Influence of 125I seed interstitial brachytherapy on recovery of facial nerve function / 中华放射医学与防护杂志

Objective To study the influence of 125I seed interstitial brachytherapy in parotid region on the recovery of facial nerve function. Methods A total of the data of 21 patients with primary parotid carcinoma were treated with resection and 125I interstitial brachytherapy. All the patients had no facial palsy before operation and the prescribed dose was 60 Gy. During 4 years of follow-up, the HouseBrackmann grading scales and ENoG were used to evaluate the function of facial nerve. According to the modified regional House-Brackmann grading scales, the facial nerve branches of patients in affected side were divided into normal and abnormal groups, and were compared with those in contra-lateral side.Results Post-operation facial palsy occurred in all the patients, but the facial palsy recovered within 6 months. The latency time differences between affected side and contralateral side were statistically significant in abnormal group from 1 week to 6 months after treatment ( t = 2.362, P = 0.028 ), and were also different in normal group 1 week after treatment ( t = 2.522, P = 0.027 ). Conclusions 125I interstitial brachytherapy has no influence on recovery of facial nerve function after tumor resection and no delayed facial nerve damage.

Effects of Acupuncture on Refractory Bell's Paralysis and Hunt's Syndrome / 日本東洋医学雑誌

We retrospectively investigated the effects of acupuncture on refractory peripheral facial paralysis. Among patients with Bell's palsy or Ramsay Hunt syndrome (type II) who underwent acupuncture between August 1996 and June 2004, were 29 patients with a minimum electroneuronography (ENoG) percent response of 0%, and NET scale-out (14 patients with Bell's palsy, 15 with Ramsay Hunt syndrome). Demographically, they 21 males and 8 females, with a mean age of 44.3±12.8 years. Their disease duration, and paralysis score assessed using the 40-point method (Yanagihara's method) were 43.2±23.9 days and 10.2±2.7 points, respectively. To evaluate treatment response, we employed the paralysis score, and a sequela score assessed using a modification of the sequela evaluation method designed by Nishimoto and Murata et al. The paralysis score exceeded 36 points within 6 months after onset. Five patients (17.2%) without sequelae were regarded as having achieved complete recovery, and 24 (82.8%) as having achieved incomplete recovery. When the minimum ENoG is 0%, recovery within 6 months beyond onset is considered impossible. The results suggest, however, the efficacy of acupuncture.

Electro-acupuncture for Facial Palsy with Synkinesis / 全日本鍼灸学会雑誌

[Objective] For one facial palsy subject with synkinesis, we applied asynchronous 100Hz EAT and examined the effects. We also examined changes in the effects according to various frequencies.<BR>[Methods] We applied EAT to Mm.faciales, and the evaluation was based mainly on EMG findings (the EMG amplitude, EMG survival continuance time) as well as facial palsy score, VAS, ENoG. We examined changes after treatment and observed the process.<BR>[Results] Change in EMG amplitude were not recognized, but the EMG persistance was shortened after treatment and during the process of observation. VAS, facial palsy score, and ENoG were improved. EMG persistance was not changed by 1 Hz EAT, was prolonged by 30Hz EAT, and was shortened by 100 Hz EAT.<BR>[Conclusion] One hundred Hz EAT shortened EMG persistance, and reduced the subjective symptoms of synkinesis. In addition, we were able to improve facial palsy score and ENoG value.

Acupuncture Treatment for Peripheral Facial Paralysis / 全日本鍼灸学会雑誌

The effect of acupuncture treatment on ending peripheral facial nerve paralysis was examined using standard set by the Japan Society of Facial Nerve Treatment. A comparison was made of how recovery was affected by acupuncture treatment alone, drug treatment alone, and a combination of drugs (steroids) and acupuncture.<BR>As a result we found that 1) in groups having an ENoG of 41% or more, the acupuncture-only group showed less recovery than did the group that received oral steroids. 2) Among the groups having an ENoG of 21% or more, there was no significant difference between the group given oral steroids and the group given both steroids and acupuncture treatment. 3) For groups having an ENoG of 1%-20%, there was no difference in recovery between the group given large doses of injected steroids and the group given large doses of injected steroids concommitant with acupuncture. But the group that was given both oral steroids and acupuncture did not recover as well as the other groups. 4) A comparison of the groups receiving only medication and receiving medication with acupuncture showed there was no special hastening of recovery seen with the administration of acupuncture; in fact, the acupuncture may have even delayed recovery.<BR>The above results indicate that the administration of steroids is more important than the use acupuncture in the treatment of peripheral facial nerve paralysis, and that a suitable treatment should commence within 7 days after the occurrence of symptoms.

The Significance of Recording Electrode Placement in ENoG Measurement / 대한이비인후과학회지

ENoG is the objective electrophysiologic measurement of the muscle compound action potential(CAP) to assess the rate of degenerated nerve fibers. However, occasional discorrelation with clinical findings may diminish the utility of the ENoG. So, we studied the significance of recording electrode placement, which is considered to affect the result of the ENoG. We performed the interside variance in 20 healthy adults(20 males) volunteers and retest was performed in 6 adults of 20 volunteers. The recording electrode was placed at 3 positions.(whole nasolabial fold(A), 2 / 3 of the nasolabial fold(B), 1 / 2 of the nasolabial fold(C)) And then we compared the results: 1) In the first measurement, the mean CAP was 3.02+/-0.98mV(A), 2.80+/-0.75mV(B), 2.56+/-0.57mV(C) on the right side, 2.70+/-1.02mV(A), 2.50+/-0.90mV(B), 2.33+/-0.86mV(C) on the left side, and there was no significant difference between right and left inter-side amplitude(p>or=0.05). 2) In the first measurement, the mean interside variance(ISV) was 32.7%(37.55+/-16.32%(A), 29.88+/-17.15%(B), and 30.67+/-18.56(C)) and there was no significant difference among them(A, B, C)(p>or=0.05). The minimal individual ISV was 20.35+/-12.44%. There was significant difference between it and the other individual 3 positions(por=0.05). The minimal individual ISV was varied in each testing at 3 positions. And the value was 14.32+/-2.69%. There was no significant difference between it and other 3 postions(p>or=0.05). So we recommand that the recording electrode may be fixed at the bilateral same position of the nasolabial fold. But if there is any indication of facial nerve decompression, you must find the best recording electrode position to get the minimal ISV before operation.

The Significance of Recording Electrode Placement in Test-Retest of Electroneuronography / 대한이비인후과학회지

ENoG is regarded as a valuable method for quantitatively assessing facial nerve function, however it is occasionally discorrelated with clinical findings. So its utility may be diminished, especially in the serial tests. So, we endeavored to find the suitable position of recording electrode in test-retest variability of ENoG. We performed the test five times individually in 18 healthy adults(all males) volunteers. The recording electrodes were placed at 3 different positions(whole nasolabial fold(A), 2/3 portion of the nasolabial fold(B), 1/2 portion of the nasolabial fold(C)). And then we compared the results between action potentials of 3 different positions. The amplitude was more stable at B or C than A. The mean interside variance(ISV) of individuals was less than 50% except one case at A, and there was no significant difference among them(p>or=0.05) except two persons between A and C(p<0.05). In the test-retest variability, the mean was 20.03%(A:20.66+/-10.72%, B:23.75+/-12.60%, C:15.69+/-10.21%). There was more smaller mean and standard deviation at C than others. So, we recommand the 1/2 of the nasolabial fold as the available position in the serial ENoG recordings.

Electrophysiological analysis of peripheral facial nerve palsy with reference to the degree of impairment / 日本温泉気候物理医学会雑誌

Degeneration of facial nerve and the facial movement in patients with peripheral facial nerve palsy in early stages must be assessed. Therefore, we conducted electroneurography (ENoG) and blink reflex (BR) tests on 30 patients with unilateral peripheral facial nerve palsy.<br>In the ENoG test, transcutaneous electrical stimulation was applied to the trunk of the facial nerve on the stylomastoid foramen and the response (M-wave) evoked from the bilateral orbicularis oculi muscle was measured. The ratio of M-wave amplitude on the paralyzed side to that on the normal side was then calcu-lated.<br>In the blink reflex response test, transcutaneous electrical stimulation was applied to the supraorbital nerves and the response evoked from the orbicularis oculi muscle was measured. The response consisted of an early ipsilateral component, R1, and a late bilateral component, R2. Further, the ratio of R2 amplitude on the normal side to that on the paralyzed side and the difference in latencies of R2 between paralyzed side and normal side were calculated from each waveform thus obtained.<br>Facial muscle movement was assessed according to the grading system proposed by the Japan Society of Facial Nerve Research (in which the normal state is represented by 40 points). After examining the relationships between the score and some parameters in ENoG and BR (the ratio of M-wave amplitude, the ratio of R2 amplitude, the difference between the two sides on the latencies of R2) on each patient, we found close correlations between the score and some parameters. In summary, assessment of ENoG and BR was useful for evaluating the clinical severity of peripheral facial nerve palsy.