ABSTRACT
Purpose: To determine the efficacy and safety of botulinum toxin injection into the lacrimal gland as a symptomatic treatment of crocodile tear syndrome (CTS). Methods: Our study included six patients of unilateral gustatory hyper lacrimation following either an episode of facial paralysis or post trauma or any related surgery that posed a risk of damaging the facial nerve. Detailed history regarding previous trauma, duration of facial paralysis, previous significant surgery, and duration of steroid use following facial paralysis was noted. Schirmer抯 test was done at baseline and 3 months follow?up. Patients� consent was taken prior to treatment with botulinum toxin injection in the lacrimal gland. Repeat injection of 5 U botulinum toxin (type A) was administered into the lacrimal gland of all patients transconjunctivally within an interval of 1 week. All patients were followed up with Schirmer抯 test at 6 weeks and 3 months. Any complications during treatment were recorded. Results: All six patients showed complete or partial disappearance of reflex lacrimation while chewing following botulinum injection measured by a significant reduction in Schirmer抯 value. When comparing Schirmer test values before (27.8 � 3.58 mm) and after (11.6 � 2.28 mm) BTX?A injection, the differences observed (P = 0.002) were statistically significant (P < 0.05). Only two patients developed mild transitory ptosis. No other complications were noted. Conclusion: Transconjunctival botulinum toxin injection into the lacrimal gland is an effective and safe method to decrease reflex lacrimation during eating or chewing in CTS or gustatory hyper?lacrimation syndrome.
ABSTRACT
I treated crocodile tears syndrome (gustatory-lacrimal reflex) after right facial nerve palsy with acupuncture. The patient was a 74-year-old female. Her right peripheral facial nerve palsy had started one and a half years earlier.<br>Most of her facial nerve palsy symptoms disappeared in about 5 months. Sixteen months after onset of the condition, her crocodile tear phenomenon occurred spontaneously. Three acupuncture points on the face were stimulated with fine needles for 10 minutes. Her crocodile tears disappeared completely with the first acupuncture session. This case suggests the possibility of acupuncture treatment for aberrant regeneration after facial nerve palsy.
ABSTRACT
Bell's palsy, most frequently occurring in peripheral facial paralysis, is a well-recoverable disease showing spontaneous healing in 70% of patients. This chronic patient of Bell's palsy has persisted for more than two years. Many medical institutes have diagnosed that it was very difficult to remedy completely. The rating score was 24 (full score : 40 points), having sequelae of synkinesis, facial spasm, crocodile tears and other problems. By thermography, the temperature difference between the normal side and the paralyzed side was 0.9°C, and the paralyzed side's temperature was lower. To improve microcirculation on the paralyzed side, electro-acupuncture treatment has been applied to the facial nerve and facial expression muscles. <BR>After evaluating mainly the score for facial paralysis and thermography, the score was increased with disappearance of the temperature difference between the normal side and the paralyzed side. Subjectively, it also became easier to move facial expression muscles, and the phenomenon of crocodile tears was decreased. Long-term electro-acupuncture treatment is considered to be effective for improving the microcirculation and enhancing the QOL of the patient.
ABSTRACT
The symptom of crocodile tears refers to an abnormal gusto-lacrimal reflex whereby any stimulus causing parotid secretion also induces lacrimation. It is a sequelae lesion of facial nerve, usually after the facial paralysis. The authors found the symptom of crocodile tears in one case after facial paralysis due to herpes zoster oticus and two cases after Bell's palsy.