 0.001) and better recovery of facial movements (p < 0.05) than patients receiving PFNR alone comparing T0 and T12 (p < 0.0001). No synkinesis were observed in the PFNR plus surgery group while 37% of patients in PFNR alone had synkinesis (p = 0.03). At 24months, none of the patients in the surgery group presented synkinesis. Conclusion: Combining early surgical treatment of paralytic lagophthalmos or epiphora with PFNR accelerated functional recovery and reduced synkinesis in patients with FP compared to facial rehabilitation alone. Further investigations in larger populations with long-term follow-up are needed. [ABSTRACT FROM AUTHOR]

A patient with sequelae of peripheral facial nerve palsy (FNP) was mainly treated with facial chuna manual therapy (FCMT) for over 6 months. The patient was diagnosed with hemophilia B and C, so invasive treatments, such as acupuncture and pharmacopuncture, were precluded. The facial nerve grading system 2.0 (FNGS) and the House–Brackmann Grading Scale (HBGS), Peitersen, Murata, Mehta, and numeric rating scale (NRS) systems were used to measure treatment effectiveness. Each scale showed improvement: FNGS, 3 to 2; HBGS, 3 to 2; Peitersen scale, 2 to 1; Murata scale, 9 to 4; Mehta scale, 14 to 1; and NRS, 8.5 to 2.5. An overall improvement was evident in facial muscle strength, particularly in synkinesis. If acupuncture and pharmacopuncture are unavailable, FCMT alone may be effective in treating FNP sequelae.

Objectives: Depressor anguli oris (DAO) excision can improve clinician‐graded, objective, and patient‐reported smile outcomes in patients with nonflaccid facial paralysis (NFFP). However, no prior research has studied changes in perceived emotions after surgery. This study quantifies changes in perceived emotions with smiling after DAO excision in the largest case series presented to date. Methods: Prospectively collected data from patients with NFFP who underwent DAO excision at a tertiary care facial nerve center were reviewed. Patient‐reported, clinician‐graded, and objective smile metrics were compared before and after surgery. Videos of faces at rest and while smiling were analyzed by artificial intelligence‐derived facial expression analysis software to quantify perceived emotions. Results: Sixty‐eight patients underwent isolated DAO excision between August 2021 and August 2023. Patients conveyed significantly more perceived happiness with smile and at rest after surgery (p < 0.001 and p = 0.012, respectively). DAO excision improved oral commissure excursion (p < 0.001), dental show (p < 0.001), and smile angle (p < 0.001) symmetry. Patients reported significant improvements in smiling and social function after surgery. Conclusions: This study demonstrates DAO excision increases perceived happiness conveyed by patients with NFFP while smiling and at rest. It confirms improved objective, clinician‐graded, and patient‐reported smile outcomes after surgery. Level of Evidence: 4 Laryngoscope, 134:4028–4035, 2024 [ABSTRACT FROM AUTHOR]

Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The mainstay treatment for postfacial paralysis synkinesis (PFPS) is chemodenervation and physiotherapy, which requires long-term maintenance neurotoxin injections. This can lead to treatment resistance. Selective neurectomy of the distal branches of the facial nerve has been suggested as an effective surgical treatment of PFPS. This study aims to provide a comprehensive systematic review evaluating the efficacy of selective neurectomy for patients presenting with PFPS. Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL were searched from inception until July 2022. Studies that investigated postoperative outcomes of pediatric and/or adult patients who underwent selective neurectomy as a treatment for PFPS were included. The database search identified 1,967 studies, and 11 were ultimately included based on inclusion and exclusion criteria. These 11 studies represented 363 patients. Studies reported on outcomes following selective neurectomy with or without adjuvant therapies for patients with PFPS. The main outcome categories identified were clinician-reported outcomes and patient-reported outcomes. The studies that used clinician-reported outcomes found an improvement in both synkinesis and facial nerve paralysis (FNP) outcomes following selective neurectomy according to their respective grading systems. Three studies looked at patient-reported outcomes and found increased patient-reported quality of life and satisfaction following selective neurectomy. The most reported complications were upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence. Selective neurectomy has demonstrated stable or improved synkinesis, FNP, and quality of life outcomes in patients with PFPS. This approach should be considered for patients with PFPS, particularly for patients with refractory symptoms or those who are unable to undergo continued medical management. [ABSTRACT FROM AUTHOR]

Postparalysis facial synkinesis (PPFS) can develop in any facial palsy and is associated with significant functional and psychosocial consequences for affected patients. While the prevention of synkinesis especially after Bell's palsy has been well examined, much less evidence exists regarding the management of patients with already established synkinesis. Therefore, the purpose of this review is to summarize the available literature and to provide an overview of the current therapeutic options for facial palsy patients with established synkinesis. A systematic literature review was undertaken, following the Preferred Reporting Items of Systematic Reviews and Meta-analyses 2020 guidelines. MEDLINE via PubMed and Cochrane Library were searched using the following strategy: ([facial palsy] OR [facial paralysis] OR [facial paresis]) AND (synkinesis) AND ([management] OR [guidelines] OR [treatment]). The initial search yielded 201 articles of which 36 original papers and 2 meta-analyses met the criteria for inclusion. Overall, the included articles provided original outcome data on 1,408 patients. Articles were divided into the following treatment categories: chemodenervation (12 studies, 536 patients), facial therapy (5 studies, 206 patients), surgical (10 studies, 389 patients), and combination therapy (9 studies, 278 patients). Results are analyzed and discussed accordingly. Significant heterogeneity in study population and design, lack of control groups, differences in postoperative follow-up, as well as the use of a variety of subjective and objective assessment tools to quantify synkinesis prevent direct comparison between treatment modalities. To date, there is no consensus on how PPFS is best treated. The lack of comparative studies and standardized outcome reporting hinder our understanding of this complex condition. Until higher quality scientific evidence is available, it remains a challenge best approached in an interdisciplinary team. An individualized multimodal therapeutic concept consisting of facial therapy, chemodenervation, and surgery should be tailored to meet the specific needs of the patient. [ABSTRACT FROM AUTHOR]

An 11‐year old, intact male Border Collie was referred with a history of subacute and progressive left eye exophthalmos and mydriasis associated with reduced pupillary light reflex, ventrolateral strabismus, and absence of physiologic nystagmus in the left eye. Neuroanatomical localization was consistent with a left oculomotor neuropathy, involving the general somatic and visceral parasympathetic efferent components. Computed tomography and magnetic resonance imaging of the head were performed. Imaging findings were consistent with an infectious‐inflammatory process involving the left retrobulbar space and regional muscles, extending intracranially through the left orbital fissure. Cerebrospinal fluid (CSF) was collected from the cerebellomedullary cistern, and the analysis revealed albuminocytologic dissociation. The dog was treated with amoxicillin and clavulanic acid and prednisolone at anti‐inflammatory dose; a significant improvement of neurologic status was observed afterward. However, 4 weeks after the initial presentation, the dog showed an abnormal, bilateral adduction of both eyes and third eyelid protrusion of the left eye while chewing the leash; the dog's mental status was normal, and the patient did not appear to be in discomfort during these episodes. A presumptive diagnosis of acquired trigemino‐oculomotor synkinesis, induced by the intracranial inflammation was made. To the authors' best knowledge, this is the first case of presumed trigemino‐oculomotor synkinesis reported in veterinary medicine. [ABSTRACT FROM AUTHOR]

Background: Split cord malformation (SCM) is a rare congenital malformation of the spinal cord in which the cord is split longitudinally. Identification and diagnosis in adulthood is rare, with the majority of cases diagnosed in the paediatric population. Isolated segmental cervical SCM is rarer still. Case presentation: Here, the authors present the case of a 26-year-old female who presented with neck pain and longstanding bimanual synkinesis secondary to an isolated type II SCM in the C4–C7 region. The authors present this novel presenting symptom in adulthood and finding of isolated cervical SCM with associated blocked cervical vertebrae, in an otherwise normal neuroaxis and spinal column. Conclusions: The case serves to highlight the importance of knowledge of this rare congenital condition to surgeons, physicians and radiologists involved in the care of both adult and paediatric patients presenting with spinal pathology. [ABSTRACT FROM AUTHOR]

Background: The prognosis of Bell's palsy is favorable. However, many patients still have residual facial weakness and sequelae such as synkinesis and hemifacial spasm. Currently, there is no adequate information on treatment response and sequelae of Bell's palsy in Thai adult patients. Objective: 1) To determine clinical characteristics, treatment response, and sequelae of Bell's palsy including synkinesis and hemifacial spasm in Thai adult patients and 2) to find factors associated with early recovery and sequelae of Bell's palsy. Materials and Methods: A retrospective chart review of patients diagnosed with Bell's palsy between January 1, 2015 and December 31, 2022, was performed. Results: Three hundred two Bell's palsy patients were identified. Females were predominant at 63.2%. The mean age at onset was 49.3 years, and the median disease duration was two days. Nineteen-point five percent of the patients had diabetes, 31.8% had associated symptoms, and the most common symptom was postauricular pain at 21.5%. Additionally, 11.9% had recurrent Bell's palsy in which two attacks of Bell's palsy were noted. The median time from the previous episode was three years. Most patients received oral prednisolone within one week for 96.7%. Seventynine-point eight percent of the patients had partial recovery within four weeks after onset. Most associated symptoms were resolved in 12 weeks for 91%. The overall recovery rate was not different between diabetic and non-diabetic patients at 100% versus 99.2%. Severe steroid side effects were not present. Seven-point nine percent of the patients had synkinesis, which started at 24 weeks and 3.6% had hemifacial spasm, which started at 12 weeks. Factors related to synkinesis and hemifacial spasm were no improvement of facial muscle movement at four weeks after the onset. Conclusion: Factors related to synkinesis and hemifacial spasm were no improvement of facial muscle movement at four weeks after onset. Longer follow-up, for at least one year, is needed to detect the sequelae of Bell's palsy especially in delayed recovery patients. [ABSTRACT FROM AUTHOR]

Abstract Background Blepharoptosis is a common symptom in ophthalmology clinic, but eyelid retraction when smiling in a ptosis eye is a rare manifestation. Here we report a novel manifestation that eyelid retraction during smiling in a patient with monocular congenital ptosis. Case description A 10-year-old girl with isolated and mild unilateral congenital ptosis showed eyelid retraction in ptotsis eye when smiling together with a lid lag on downgaze. She didn’t have any systematic and ocular diseases other than myopia and astigmatism.Eyelid retraction during smiling is 5 mm, resulting in a significant difference in the height of bilateral palpebral fissures.As for ptosis, is mild.The margin to reflex distance 1 is 1.0 mm on the right eye(ptosis eye) and 3.0 mm on the left eye. A lid lag of 1.0 mm on downward gaze was noted on the right, she could close her eyes fully while sleeping.The ice pack test, laboratory test for thyroid function, whole-exome sequencing (WES) and magnetic resonance imaging(MRI) of the orbital and ocular motor nerves showed normal results.Her symptoms alleviated after 6 months, with the retraction of the right upper eyelid when smiling was approximately 3 mm, thus the difference in the palpebral fissure height when smiling was smaller than that at the initial presentation. Conclusion Blepharoptosis may accompanied with abnormal innervation like eyelid retraction, this phenomenon can be alleviated with age.The results of the levator muscle function test should be carefully examined to determine whether it is ptosis in an impaired innervation eyelid.

The prognostic value of electroneurography (ENoG) for predicting the incidence of synkinesis is reportedly about 40 % using the formal standard method (ENoG-SM). However, the prognostic value of ENoG using the newly developed midline method (ENoG-MM) has not been determined. The aim of this study was to demonstrate the optimal prognostic value and advantages of ENoG-MM for predicting the incidence of synkinesis. Participants were 573 patients treated for peripheral facial palsy including Bell's palsy or Ramsay Hunt syndrome. We investigated the clinical presence of any oral-ocular or ocular-oral synkinesis from the medical records. ENoG-MM and ENoG-SM were performed 10–14 days after symptom onset. In ENoG-MM, compound muscle action potentials were recorded by placing the anode on the mental protuberance and the cathode on the philtrum. In ENoG-SM, electrodes were placed on the nasolabial fold. Synkinesis was clinically assessed at the end of follow-up or at >1 year after onset. The sensitivity and specificity of ENoG values for predicting the incidence of synkinesis were compared between ENoG-MM and ENoG-SM at every 5 % around 40 % (range, 30–50 %). At every 5 % of ENoG values around 40 %, ENoG-MM provided higher sensitivity and lower specificity for predicting the incidence of synkinesis compared with ENoG-SM. In particular, when the cut-off value was set at 45 %, sensitivity was 100 % and 95.3 % with ENoG-MM and ENoG-SM, respectively. In peripheral facial palsy, ENoG-MM offered higher sensitivity than ENoG-SM for predicting synkinesis. ENoG-MM is useful for screening patients at risk of developing synkinesis. In clinical practice, an ENoG-MM cut-off value of 45 % must be the optimal prognostic value because of the 100 % sensitivity. [ABSTRACT FROM AUTHOR]

Background: Blepharoptosis is a common symptom in ophthalmology clinic, but eyelid retraction when smiling in a ptosis eye is a rare manifestation. Here we report a novel manifestation that eyelid retraction during smiling in a patient with monocular congenital ptosis. Case description: A 10-year-old girl with isolated and mild unilateral congenital ptosis showed eyelid retraction in ptotsis eye when smiling together with a lid lag on downgaze. She didn't have any systematic and ocular diseases other than myopia and astigmatism.Eyelid retraction during smiling is 5 mm, resulting in a significant difference in the height of bilateral palpebral fissures.As for ptosis, is mild.The margin to reflex distance 1 is 1.0 mm on the right eye(ptosis eye) and 3.0 mm on the left eye. A lid lag of 1.0 mm on downward gaze was noted on the right, she could close her eyes fully while sleeping.The ice pack test, laboratory test for thyroid function, whole-exome sequencing (WES) and magnetic resonance imaging(MRI) of the orbital and ocular motor nerves showed normal results.Her symptoms alleviated after 6 months, with the retraction of the right upper eyelid when smiling was approximately 3 mm, thus the difference in the palpebral fissure height when smiling was smaller than that at the initial presentation. Conclusion: Blepharoptosis may accompanied with abnormal innervation like eyelid retraction, this phenomenon can be alleviated with age.The results of the levator muscle function test should be carefully examined to determine whether it is ptosis in an impaired innervation eyelid. [ABSTRACT FROM AUTHOR]

Developmental coordination disorder (DCD) impacts the quality of life and ability to perform coordinated actions in 5% of school‐aged children. The quality of body representations of individuals with DCD has been questioned, but never assessed. We hypothesize that children with DCD have imprecise body representations in the sensory and motor domains. Twenty neurotypical children, seventeen children with DCD (8–12 years old) and twenty neurotypical adults (25–45 years old) performed both sensory and motor body representation tasks: a limb identification and a limb movement task. We observed lower accuracy in the sensory task but not in the motor task. In both tasks, we observe a larger amplitude of errors, or synkinesis, in children with DCD than in neurotypical children. In neurotypical children, accuracy was lower than in neurotypical adults in the motor and sensory task, and the amplitude of sensory errors and synkinesis was higher than in neurotypical adults. Using a linear regression model, we showed that sensory accuracy is a good predictor of synkinesis production, and that synkinesis production is a good predictor of sensory accuracy, as can be expected by the perception‐action loop. Results support the hypothesis of an imprecision of body representation in DCD. We suggest that this imprecision arises from noise in the body representation used at the level of internal models of action. Future studies may assess whether slower plasticity of body representations, initial imprecision, or both may account for this observation. At the clinical level, prevention strategies targeting body representation in early childhood are strategically important to limit such impairments. Research Highlights: Body representation is impaired in children with DCD and has a significant cost in terms of the accuracy of sensory identification of body parts and associated movements.Inaccuracies in the body representation measured in perception and in action (error amplitude and synkinesis) are related in both NT children and adults.In typical development, we provide evidence of a strong link between body schema and body image. [ABSTRACT FROM AUTHOR]

Objective: Facial selective neurectomy (SN) improves facial function by denervation of muscles antagonistic to the smile in nonflaccid facial paralysis (NFFP) patients. This study aims to assess whether and which objective facial function metrics affect favorable SN outcome in NFFP patients, as perceived by facial nerve (FN) practitioners. Study Design: Retrospective cohort study. Setting: NFFP patients who underwent SN at the facial nerve center. Methods: Standardized preoperative and postoperative facial photographs of patients undergoing SN were analyzed using clinician‐graded measures (eFACE) and automated facial measurement (Emotrics). Favorable outcome was ranked subjectively by 3 independent FN practitioners. Correlations between objective metrics and favorable subjective outcome were examined. Results: Fifty‐eight SN cases were included. Oral commissure excursion with smile, interlabial distance, and lower lip movement were all considered statistically significantly important for favorable outcome perception. Each +1 mm of smile excursion increases the odds of a favorable outcome by 75.4% (odds ratio [OR]: 1.754). Each +1 mm of interlabial distance asymmetry decreases the odds of a favorable outcome by 24.7% (OR: 0.753). Each +1‐point change in lower lip movement eFACE score increases the odds of a favorable outcome by 2.7% (OR: 1.027). Conclusion: Several smile metrics contribute to favorable SN outcome perception among FN practitioners. Smile excursion, interlabial distance, and lower lip movement were significant predictors of success. These observations may be extrapolated to other facial reanimation interventions and serve surgeons and patients during counseling and expectation management, and during surgery. [ABSTRACT FROM AUTHOR]

BackgroundFacial synkinesis (FS) is a distressing sequela of facial palsy (FP) characterized by involuntary, simultaneous movements of facial muscles occurring during voluntary facial expressions. Treatment of synkinesis is challenging, and preventive methods are needed.AimThis study evaluated the efficacy of physical facial nerve rehabilitation (PFNR) therapy alone vs. PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis.MethodsTwenty five outpatients were randomized to receive either PFNR alone (neuromuscular retraining and Kabat proprioceptive neuromuscular facilitation) or PNFR and early (90 days after FP onset) eyelid surgery (involving a conservative oculoplastic correction for lagophthalmos with epiphora or ectropion). Comprehensive otolaryngological assessments and Magnetic Resonance Imaging (MRI) were conducted. Synkinesis progression was measured using Another Disease Scale (ADS) at baseline, 3-, 6-, 12-, and 24-months post-treatment. The data were analyzed with ANOVA, τ-test, Chi-Square analyses.ResultsPatients undergoing eyelid surgery with PFNR showed faster (p

Objective: The aim of this observational retrospective study was to report quality of life (QoL) in patients with postoperative facial nerve (FN) palsy after vestibular schwannoma (VS) surgery, investigating clinical factors related to functional outcomes. Methods: Forty-eight consecutive patients (M:F 25:23; median age: 52.5 years) with facial palsy following surgery for sporadic VS were considered retrospectively. FN palsy was graded by using the Sunnybrook facial grading system (SBFGS), while postoperative QoL and subjective functional aspects were assessed by using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale, the Synkinesis Assessment Questionnaire, and questions on eating and drinking. Results: A significant correlation emerged between all Sunnybrook scores and median PANQOL domain regarding facial function. Increasing overall SBFGS scores were associated with reduced risk of slow chewing on the affected side (p = 0.004), lack of masticatory strength (p = 0.025), masticatory fatigue (p < 0.001), accumulation of food in the oral vestibule (p < 0.001), difficulty in drinking from a glass (p = 0.019), and fluid spillage while drinking (p = 0.016). Conclusions: This study suggests that the clinical evaluation of patients with FN palsy after VS surgery should be integrated with patient reports about functional outcomes and perceived QoL to help clinicians guide rehabilitation choices.

Long-standing facial palsy sequelae cause functional, aesthetic, and psychological problems in patients. Botulinum toxin is an effective way to manage them, but no standardized recommendations exist. Through this non-systematic review, we aimed to guide any practitioner willing to master the ins and outs of this activity. We reviewed the existing literature and completed, with our experience as a reference center, different strategies of botulinum toxin injections used in facial palsy patients, including history, physiopathology, facial analysis, dosages, injection sites, and techniques, as well as time intervals between injections. The reader will find all the theorical information needed to best guide injections according to the patient's complaint, which is the most important information to consider. [ABSTRACT FROM AUTHOR]

Facial nerve paralysis induced by acute traumatic facial nerve injuries limited to the zygomatic and buccal branches shows unique complications, such as strong co-contractions of the lower facial muscles around the lips during voluntary blinking (ocular-oral synkinesis). We investigated the characteristics of facial complications after facial nerve injury in the mid-face area and reported the treatment results. A total of 21 patients with facial nerve injuries to the zygomatic and/or buccal branches were evaluated for the degree of facial synkinesis and mouth asymmetry. Patients with mild-to-moderate symptoms were treated using physical rehabilitation therapy combined with botulinum toxin (Botox) injection, and patients with severe or uncontrolled symptoms were treated using surgical therapy. Initial/final mean synkinesis scores and mouth asymmetry degrees were 2.17/1.75 and 0.85/0.66 in the physical therapy group and 3.11/0.78 and 2.41/−0.31 in the surgery group, respectively. Physical therapy with Botox injection alone did not show significant improvements in synkinetic symptoms of the patients with mild-to-moderate synkinesis (p > 0.05), whereas surgical therapy resulted in significant improvements in synkinesis and mouth asymmetry (p < 0.05). Surgical treatment is an effective adjustment procedure for the management of facial complications in patients with severe or uncontrolled synkinesis after facial nerve injury to the mid-face area. [ABSTRACT FROM AUTHOR]

Introduction: Bell's Palsy, a disorder characterized by the abrupt onset of facial paralysis, has a significant impact on individuals globally. The precise contribution of the Herpes Simplex Virus (HSV) to its aetiology remains uncertain. The present study investigates the correlation between Herpes Simplex Virus (HSV) and Bell's Palsy, as well as evaluates the effectiveness of specialized facial therapy in its treatment. Methodology: A five-year longitudinal study was conducted at a tertiary care centre, with a sample of 100 patients diagnosed with Bell's Palsy, ranging in age from 18 to 65 years. The participants were divided into two groups: one receiving normal treatment and the other receiving specialized facial therapy. The assessments included HSV testing, the House-Brackmann scale for evaluating facial nerve function, the Facial Clinimetric Evaluation (FaCE) scale for assessing quality of life, and measures of patient satisfaction. Findings: The findings of the study revealed evidence supporting a robust association between HSV and the severity of Bell's Palsy. Significantly, individuals who underwent specialized facial therapy exhibited significant enhancements in facial nerve function, a decrease in synkinesis episodes, and better scores suggesting improved quality of life compared to those who received standard care. Additionally, this particular cohort also confirmed a noteworthy rise in patient satisfaction. Conclusion: This study indicates the potential association between HSV and Bell's Palsy while emphasizing the advantages of facial therapy. The above findings are of great significance; however, additional research is required in order to develop more precise ways of managing Bell's Palsy. [ABSTRACT FROM AUTHOR]

Background: Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores. Methods: Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG synkinesis score (ESS, number of synkinesis per movement sequence)) were evaluated at the end of the follow-up. Results: In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5–3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman's model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook synkinesis score (Spearman's rho: 0.8268, p < 0.0001). Conclusions: We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG. [ABSTRACT FROM AUTHOR]

Resumen: Objetivo: Valorar el efecto del tratamiento con infiltraciones de toxina botulínica tipo A (TXB-A) en la funcionalidad facial, las sincinesias y la calidad de vida en pacientes con secuelas de parálisis facial periférica (PFP). Material y métodos: Presentamos un estudio prospectivo con una muestra de 20 pacientes con secuelas de PFP (15 mujeres, 5 varones) a los que se infiltró TXB-A (Botox® o Xeomin®). Todos los pacientes realizaron previamente un tratamiento personalizado basado en la reeducación neuromuscular. Se realizó una evaluación clínica previa a las infiltraciones y otra al cabo de 4 semanas. El efecto de las infiltraciones sobre la funcionalidad facial fue valorado mediante la escala Sunnybrook Facial Grading System (SFGS); el efecto sobre la calidad de vida se evaluó a través del cuestionario Facial Clinimetric Evaluation Scale (FaCE), y el efecto sobre la reducción de sincinesias se estudió utilizando el Synkinesis Assessment Questionnaire (SAQ). Resultados: La media de los valores del SFGS se incrementó tras el tratamiento con TXB-A, de 64,8 a 69,9 (p = 0,004). También se incrementó la media de los valores del FaCE Total, de 52,42 a 64,5 (p

Background: Facial palsy causes severe functional disorders and impairs quality of life. Disturbing challenges for patients with acute facial palsy, but also with those with chronic facial palsy with synkinesis, are the loss of the ability to smile and insufficient eyelid closure. A potential treatment for these conditions could be a closed-loop electro-stimulation system that stimulates the facial muscles on the paretic side as needed to elicit eye closure, eye blink and smile in a manner similar to the healthy side. Methods: This study focuses on the development and evaluation of such a system. An artificial intelligence (AI)-based auricular-triggered algorithm is used to classify the intended facial movements. This classification is based on surface electromyography (EMG) recordings of the extrinsic auricular muscles, specifically the anterior, superior, and posterior auricular muscle on the paretic side. The system then delivers targeted surface electrical stimulation to contract the appropriate facial muscles. Results: The evaluation of the system was conducted with 17 patients with facial synkinesis, who performed various facial movements according to a paradigm video. The system’s performance was evaluated through a simulation, using previously captured data as the inputs. The performance was evaluated by means of the median macro F1-score, which was calculated based on the stimulation signal (output of the system) and the actual movements the patients performed. Conclusions: This study showed that such a system, using an AI-based auricular-triggered algorithm, can support with a median macro F1-score of 0.602 for the facial movements on the synkinetic side in patients with unilateral chronic facial palsy with synkinesis.

Background: Bell's palsy is when one side of the face suddenly becomes paralyzed. This can cause problems with how the face moves and feels. Two different therapies, Kabat Rehabilitation and Kinesiotaping, have been used to try to make people with Bell's palsy feel better. Objective: To compare effects of Kabat rehabilitation and Kinesiotaping on functional disability, synkinesis and patient satisfaction in patients with bell’s palsy. Methodology: In a study with 72 participants aged 20 to 60, all diagnosed with Bell's palsy for less than two weeks, individuals were split into two groups. Group A underwent a treatment called Kabat Rehabilitation, while Group B received both Kabat Rehabilitation and Kinesiotaping. The study evaluated how well the face moved, unwanted facial movements, and patient satisfaction using specific measures. These evaluations were conducted at the beginning, middle (Week 3), and end (Week 6) of the study. Results: In a study of Bell's palsy treatments, Kabat Rehabilitation and Kinesio Kabat Rehabilitation were compared. By Week 6, the Kinesio Kabat group demonstrated greater improvements in physical function (Avg Diff.=-6.97, P

Here we report the first case of phenytoin intoxication that was closely associated with hand-foot synkinesis. This case suggests a close association between cerebellar dysfunction and hand-foot synkinesis. In patients with hand-foot synkinesis, lesions of not only the secondary motor areas but also the cerebellum should be considered.

Objective: To explore whether early physical interventions, including neuromuscular retraining therapy, can minimize excessive movement or any unwanted co-contraction after a severe Bell's palsy. Data sources: From March 2021 to August 2022, the therapist treated Bell's palsy patients for the acute (<3 months, Group A), subacute (3–6 months, Group B) and chronic (> 6 months, Group C) stages of the condition. Methods: We explored whether early physical interventions, including neuromuscular retraining therapy, can minimize facial synkinesis after a severe episode of Bell's palsy. Each patient was informed about the potential for synkinesis and the therapist explained that the main purpose of neuromuscular retraining therapy is to learn new patterns to minimize synkinesis. The facial function of Group A was compared to that of Groups B and C using the 'Synkinesis' scale of the Sunnybrook Facial Grading System. Results: The final facial function score after neuromuscular retraining therapy was significantly associated with both the initial electroneuronographic degeneration rate and initial facial function. Early therapy did not prevent synkinetic movement in 84.7% of the patients. But, there was a significant difference between patients who started early neuromuscular retraining therapy and other groups in final facial function. Conclusion: Synkinesis in Bell's palsy patients can be minimized if physiotherapy commences before synkinesis develops; appropriate neuromuscular retraining therapy timing is essential. A patient with sudden severe Bell's palsy should receive oral steroids as soon as possible, along with physical therapy (including neuromuscular retraining therapy) within 3 months, to minimize synkinesis just before synkinesis onset. [ABSTRACT FROM AUTHOR]

The disease of n.facialis is in the first place among peripheral neuritis, in terms of frequency and importance of functional disorders. Paresis of the n.facialis usually occurs on one side of the face and affects movements of the forehead, eye, nose and mouth. During the infection, in the channel through which the nerve passes (canalis n.facialis), edema occurs, which leads to pressure on the nerve fibers and blood vessels that supply the nerve with innervation and circulation. The damages of n. facialis, are manifested by immobility on one side of the face. Methods for functional testing of patients with facial neuritis include: Manual Muscle Testing (MMT) for examination of mimic muscles. The aim of the research is: To determine the effectiveness of neurorehabilitation of patients with peripheral facial nerve paresis. Research methods: The research was conducted in Clinical Hospital - Tetovo, at the Department of Physical Therapy and Neurorehabilitation, over a period of 6 months, from the middle of June until the middle of November 2023. The aim of the treatment is to prevent the appearance of muscle atrophy and synkinesis of the facial muscles. Results: Randomized Controlled Trials (RCTs) that include exercises with active movements already in the acute stages show better recovery, especially in severe cases, without increasing - or even decreasing – synkinesis (Wen C, Zhang B. 2004), (Nicastri M, Mancini P, et al.2013). Regarding the electrical neurostimulation of the facial nerve, recent evidence from controlled literature show a positive effect with respect to synkinesis (Fargher KA, Coulson SE 2017). (Tuncay F, et al.) Conclusion: According to (Carraro 2018), the misconception that stimulation of the affected nerve hinders reinnervation (restoration of nerve function) has been disproved in recent studies. Initial studies even show that lowfrequency electrical stimulation promotes innervation (Gordon et al. 2018). [ABSTRACT FROM AUTHOR]

Bell’s palsy is the most common cause of facial paralysis, affecting one in every 60 people in their lifetime. Transcutaneously applied selective electrical muscle stimulation could potentially accelerate recovery from Bell’s palsy but this intervention remains controversial. Studies have shown benefit, but concerns for lack of efficacy and potential for worsening synkinesis remain. We performed a prospective controlled trial comparing outcomes at initial recovery and six months later with selective electrical muscle stimulation and usual physical therapy versus usual physical therapy alone in adults with acute Bell’s palsy. Outcomes were facial function assessed with the House Brackman and eFACE scales. Outcomes were evaluated at discharge and six months after discharge. Discharge occurred when participants were judged to be fully recovered by their treating therapist and supervisor. 38 adults participated in the study. Participants in the electrical stimulation group achieved maximal recovery twice as fast as the control group (2.5 weeks versus 5.2 weeks) with no significant differences in facial function or synkinesis between groups at any time point. This study is the first human trial of electrical stimulation in Bell’s palsy to follow patients 6 months from recovery and supports that selective electrical muscle stimulation accelerates recovery and does not increase synkinesis. [ABSTRACT FROM AUTHOR]

Objectives: Selective orbicularis neuromyectomy for postparetic periocular synkinesis was first reported in 2015. This study aims to statistically evaluate the accumulated outcomes and stability of this treatment. Methods: Twenty-five patients with postparetic periocular synkinesis were treated with this procedure between March 2010 and February 2020. Every patient was evaluated using the Sunnybrook scale, and their palpebral fissure width was measured using preoperative and postoperative videos. Patients who underwent >1-year follow-up were included in the study. Chemodenervation or physical therapy was not performed during the follow-up periods. Results: Of the 25 patients, 20 were included in this study. The follow-up period was 13-96 months (median 32 months). The mean of the patients' synkinesis scores fell by 4.6 points. Palpebral fissure width while puckering and at rest was significantly different between the preoperative and postoperative measurements (p < 0.01). Lower lid drooping gradually deteriorated in one patient 7 years after the treatment and was corrected secondarily. Conclusions: This study demonstrates that selective orbicularis neuromyectomy is a simple and sustainable treatment for periocular synkinesis. However, further longer follow-up of elderly patients and objective analysis are warranted.

Bell’s palsy is the most common cause of facial paralysis, affecting one in every 60 people in their lifetime. Transcutaneously applied selective electrical muscle stimulation could potentially accelerate recovery from Bell’s palsy but this intervention remains controversial. Studies have shown benefit, but concerns for lack of efficacy and potential for worsening synkinesis remain. We performed a prospective controlled trial comparing outcomes at initial recovery and six months later with selective electrical muscle stimulation and usual physical therapy versus usual physical therapy alone in adults with acute Bell’s palsy. Outcomes were facial function assessed with the House Brackman and eFACE scales. Outcomes were evaluated at discharge and six months after discharge. Discharge occurred when participants were judged to be fully recovered by their treating therapist and supervisor. 38 adults participated in the study. Participants in the electrical stimulation group achieved maximal recovery twice as fast as the control group (2.5 weeks versus 5.2 weeks) with no significant differences in facial function or synkinesis between groups at any time point. This study is the first human trial of electrical stimulation in Bell’s palsy to follow patients 6 months from recovery and supports that selective electrical muscle stimulation accelerates recovery and does not increase synkinesis.

Keywords: Facial Clinimetric Evaluation scale; facial comfort; facial palsy; quality of life; social function; synkinesis EN Facial Clinimetric Evaluation scale facial comfort facial palsy quality of life social function synkinesis 790 793 4 08/17/23 20230901 NES 230901 Key points The Facial Clinimetric Evaluation (FaCE) scale, consisting of six subscales, measures facial palsy-specific quality of life. In 80 patients, we analysed the subscales' correlations with a validated Visual Analogue Scale (VAS) score that quantifies overall facial palsy-related burden. This VAS validation group completed both the FaCE scale and the VAS on two occasions (T1 and T2), 1-week apart. Patients were asked to complete the validated Dutch FaCE questionnaire and, using a novel Visual Analogue Scale (VAS), to holistically score how physically and mentally burdensome their facial palsy had been in the past week. [Extracted from the article]

INTRODUCTION. Effective kinesitherapy of peripheral and central paralysis of the mimic, masticatory, lingual and pharyngeal muscles requires in-depth study of the features of the cooperative work of these muscles in the norm and in pathology. AIM. To acquaint rehabilitation specialists with motor automatisms of the brachiofacial area and show the principles of their practical use. MATERIAL AND METHODS. We studied more than 70 literature sources on involuntary activity of the maxillofacial region and adjacent regions muscles as well as we summarized our own experience in rehabilitation of patients with peripheral facial neuropathies and with bulbar and pseudobulbar syndromes RESULTS AND DISCUSSION. The study showed that the face, neck, and arm are involved in various mesencephalic-bulbar automatisms, both normal (ontogenetic and psychosomatic synkinesia, postural-ocular and postural-mandibular reflexes) and pathological (trunk eye-facial synkinesia, oral automatic reflexes), much more closely than other body parts. All of them, with the exception of facial hyperkinesias, may serve as a basis for optimizing kinesitherapy methods for movement disorders of the brachiofacial region. CONCLUSION. The face, neck, and hand are closely involved in a variety of stem and subcortical automatisms. The better the physical therapist is familiar with the features of the existing or potentially available to the patient reflex activity in the part of the body being rehabilitated, the more effective the rehabilitation treatment will be. The face, neck and arm are closely involved in a variety of stem and subcortical automorphisms. The better a doctor or an instructor in exercise therapy is acquainted with the reflex activity present or potentially available in the part of the body to be rehabilitated, the more effective the rehabilitation treatment will be.

Introduction: Coordinated alignment of the eyes during gaze fixation and eye movements are an important component of normal visual function. We have previously described the coordinated behavior of convergence eye movements and pupillary responses using a 0.1 Hz binocular disparity-driven sine profile and a step profile. The goal of this publication is to further characterize ocular vergence-pupil size coordination over a wider range of frequencies of ocular disparity stimulation in normal subjects. Methods: Binocular disparity stimulation is generated by presentation of independent targets to each eye on a virtual reality display, while eye movements and pupil size are measured by an embedded video-oculography system. This design allows us to study two complimentary analyses of this motion relationship. First, a macroscale analysis describes the vergence angle of the eyes in response to binocular disparity target movement and pupil area as a function of the observed vergence response. Second, a microscale analysis performs a piecewise linear decomposition of the vergence angle and pupil relationship to permit more nuanced findings. Results: These analyses identified three main features of controlled coupling of pupil and convergence eye movements. First, a near response relationship operates with increasing prevalence during convergence (relative to the "baseline" angle); the coupling is higher with increased convergence in this range. Second, the prevalence of "near response"-type coupling decreases monotonically in the diverging direction; the decrease persists after the targets move (converge back) from maximum divergence toward the baseline positions, with a minimum prevalence of near response segments near the baseline target position. Third, an opposite polarity pupil response is infrequent, but tends to be more prevalent when the vergence angles are at maximum convergence or divergence for a sinusoidal binocular disparity task. Discussion: We suggest that the latter response is an exploratory "rangevalidation" when binocular disparity is relatively constant. In a broader sense, these findings describe operating characteristics of the near response in normal subjects and form a basis for quantitative assessments of function in conditions such as convergence insufficiency and mild traumatic brain injury. [ABSTRACT FROM AUTHOR]