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INTRODUCCIÓN: Problema de Investigación: La parálisis facial periférica es una de las causas más frecuentes de deformidad estética facial y alteraciones funcionales, entre los factores de riesgo de parálisis facial está la hipertensión arterial. OBJETIVO: Determinar la asociación entre hipertensión arterial y Parálisis Facial Periférica en pacientes que acuden a Consulta Externa del Servicio de Medicina Física y Rehabilitación del Hospital de Clínicas Universitario durante la gestión 2013 a 2016 DISEÑO METODOLÓGICO: El presente estudio es un estudio analítico de casos y controles, realizado en pacientes que acuden a Consulta Externa del Servicio de Medicina Física y Rehabilitación del Hospital Clínicas Universitario de enero de 2008 a diciembre de 2010. En total se estudiaron 122 pacientes con parálisis facial leve, moderada y severa, en diferentes edades y con distintos factores de riesgo, estos datos fueron estratificados por la Escala de House Brackman. Los casos fueron pacientes con parálisis facial severa y los controles pacientes con parálisis facial moderada y leve. RESULTADOS: Se encontró asociación positiva entre la hipertensión arterial y la parálisis facial severa (p=0.025), triplicando la hipertensión arterial el riesgo de padecer una parálisis facial severa (OR=3.3), en todo los grupos de edad. CONCLUSIÓN: La hipertensión arterial sistémica es un factor de riesgo de parálisis facial severa, independientemente de la edad de la persona.
INTRODUCTION: Research Problem: Peripheral facial paralysis is one of the most frequent causes of facial aesthetic deformity and functional alterations, among the risk factors for facial paralysis is high blood pressure. OBJECTIVE: To determine the association between arterial hypertension and Peripheral Facial Paralysis in patients attending the External Consultation of the Physical Medicine and Rehabilitation Service of the Hospital de Clínicas Universitario during the TERM 2013 to 2016 METHODOLOGICAL DESIGN: The present study is an analytical study of cases and controls, carried out in patients who attend the Outpatient Service of Physical Medicine and Rehabilitation of the Hospital Clínicas Universitario from January 2008 to December 2010. In total, 122 patients were studied. Mild, moderate and severe facial paralysis, at different ages and with different risk factors, these data was stratified by the House Brackman Scale. The cases were patients with severe facial paralysis and the controls patients with moderate and mild facial paralysis. RESULTS: A positive association was found between arterial hypertension and severe facial paralysis (p = 0.025), tripling the arterial hypertension the risk of suffering a severe facial paralysis (OR = 3.3), in all the age groups. CONCLUSION: Systemic arterial hypertension is a risk factor for severe facial paralysis, regardless of the age of the person.
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Humans , Facial Nerve , Facial Paralysis/rehabilitation , Hypertension , Rehabilitation ServicesABSTRACT
Objective To investigate the therapeutic effect of modulated medium frequency current therapy (MMFCT) combined with infrared therapy on patients of acute facial neuritis. Methods A total of forty-six patients with acute facial neuritis were divided into two groups (observation group and control group) randomly and medially. Every patient received medication. Meanwhile, observation group received MMFCT and infrared therapy. Before the treatment, and after two and four weeks of treatment, Portmann scale were used to evaluate the autonomic movements of the facial expression muscles on both sides. After 4 weeks of treatment, the outcome was evaluated by House-Brackmann facial nerve grading system. Results There were no significant differences in Portmann scales before treatment between two groups. Portmann scales were higher in observation group than those of control group after two and four weeks of treatment (P<0.05). With the duration of treatment, Portmann scales were increased successively in two groups. The significant difference was found in multiple comparisons between groups. After 4 weeks of treatment, the efficacy was significant in the observation group, compared with control group, the difference was significant (P<0.05). Conclusion Modulated medium frequency current therapy combined with infrared therapy have a better effect than isolated medication.
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Objective To compare the clinical efficacy between Jian Huan Tong Tiao needling (acupuncture at both healthy and affected sides) and acupuncture at the affected side alone in treating peripheral facial paralysis (FP) in acute stage, and to provide evidences for the acupuncture treatment of peripheral FP in acute stage.Method Fifty patients were randomized into a Jian Huan Tong Tiao needling group (25 cases) and an affected side needling group (25 cases). By selecting the same acupoints, the Jian Huan Tong Tiao needling group received acupuncture at both sides, while the affected side needling group received acupuncture only at the affected side, once every other day, successively for 4 weeks. House-Brackmann (H-B) facial nerve grading system was used to score the facial nerve function before and after the treatment, and the therapeutic efficacies were compared between the two groups.Result The facial nerve function was improved in both groups, while the therapeutic efficacy was superior in the Jian Huan Tong Tiao needling group to that in the affected side needling group (P<0.05); after 2-week treatment, the H-B score was higher in the Jian Huan Tong Tiao needling group than in the affected side needling group (P<0.05); of the recovered cases, the relapse rate was lower in theJian Huan Tong Tiao needling group than in the affected side needling group (P<0.05). Conclusion Jian Huan Tong Tiao needling can boost the recovery of the facial nerve function in peripheral FP, reduce the relapse rate, and produce a higher therapeutic efficacy than needling the affected side alone.
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Abstract Introduction Ramsay Hunt syndrome is the second most common cause of facial palsy. Early and correct treatment should be performed to avoid complications, such as permanent facial nerve dysfunction. Objective The objective of this study is to review the prognosis of the facial palsy on Ramsay Hunt syndrome, considering the different treatments proposed in the literature. Data Synthesis We read the abstract of 78 studies; we selected 31 studies and read them in full. We selected 19 studies for appraisal. Among the 882 selected patients, 621 (70.4%) achieved a House-Brackmann score of I or II; 68% of the patients treated only with steroids achieved HB I or II, versus 70.5% when treated with steroids plus antiviral agents. Among patients with complete facial palsy (grades V or VI), 51.4% recovered to grades I or II. The rate of complete recovery varied considering the steroid associated with acyclovir: 81.3% for methylprednisolone, 69.2% for prednisone; 61.4% for prednisolone; and 76.3% for hydrocortisone. Conclusions Patients with Ramsay-hunt syndrome, when early diagnosed and treated, achieve high rates of complete recovery. The association of steroids and acyclovir is better than steroids used in monotherapy.
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Objective To observe the clinical efficacy of reinforcing-reducing needling methods in treating peripheral facial paralysis. Method Seventy facial paralysis patients were randomized into two groups to compare the reinforcing-reducing needling methods and conventional acupuncture. The House-Brackmann (H-B) scale was observed and compared prior to the treatment, right after the treatment, and respectively after 30-day, 3-month, and 6-month treatments, and the clinical efficacy was evaluated after 6-month treatments. Result The H-B score of the reinforcing-reducing manipulation group was superior to that of the conventional group (P<0.05), and the therapeutic efficacy of the manipulation group was more significant than that of the conventional group (P<0.05). Conclusion The reinforcing-reducing needling methods can produce a better therapeutic efficacy in treating peripheral facial paralysis compared to conventional acupuncture.
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Objective To observe the clinical efficacy of Yu’s meridian detection and treatment plus acupuncture in treating facial paralysis.Method Sixty patients with facial paralysis in acute stage were randomized into a treatment group and a control group, 30 cases in each group. The treatment group was intervened by Yu’s meridian detection and treatment plus acupuncture, while the control group was by ordinary acupuncture. The House-Brackmann (H-B) scale and symptom-sign scores were observed before and after the treatment.Result The H-B scale scores were changed significantly in the two groups after the treatment (P<0.05). After the treatment, the H-B score of the treatment group was significantly different from that of the control group (P<0.05). The symptom-sign scores were significantly changed in both groups after the treatment (P<0.01). The symptom-sign score of the treatment group was significantly different from that of the control group after the treatment (P<0.05).Conclusion Yu’s meridian detection and treatment plus acupuncture is an effective method in treating facial paralysis.
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@#Objective To investigate the reliability and validity of Simple Facial Grading System (SFGS) in patients with idiopathic facial palsy. Methods 80 patients with idiopathic facial palsy were evaluated with the House-Brackmann (H-B) scale and SFGS before and every 2 weeks after treatment until 12 weeks or recovery. They were assessed by 2 testers before and 2 weeks after treatment. The results were analyzed and compared. Results The Cronbach's α coefficient was 0.93 of SFGS, and 0.74 of H-B scale. The intraclass correlation coefficient (ICC) between testers was 0.84 or higher of SFGS, and 0.77 or higher of H-B scale. The Spearman's rank correlation coefficient between SFGS and H-B scale was 0.73, Kappa coefficients was 0.81 for grade II, 0.74 for grade III, 0.49 for grade IV, 0.66 for grade V, and 0.92 for grade VI. The scores of SFGS and H-B scale positively correlated with the recovery time. Conclusion SFGS is a kind of evaluation for peripheral facial paralysis with satisified reliability and validity, which can be applied to evaluate the severity and outcome during acute stage.
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Objective To investigate the reliability and validity of Simple Facial Grading System (SFGS) in patients with idiopathic fa-cial palsy. Methods 80 patients with idiopathic facial palsy were evaluated with the House-Brackmann (H-B) scale and SFGS before and ev-ery 2 weeks after treatment until 12 weeks or recovery. They were assessed by 2 testers before and 2 weeks after treatment. The results were analyzed and compared. Results The Cronbach'sαcoefficient was 0.93 of SFGS, and 0.74 of H-B scale. The intraclass correlation coeffi-cient (ICC) between testers was 0.84 or higher of SFGS, and 0.77 or higher of H-B scale. The Spearman's rank correlation coefficient be-tween SFGS and H-B scale was 0.73, Kappa coefficients was 0.81 for grade II, 0.74 for grade III, 0.49 for grade IV, 0.66 for grade V, and 0.92 for grade VI. The scores of SFGS and H-B scale positively correlated with the recovery time. Conclusion SFGS is a kind of evaluation for peripheral facial paralysis with satisified reliability and validity, which can be applied to evaluate the severity and outcome during acute stage.
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@#Objective To investigate the reliability and validity of Simple Facial Grading System (SFGS) in patients with idiopathic facial palsy. Methods 80 patients with idiopathic facial palsy were evaluated with the House-Brackmann (H-B) scale and SFGS before and every 2 weeks after treatment until 12 weeks or recovery. They were assessed by 2 testers before and 2 weeks after treatment. The results were analyzed and compared. Results The Cronbach's α coefficient was 0.93 of SFGS, and 0.74 of H-B scale. The intraclass correlation coefficient (ICC) between testers was 0.84 or higher of SFGS, and 0.77 or higher of H-B scale. The Spearman's rank correlation coefficient between SFGS and H-B scale was 0.73, Kappa coefficients was 0.81 for grade II, 0.74 for grade III, 0.49 for grade IV, 0.66 for grade V, and 0.92 for grade VI. The scores of SFGS and H-B scale positively correlated with the recovery time. Conclusion SFGS is a kind of evaluation for peripheral facial paralysis with satisified reliability and validity, which can be applied to evaluate the severity and outcome during acute stage.
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OBJECTIVES: We have analyzed the correlation between the House-Brackmann (HB) scale and Facial Nerve Grading System 2.0 (FNGS 2.0) in patients with Bell palsy, and evaluated the usefulness of the new grading system. METHODS: Sixty patients diagnosed with Bell palsy from May 2009 to December 2010 were evaluated using the HB scale and FNGS 2.0 scale during their initial visit, and after 3 and 6 weeks and 3 months. RESULTS: The overall intraclass correlation coefficient (ICC) was 0.908 (P=0.000) and the Spearman correlation coefficient (SCC) was 0.912 (P<0.05). ICC and SCC displayed differences over time, being 0.604 and 0.626, respectively, at first visit; 0.834 and 0.843, respectively, after 3 weeks; 0.844 and 0.848, respectively, after 6 weeks; and 0.808 and 0.793, respectively, after 3 months. There was a significant difference in full recovery, depending on the scale used (HB, P=0.000; FNGS 2.0, P<0.05). The exact agreements between regional assessment and FNGS 2.0 for the mouth, eyes, and brow were 72%, 63%, and 52%, respectively. CONCLUSION: FNGS 2.0 shows moderate agreement with HB grading. Regional assessment, rather than HB grading, yields stricter evaluation, resulting in better prognosis and determination of grade.
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Humans , Bell Palsy , Eye , Facial Nerve , Mouth , PrognosisABSTRACT
O conhecimento detalhado da anatomia do nervo facial e de seus ramos, em especial o ramo marginal mandibular, é de fundamental relevância em cirurgias para tratamento de fraturas mandibulares com uso do acesso cirúrgico Risdon, evitando-se possíveis lesões. O objetivo deste trabalho é o de avaliar a função do ramo marginal mandibular após tratamento cirúrgico dessas fraturas, utilizando-se o acesso tipo Risdon. Foi avaliada a função do nervo marginal mandibular de 44 pacientes com fraturas de corpo e ângulo mandibulares, utilizando exame visual com base na escala de classificação do nervo facial House-Brackmann, no pré-operatório e pós-operatório (24h). Os pacientes que apresentaram algum grau de disfunção em 24 h foram reavaliados em 01 semana, 01 mês e 03 meses de pós-operatório. Do total avaliado, treze (29,55%) apresentaram algum grau de disfunção no 1º DPO, e trinta e um pacientes (70,45%) apresentaram normalidade na função, sendo o gênero feminino mais acometido (71,43%). Após 03 meses, 91% dos pacientes apresentaram grau I (normal) e 9%, grau II (disfunção branda). Assim, pode-se concluir que a maioria dos pacientes avaliados apresentou normalidade na função do nervo marginal mandibular em todos os tempos pós-operatórios, sendo a disfunção branda a mais encontrada, demonstrando segurança nos acessos Risdon realizados.
Detailed knowledge of the anatomy of the facial nerve and its branches, especially the marginal mandibular one is of fundamental importance in surgical treatment of mandibular fractures by making use of the Risdon surgical approach. The aim of this study is to evaluate the function of the marginal mandibular branch of facial nerve after surgical treatment these fractures by access Risdon. 44 patients with fractures of the mandibular body and angle, and the marginal mandibular nerve function being analyzed through visual inspection based on the rating scale in House-Brackmann facial nerve, in the preoperative and postoperatively (24 hours). Patients who had some degree of dysfunction within 24 hours were reassessed during 01 week, 01 month and 03 months postoperatively. Thirteen (29.55%) had some degree of dysfunction in a PO and thirty one (70.45%) patients had normal function, being females the most affected ones (71.43%). After 03 months, 91% of patients had grade I (normal) and 9% had grade II (mild dysfunction). It can be concluded that the majority of patients showed normal function of the marginal mandibular nerve at all times postoperatively demonstrating safety in the Risdon approaches performed.
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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.
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BACKGROUND AND OBJECTIVES: The facial nerve grading system proposed by House and Brackmann is the most widely accepted for the clinical assessment of facial nerve injury. It is, however, subjective and discontinuous, and prone to interobserver variation. In order to remove subjectivity from analysis, we have therfore proposed the FEMA grading system at the Korean Otologic Study Group in 1995. This study describes the FEMA grading system and determines its reliability and usefulness by comparing it with the House-Brackmann system in assessing facial paralysis. MATERIALS AND METHODS: Ten experienced otolaryngologists using the FEMA and H-B systems studied 30 patients with various degrees of facial palsy. RESULTS: In the average of coincidence rate, the FEMA system showed 84.4% and the H-B system was 73.7% (p<0.05). The standard deviation in the grading by the FEMA system was lower than that by the H-B system (p=0.082). CONCLUSION: The study found that the FEMA grading system is more exact and objective in describing the severity of facial palsy than the House-Brackmann grading system. Especially, the FEMA grading system is more convenient to use in patients with partial weakness.