Prognostic role of neutrophil lymphocyte ratio and mean platelet volume in Bell's palsy: Comparison of diabetic and non-diabetic patients

Abstract Objectives: A low Neutrophil Lymphocyte Ratio (NLR) has been shown to be associated with good prognosis in Bell's Palsy (BP). However, the effect of chronic diseases that may affect the NLR, including Diabetes Mellitus (DM), has not been clarified in this context. This study aimed to evaluate the relationship between NLR and Mean Platelet Volume (MPV) in BP according to whether it is accompanied by DM, and their relationship with prognosis. Methods: A prospective observational study was conducted from May 2014 to May 2020 in a tertiary referral center, of all 79 consecutive participants diagnosed with BP in department of otolaryngology and 110 consecutive healthy participants admitted to the check-up unit. Patients diagnosed with BP were divided into two groups according to whether they were diagnosed with DM: diabetic BP patients (DM-BP, n = 33) and non-diabetic BP patients without any chronic disease (nonDM-BP, n = 46). Neutrophil (NEUT) and Lymphocyte (LYM) counts, and Mean Platelet Volume (MPV) were assessed from peripheral blood samples, and the NLR was calculated. Prognosis was evaluated using the House-Brackmann Score (HBS) six months after diagnosis. Results: The mean NLR was 2.85 ± 1.85 in BP patients and 1.69 ±0.65 in the control group. The mean NLR was significantly higher in BP patients than healthy controls (p < 0.001). The mean NLR was 2.58 ± 1.83 in the nonDM-BP group, 3.23 ± 1.83 in the DM-BP group, and 1.69 ± 0.65 in the control group. The NLR was significantly higher in the nonDM-BP and DM-BP groups than in the control group (p < 0.05). The recovery was 90% according to the HBS. The optimal cut-off value was 2.41 (p = 0.5). Conclusion: The NLR was increased in both diabetic and non-diabetic BP and had similar prognostic value in predicting the HBS before treatment in diabetic and non-diabetic patients with BP. MPV wasn't significantly different in diabetic and non-diabetic BP patients compared with the normal population.

Ossification of bilateral stylohyoid ligament with Bell facial paralysis: a case report and literature review / 口腔疾病防治

Objective @# investigate the correlation between the ossification of the styloid hyoid ligament and Bell’s facial paralysis and provide a reference for clinical diagnosis and treatment.@* Methods@# A case of ossification of the bilateral stylohyoid ligament with Bell's facial palsy caused by ossification of the bilateral stylohyoid ligament was diagnosed by clinical manifestations, differential diagnosis and imaging examination. The surgical plan was determined, and combined surgical resection of the ossified area of the styloid hyoid ligament and the greater horn of the hyoid was performed. Postoperative cefoxitin sodium anti-inflammatory treatment, methylprednisolone hormone treatment, acyclovir antiviral treatment, mecobalamin nutritional neurotherapy, and the relevant literature were analyzed. @* Results@# The patient experienced pain when swallowing before surgery, disappearance of right frontal ridges, incomplete eyelid closure, and ptosis of mouth corners. An MRI scan of the brain excluded intracranial space-occupying lesions and resulted in the diagnosis of Bell’s facial paralysis. High-resolution CT of the styloid process confirmed ossification of the styloid hyoid ligament. Styloid process shortening and partial hyoid resection were performed under general anesthesia. Half a month after discharge, the symptoms of sore throat and pain in swallowing disappeared, facial nerve function recovered well, right eyelid closure function recovered well, and right mouth droop improved. The facial nerve function basically returned to normal after 1 month of follow-up. A review of the relevant literature showed that ossification of the stylohyoid ligament to form pseudojoint dilation can locally stimulate the peripheral facial nerve and lead to facial paralysis symptoms. @*Conclusion@# Ossification of the styloid hyoid ligament is usually characterized by pharyngeal pain, which can be confirmed by imaging examination. Ossification of the styloid hyoid ligament with facial paralysis is rare in the clinic, so it is necessary to make a clear diagnosis and treat the symptoms.

Aciclovir endovenoso como tratamiento en la parálisis facial periférica e idiopática en un recién nacido. Reporte de caso

Introducción: la parálisis facial neonatal debida a la parálisis de Bell es rara. El mecanismo de parto traumático representa una etiología más común. Caso clínico: neonato, previamente sano, con parto espontáneo no instrumentalizado y sin complicaciones obstétricas, que cursó con parálisis facial derecha aguda. La imagen cerebral fue normal y los hallazgos clínicos compatibles con parálisis de Bell, con buena respuesta al manejo antirretroviral y fisioterapia. Discusión: la mayoría de infantes con parálisis de Bell mejora con o sin tratamiento y sin secuelas graves. No hay evidencia concluyente en la población pediátrica sobre el beneficio de usar esteroides, solos o con antirretrovirales. Actualmente, tampoco existe un consenso sobre la seguridad de usar esteroides posnatales tardíos, que se deben reservar para neonatos sin otra opción. El aciclovir a dosis de 60 mg/Kg/día es seguro en neonatos. Conclusiones: la parálisis de Bell neonatal puede presentar una respuesta favorable a la terapia antirretroviral y fisioterapia, prescindiendo del uso de esteroides.

SUMMARY Introduction: Neonatal facial palsy due to Bell's palsy is rare. A traumatic delivery mechanism represents a common etiology. Clinical case: Neonate, without previous illnesses, born by spontaneous non-instrumentalized delivery and without any obstetric complications; who presented acute right facial palsy, with normal brain imaging and clinical findings compatible with Bell's palsy, who had a good response to antiretroviral management and physical therapy. Discussion: Most infants with Bell's palsy improve with or without treatment, with no serious sequelae. In pediatric population, evidence on benefits of steroids use, alone or with antiretrovirals, has not been conclusive. There is not a current consensus on the safety of late postnatal steroid use, and they should be reserved for neonates who have no other treatment choice. Acyclovir use at 60/mg/Kg/day it's safe in neonates. Conclusions: Neonatal Bell's palsy may present a favorable response to antiretroviral therapy and an adherent physical rehabilitation program, irrespective of steroids use.

Reabilitação fonoaudiológica na paralisia facial periférica: revisão integrativa / Speech-language rehabilitation in peripheral facial paralysis: integrative review

RESUMO Objetivos identificar e analisar a produção científica sobre as estratégias terapêuticas empregadas na reabilitação fonoaudiológica de pessoas com paralisia facial periférica (PFP). Estratégia de pesquisa foi realizada uma revisão integrativa, utilizando-se as bases de dados SciELO, PubMed, Web of Science, ScienceDirect e Portal CAPES. Os descritores foram: paralisia facial e paralisia de Bell, combinados com reabilitação, terapia miofuncional e fonoaudiologia ou seus correlatos em inglês. Critérios de seleção estudos disponíveis na íntegra, que abordaram a reabilitação fonoaudiológica em pessoas com PFP, publicados no período entre 1999 e 2019, em português brasileiro, inglês ou espanhol. Resultados foram identificadas 650 publicações, mas apenas cinco artigos contemplaram os critérios de inclusão propostos. Dentre estes, a SciELO e PubMed obtiveram dois artigos incluídos cada. Além disso, a maioria foi publicada nos últimos dez anos e produzida no Brasil. O português brasileiro foi o idioma de publicação de três dos cinco artigos incluídos, não ocorrendo predominância de um nível de evidência específico. A descrição dos procedimentos utilizados não foi suficientemente detalhada nos estudos. Exercícios isotônicos e isométricos foram abordados mais frequentemente. A bandagem surgiu como recurso terapêutico em um estudo. Conclusão embora haja um grande número de artigos relacionadas à PFP, apenas cinco estudos descreveram procedimentos fonoaudiológicos para pessoas com PFP, com nível de evidência baixo. Portanto, novos estudos abordando o tema são necessários.

ABSTRACT Purpose identify and analyze the scientific production about the therapeutic strategies employed in the speech-language rehabilitation of people with peripheral facial paralysis. Research strategy an integrative review was performed using the SciELO, PubMed, Web of Science, ScienceDirect and Portal CAPES databases. The descriptors were: facial paralysis and Bell's palsy, combined with rehabilitation, myofunctional therapy and Speech, Language and Hearing Sciences or their correlates in english. Selection criteria studies available in their entirety, which addressed speech-language rehabilitation in people with peripheral facial paralysis, published between 1999 and 2019, in Brazilian Portuguese, english or spanish, were selected. Results 650 publications were identified, but only five articles met the proposed inclusion criteria. Among these, SciELO and PubMed obtained two articles included each. In addition, most were published in the last ten years and produced in Brazil. Brazilian Portuguese was the language of publication of three of the five included, with no predominance of a specific level of evidence. The description of the procedures used was not sufficiently detailed in the studies. Isotonic and isometric exercises were approached more frequently. Bandage emerged as a therapeutic resource in one study. Conclusion Although there are a large number of articles related to peripheral facial paralysis, only five studies described speech-language procedures for people with peripheral facial paralysis, with low level of evidence. Therefore, further studies addressing the topic are needed.

Acupuntura y terapia neural para el tratamiento de la Parálisis de Bell / Acupuncture and Neural Therapy for Treating Bell's Palsy

Introducción: La efectividad de las terapias alternativas para el tratamiento de la parálisis de Bell es aún controvertida. Objetivo: Reportar la experiencia en el tratamiento de la PB mediante la administración conjunta de acupuntura y terapia neural. Métodos: Se recopiló información de 30 pacientes con parálisis de Bell, quienes recibieron una sesión semanal de acupuntura y terapia neural de manera conjunta y fueron evaluados mediante la escala House-Brackmann durante 12 semanas. Resultados: El 80 por ciento (24) de los pacientes continuaron el tratamiento hasta la semana 12 y al término de la misma ninguno alcanzó función motora normal. Apenas 6 (25 por ciento) pacientes mostraron signos de recuperación entre las semanas 6 y 12. Así, el porcentaje de pacientes con grado IV se redujo de 6 (20 por ciento) durante la evaluación inicial a 3 (12 por ciento) durante la semana 9 (p = 0,001) y el de pacientes con grado III de 12 (50 por ciento) durante la semana 9 a 9 (38 por ciento) durante la semana 12 (p = 0,663). Se evidenciaron efectos adversos en 9 (32 por ciento) pacientes, lo que incluyó hematoma en el sito de puntura y síncope, que se resolvieron sin complicaciones. Conclusiones: La administración conjunta de acupuntura y terapia neural durante al menos 6 semanas tuvo efectos modestos sobre la recuperación de pacientes con parálisis de Bell sin producir efectos adversos mayores(AU)

Introduction: The effectiveness of alternative therapies for treating Bell's palsy is still controversial. Objective: To report the experience in the treatment of Bell's palsy through joint administration of acupuncture and neural therapy. Methods: Information was collected from 30 patients with Bell's palsy, who received a weekly session of acupuncture and neural therapy jointly and were assessed using the House-Brackmann scale for 12 weeks. Results: 80 percent (24) of the patients continued treatment until week 12 and, at the end of the week, none reached normal motor function. Only 6 patients (25 percent) showed signs of recovery between weeks 6 and 12. Thus, the percentage of patients with grade IV decreased from 6 (20 percent), during the initial evaluation, to 3 (12 percent), during week 9 (p<0.001); while the percentage of patients with grade III decreased from 12 (50 percent), during week 9, to 9 (38 percent), during week 12 (p=0.663). Adverse effects were evidenced in 9 (32 percent) patients, including hematoma at the puncture site and syncope, which was solved without complications. Conclusions: Joint administration of acupuncture and neural therapy for at least six weeks had modest effects on the recovery of patients with Bell's palsy, without producing major adverse effects(AU)

Uso de láser de baja potencia como coadyuvante en tratamiento con terapias combinadas en paciente con parálisis facial periférica / Use of low level laser therapy as an adjunct in treatment with combined therapies in patients with peripheral facial palsy

La parálisis facial periférica es un trastorno neurológico que tiene consecuencias motoras y sensoriales y que afecta al nervio facial. Ocasiona alteraciones en la acción de los músculos del rostro, en la secreción de saliva, lágrimas y en el sentido del gusto.El objetivo de esta publicación es dar cuenta de un caso en el que se realizó un tratamiento con terapias combinadas mínimamente invasivas junto con el uso de láserterapia de baja potencia, en un paciente femenino, 52 años de edad, con antecedentes médicos relevantes, derivada para evaluación estética. La paciente presenta una parálisis facial moderada sin resolver. Fue sometida a láserterapia con longitud de onda (808 nm) y una energía de 3 Joules por sesión en el lado afectado, complementada con toxina botulinica Tipo A, en el lado sano.El tratamiento de parálisis facial periférica con terapias combinadas mínimamente invasivas ha mostrado ser una herramienta útil terapéutica de las secuelas faciales. A su vez, la terapia de fotobiomodulación con láser de baja potencia es prometedora como coadyuvante en el proceso de reparación nerviosa lo que permitiría la recuperación funcional del nervio facial a mediano y largo plazo.

Peripheral Facial Palsy is a neurological disorder that has motor and sensory consequences and affects the facial nerve. It causes alterations in the action of the muscles of the face, in the secretion of saliva, tears, and in the sense of taste.The objective of this publication is to report a case in which a treatment with minimally invasive combined therapies was performed together with the use of low-level laser therapy, in a 52-year-old female patient. With relevant medical history, referred for aesthetic evaluation and with unresolved moderate facial paralysis. She was subjected to laser therapy with wavelength (808 nm) and an energy of 3 Joules per session on the affected side, supplemented with Botulinum Toxin Type A, on the healthy side.The treatment of peripheral facial paralysis with minimally invasive combined therapies has proven to be a useful therapeutic tool for facial sequelae. In turn, low-level laser photobiomodulation therapy is promising as an adjunct in the nerve repair process, which would allow functional recovery of the facial nerve in the medium and long term.

Main prognostic factors and physical therapy modalities associated with functional recovery in patients with peripheral facial paralysis / Principais fatores prognósticos e modalidades fisioterapêuticas associados à recuperação funcional em pacientes com paralisia facial periférica / Principales factores pronósticos y modalidades de fisioterapia relacionadas a la recuperación funcional de pacientes con parálisis facial periférica

ABSTRACT Patients with peripheral facial paralysis (PFP) have some degree of recovery. The aim of this study was to evaluate prognostic factors and physical therapy modalities associated with functional recovery in patients with PFP. This is a cohort study with 33 patients. We collected the following variables of patients who underwent treatment at the rehabilitation center: age, sex, risk factors, affected side, degree of facial paralysis (House-Brackmann scale), start of rehabilitation, and therapy modality (kinesiotherapy only; kinesiotherapy with excitomotor electrotherapy; and kinesiotherapy with excitomotor electrotherapy and photobiomodulation therapy). The outcomes were: degree of facial movement (House-Brackmann) and face scale applied 90 days after treatment. Degree of PFP was associated with functional recovery (RR=0.51, 95% CI: 0.51-0.98; p=0.036). The facial movement was associated with the time to start rehabilitation (r=−0.37; p=0.033). Lower facial comfort was observed among women, worse ocular comfort was associated with diabetes mellitus, worse tear control with prior PFP, and worse social function with the degree of PFP. Our results indicate that the all modalities present in this study showed the same result in PFP. Recovery of PFP was associated with degree of nerve dysfunction, the length of time to onset of rehabilitation, female sex, hypertension, diabetes mellitus, and previous PFP, all of which were associated with worse outcomes on the face scale.

RESUMO Os pacientes com paralisia facial periférica (PFP) apresentam diversos graus de recuperação. O objetivo deste estudo foi avaliar os fatores prognósticos e as modalidades fisioterapêuticas associados à recuperação funcional em pacientes com PFP. Trata-se de um estudo coorte prospectiva de 33 pacientes. Foram coletadas variáveis de pacientes submetidos ao tratamento no centro de reabilitação: idade, sexo, fatores de risco, lado afetado, grau de paralisia facial (escala de House-Brackmann), início da reabilitação e modalidade de terapia (cinesioterapia; cinesioterapia associada à eletroterapia; cinesioterapia associada à eletroterapia e terapia de fotobiomodulação). Os desfechos foram: grau de movimento facial (House-Brackmann) e face scale aplicados 90 dias após o tratamento. O grau de PFP foi associado à recuperação funcional (RR=0,51, 95% IC: 0,51-0,98; p=0,036). O movimento facial foi associado com o tempo para iniciar a reabilitação (r=−0,37; p=0,033). Menor conforto facial foi observado entre as mulheres, pior conforto ocular em indivíduos com diabetes mellitus, pior controle lacrimal em indivíduos com PFP prévia e pior função social com o grau de PFP. Todas as modalidades apresentadas neste estudo tiveram o mesmo resultado na PFP. A recuperação da PFP foi associada ao grau de disfunção nervosa, ao tempo de início da reabilitação, ao sexo feminino, à hipertensão arterial sistêmica, ao diabetes mellitus e à PFP prévia, todos associados a piores desfechos na face scale.

RESUMEN Los pacientes con parálisis facial periférica (PFP) tienen diferentes grados de recuperación. El presente estudio tuvo como objetivo evaluar los factores pronósticos y las modalidades de fisioterapia relacionadas a la recuperación funcional de pacientes con PFP. Este es un estudio de cohorte prospectivo con 33 pacientes. Se recogieron las siguientes variables de pacientes sometidos a tratamiento en el centro de rehabilitación: edad, sexo, factores de riesgo, lado afectado, grado de parálisis facial (escala de House-Brackmann), inicio de la rehabilitación y modalidad de terapia (kinesioterapia, kinesioterapia asociada a la electroterapia, kinesioterapia asociada a la electroterapia y terapia de fotobiomodulación). Los resultados fueron: grado de movimiento facial (House-Brackmann) y face scale, aplicados 90 días después del tratamiento. El grado de PFP se asoció con la recuperación funcional (RR=0,51,95% IC: 0,51-0,98; p=0,036). El movimiento facial se asoció con el tiempo para comenzar la rehabilitación (r=−0,37; p=0,033). Se observó menor comodidad facial entre las mujeres, peor comodidad ocular en personas con diabetes mellitus, peor control lagrimal en individuos con PFP previa y peor función social con el grado de PFP. Todas las modalidades presentadas en este estudio tuvieron el mismo resultado en PFP. La recuperación de la PFP se asoció con el grado de disfunción nerviosa, el tiempo inicial de la rehabilitación, el sexo femenino, la hipertensión arterial sistémica, la diabetes mellitus y la PFP previa, todos asociados con peores resultados en face scale.

Early treatment of suspension moxibustion for Bell's palsy in acute stage / 中国针灸

OBJECTIVE@#To observe the efficacy of early treatment of suspension moxibustion for Bell's palsy and its influence on the prognosis, and to explore whether the early treatment of suspension moxibustion has non-inferiority effect to hormone treatment and whether suspension moxibustion combined with hormone treatment has the synergistic effect.@*METHODS@#A total of 132 patients with acute-stage Bell's palsy were divided into a hormone group (94 cases) and a moxibustion group (38 cases) by non-random method, and the hormone group was further randomly divided into a hormone with moxibustion group (48 cases) and a hormone without moxibustion group (46 cases). The acupuncture and oral administration of mecobalamin capsule were used as basic treatment. Acupuncture was applied at Yangbai (GB 14), Sibai (ST 2), Quanliao (SI 18), Dicang (ST 4), Jiache (ST 6), Yifeng (TE 17), etc., with the needles retained for 30 min, once a day, 5 consecutive days per week; there was an interval of 2 days between two weeks, and a total of 4-week treatment was given. The oral administration of mecobalamin capsule was given 0.5 mg each time, 3 times a day for 4 weeks. The patients in the moxibustion group, on the basis of basic treatment, were treated with the suspension moxibustion at Yangbai (GB 14), Sibai (ST 2), Dicang (ST 4), Jiache (ST 6), Wangu (GB 12), Yifeng (TE 17) of affected side, 5 min per acupoint, once a day, 5 consecutive days per week; there was an interval of 2 days between two weeks, and a total of 4-week treatment was given. The patients in the hormone without moxibustion group, on the basis of basic treatment, were treated with prednisone acetate tablets. The patients in the hormone with moxibustion group, on the basis of basic treatment, were treated with suspension moxibustion and prednisone acetate tablets. All the treatment was given for 4 weeks. The House-Brcackmann facial nerve grading (H-B) global score and facial disability index (FDI) scale were used to evaluate the curative effect in the three groups before treatment, 2 weeks and 4 weeks into treatment and 4 weeks after treatment; the efficacy was compared among the three groups.@*RESULTS@#Compared before treatment, the H-B grading and FDI scores were significantly improved 2 weeks and 4 weeks into treatment and 4 weeks after treatment (0.05); the H-B grading and FDI scores in the hormone with moxibustion group were superior to those in the moxibustion group and the hormone without moxibustion group 4 weeks into treatment and 4 weeks after treatment (0.05). At the end of follow-up, the cured rate in the hormone with moxibustion group was 81.3% (39/48), which was superior to 68.4% (26/38) in the moxibustion group and 60.9% (28/46) in the hormone without moxibustion group (0.05).@*CONCLUSION@#The three treatment methods are all safe and effective for acute-stage Bell's palsy. The suspension moxibustion combined with hormone therapy are superior to suspension moxibustion or hormone therapy alone. Early treatment of suspension moxibustion is safe and effective for Bell's palsy, and has obvious synergistic effect with hormone. For the patients who cannot use hormone, suspension moxibustion could replace hormone, which is non-inferior to hormone.

Effect of Thick-Needle Therapy in Patients with Bell's Palsy at Recovery Stage: A Multi-center Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To compare the clinical effects of thick-needle therapy (TNT) and acupuncture therapy (AT) on patients with Bell's palsy (BP) at the recovery stage.@*METHODS@#A total of 146 eligible participants from 3 hospitals in China were randomized into the TNT group (73 cases) and the AT group (73 cases) using a central randomization. Both groups received Western medicine thrice a day for 4 weeks. Moreover, patients in the TNT group received subcutaneous insertion of a thick needle into Shendao (GV 11) acupoint, while patients in the AT group received AT at acupoints of Cuanzhu (BL 2), Yangbai (GB 14), Dicang (ST 4), Xiaguan (ST 7), Jiache (ST 6), Yingxiang (LI 20) and Hegu (LI 4), 4 times a week, for 4 weeks. Both groups received 2 follow-up visits, which were arranged at 1 month and 3 months after treatment, respectively. The primary outcome measure was House-Brackmann Facial Nerve Grading System (HBFNGS) grade. And the clinical recovery rates of both groups were evaluated according to the HBFNGS grades after treatment. The secondary outcome measures included the facial disability index (FDI) and electroneurogram (EnoG). The adverse events were observed and recorded in both groups.@*RESULTS@#Three cases withdrew from the trial, 2 in the TNT group and 1 in the AT group. There was no signifificant difference in the clinical recovery rates between the TNT and AT groups after 4-week treatment [40.85% (29/71) vs. 34.72% (25/72), P>0.05]. At the 2nd follow-up visit, more patients in the TNT group showed reduced HBFNGS grades than those in the AT group (P0.05).@*CONCLUSION@#The clinical effect of TNT was equivalent to that of AT in patients with BP at recovery stage, while the post-treatment effect of TNT was superior to that of AT. (Registration No. ChiCTR-INR-16008409).

Discussion on refractory factors of Bell's palsy and clinical experience in treatment / 中国针灸

The specific therapeutic regimen of Bell's palsy was proposed in association with the common refractory factors and the clinical experience of professor -. It is viewed that aging, absent intervention standard treatment at early stage, no prodromal symptoms and progressive onset are the refractory factors. Acupuncture at the local area is predominated in treatment. The different acupoint prescription regimens of acupuncture therapy are selected depending on muscle relaxation, muscle stiffness and specific accompanying symptoms, associated with electric stimulation, moxibustion and the tapping technique with plum-blossom needle so as to ensure the improvement of clinical therapeutic effect.

Laserterapia de baixa potência e paralisia facial periférica: revisão integrativa da literatura. Terapia a laser e Paralisia de Bell / Low level light therapy and peripheral facial paralysis: integrating literature review. Laser therapy and Bell palsy / Laserterapia de baja potencia y paralisia facial periférica: revisión integral de la literatura. Terapia láser y parálisis de Bell

Introdução: A paralisia facial periférica é um distúrbio da motricidade orofacial responsável por trazer impactos negativos em diversos âmbitos na vida dos indivíduos. Entre os profissionais envolvidos no tratamento, o fonoaudiólogo é responsável pelo importante papel de promover a reabilitação das funções orofaciais do indivíduo. Dentre os diversos recursos que este pode utilizar, está o laser de baixa intensidade, ainda pouco investigado na literatura científica. Objetivo: realizar uma revisão integrativa da literatura acerca da utilização e o efeito do laser de baixa intensidade como método terapêutico das paralisias faciais periféricas. Métodos: (1) formulação da pergunta norteadora do estudo "Qual a evidência científica da eficácia, descrita na literatura científica, do uso do laser de baixa intensidade no tratamento da paralisia facial periférica?"; (2) Definição dos descritores, pelo DeCS e MeSH, combinados através do operador booleano AND: Terapia com luz de baixa intensidade; Terapia a laser; Paralisia facial e Paralisia de Bell; (3) Bases de dados PubMed e BIREME; (4) Delimitação dos critérios elegibilidade e (5) coleta e triagem dos artigos. Critérios de Seleção: Utilizar laser como recurso terapêutico e pacientes com paralisia facial em sua metodologia. Resultados: participaram desta revisão 10 artigos que encontraram efeitos positivos da laserterapia utilizando dosagens entre 4 e 105 J/cm2 e comprimentos de onda entre 670 e 1064 nm em um período entre 4 e 20 sessões. Conclusão: os efeitos do laser de baixa potência são benéficos em pacientes acometidos por paralisia facial periférica e potencializam-se quando associados a outros recursos terapêuticos da Fonoaudiologia.

Introduction: Peripheral facial palsy is an orofacial motor disorder that is responsible for bringing negative impacts in different settings in the life of individuals. Among the professionals involved in the treatment, the speech therapist is responsible for the important role of promoting the rehabilitation of the orofacial functions of the individual. Among the several resources that it can use, is the low intensity laser, still little investigated in the scientific literature. Objective: review the use and efficacy of low intensity laser as a therapeutic method for peripheral facial paralysis. Methods: (1) formulation of the guiding question of the study "What is the scientific evidence of efficacy of the use of low frequency laser in the treatment of peripheral facial paralysis? "; (2) Definition of descriptors, by DeCS and MeSH, combined through the Boolean operator AND: Low intensity light therapy; Laser therapy; Facial Paralysis and Bell's Palsy; (3) PubMed and BIREME databases; (4) Delimitation of eligibility criteria and (5) collection and sorting of articles. Selection criteria: Using laser as a therapeutic resource and patients with facial paralysis in their methodology. Results: Ten studies enrolled in this revision found positive effects of laser therapy using laser dosages between 4 and 105 J/cm2 and wavelengths between 670 and 1064 nm in a period between 4 and 20 sessions. Conclusion: the effects of low power laser are benefic in patients with peripheral facial paralysis and potentialized when associated with other therapeutic resources of speech therapy.

Introducción: La parálisis facial periférica es un trastorno de la motricidad orofacial responsable de traer impactos negativos en diversos ámbitos en la vida de los individuos. Entre los profesionales involucrados en el tratamiento, el fonoaudiólogo es responsable del importante papel de promover la rehabilitación de las funciones orofaciales del individuo. Entre los diversos recursos que éste puede utilizar, está el láser de baja intensidad, aún poco investigado en la literatura científica. Objetivo : realizar una revisión integrativa de la literatura acerca de la utilización y el efecto del láser de baja intensidad como método terapéutico de las parálisis faciales periféricas. Metodos: (1) la formulación de la pregunta guía del estudio "¿Cuál es la evidencia científica de su efectividad se describe en la literatura científica, el uso del láser de baja intensidad en el tratamiento de la parálisis facial periférica"; (2) Definición de los descriptores, por el DeCS y MeSH, combinados a través del operador booleano AND: Terapia con luz de baja intensidad; Terapia láser; Parálisis facial y parálisis de Bell; (3) Bases de datos PubMed y BIREME; (4) Delimitación de los criterios elegibles y (5) recolección y clasificación de los artículos. Criterios de selección: Utilizar láser como recurso terapéutico y pacientes con parálisis facial en su metodología. Resultados: Diez estudios incluidos en esta revisión encontraron efectos positivos de la terapia con láser usando dosis de láser entre 4 y 105 J/cm2 y longitudes de onda entre 670 y 1064 nm en un período de entre 4 y 20 sesiones. Conclusión: los efectos del láser de baja potencia son beneficiosos en pacientes con parálisis facial periférica y se potencian cuando se asocian con otros recursos terapéuticos de la terapia del habla.

Study on Prognostic Value of Electrophysiological Tests in Bell’s Palsy

Introduction: Bell’s palsy is an idiopathic peripheral disease of the seventh cranial nerve. More than 70% of patients attaincomplete clinical recovery, with no noticeable residua. Electrophysiological tests may offer valuable information in defining theseverity of nerve injury and a possible subsequent dysfunction.Aim: This study aims to assess the prognostic value of electrophysiological tests in the management of Bell’s palsy.Materials and Methods: All the patients with Bell’s palsy and without clinical evidence of other cranial nerve damage or centralnervous system diseases were included in the study. Nerve conduction study was performed on the 14th day or on the firstvisit of the patient to the hospital.Results: In 101 patients, majority of patients come under Grade IV (43.6%) and next comes Grade V (31.7%). Eighty-twopatients (81.2%) had normal latency, among these, 73 cases recovered within 6 months. Of 17 who had prolonged latency,seven patients recovered fully.Conclusions: Electrophysiological studies can predict the duration of the clinical recovery and the outcome of the illness. Theamplitude ratio of compound muscle action potential is the most reliable parameter in assessing the prognosis.

Acupuntura y masaje tuina en el tratamiento de la parálisis de Bell / Acupuncture and tuina massage in the treatment of Bell's palsy

RESUMEN Introducción: La Parálisis Facial Periférica se define como la debilidad o parálisis de la musculatura inervada por el nervio facial debida a lesiones del VII par craneal en cualquier lugar de su recorrido desde el núcleo de origen a las estructuras que inerva. Objetivo: Valorar el uso de la acupuntura y el masaje tuina en el tratamiento de los pacientes con parálisis facial de Bell. Métodos: Estudio clínico terapéutico, prospectivo y longitudinal en pacientes con parálisis facial periférica de Bell en el período comprendido entre enero del 2017 a enero del 2018.Los pacientes fueron evaluados mediante interrogatorio y examen físico neurológico y tradicional. Al inicio y final del tratamiento se aplicó la escala de House-Brackmann como instrumento de evaluación de la terapia empleada. Se exploraron variables demográficas, clínicas y de resultado. Resultados: Predominó el sexo masculino y el grupo etario de 30 a 50 años, el diagnóstico tradicional más frecuente fue el viento frio yen el 84,6 % de los pacientes el tratamiento aplicado fue satisfactorio, con un tiempo promedio de recuperación de 38 días. Conclusiones: La aplicación de la acupuntura y el masaje tuina son técnicas tradicionales exitosas al tratar la Parálisis Facial Periférica

ABSTRACT Introduction: Peripheral Facial Palsy is defined as the weakness or paralysis of the musculature innervated by the facial nerve due to lesions of the seventh cranial nerve anywhere in its path from the nucleus of origin to the structures innervated by it. Objective: to assess the use of acupuncture and tuina massage in the treatment of patients with Bell's palsy. Methods: a prospective and longitudinal therapeutic clinical study of patients with Bell's peripheral facial palsy from January 2017 to January 2018, evaluated by questioning and neurological and traditional physical examination. At the beginning and end of the treatment the House-Brackmannc scale was applied as an instrument to evaluate the application of the treatment. Demographic, clinical and outcome variables were explored. Results: male gender predominated and the group from 30 to 50 years old, the most frequent traditional diagnosis was cold wind and in 84.6 % of patients the treatment applied was satisfactory, with an average recovery time of 38 days. Conclusions: the application of acupuncture and tuina massage is a successful traditional technique to treat Peripheral Facial Palsy.

Clinical Implication of Facial Nerve Decompression in Complete Bell's Palsy: A Systematic Review and Meta-Analysis

We compared the therapeutic efficacy of facial nerve decompression (FND) and conservative treatment in patients with Bell's palsy through a systematic review and meta-analysis. Primary database search was performed in PubMed, Medline, and Embase. After screening, 13 studies were assessed for their eligibility. Among them, seven studies employing either the House-Brackmann grading system (HBGS) or May's classification (modified HBGS) were selected for quantitative and qualitative analysis. Based on May's classification, the degree of recovery was classified into complete (HBGS I), fair (HBGS II–III), or failed (HBGS IV–VI) recovery. The outcomes were assessed between 6 and 12 months after surgery. The estimated pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects model. Cohorts were comprised of patients who underwent FND (n=202, 53.0%) and conservative treatments (n=179, 47.0%). In pooled analysis, the rate of complete recovery was significantly higher in the FND group than in the control group (OR, 2.06; 95% CI, 1.22 to 3.48; P=0.007) showing neither heterogeneity nor publication bias. Meanwhile, the rates of fair recovery (OR, 0.71; 95% CI, 0.42 to 1.21; P=0.208) and failed recovery (OR, 0.60; 95% CI, 0.22 to 1.67; P=0.327) in the FND group were similar to that in the control group. In subgroup analyses, there was no significant difference in the OR according to the operation timing and surgical approach. FND can be a possible treatment option for patients with complete Bell's palsy, especially for complete recovery, which provide insights on decision-making and outcome prediction. However, FND should be determined carefully given the risk of small study effects and possible complications.

Association Between High Neutrophil to Lymphocyte Ratio and Delayed Recovery From Bell's Palsy

OBJECTIVES: Factors predictive of the severity of and recovery from Bell's palsy remain unclear. This study evaluated the association between neutrophil to lymphocyte ratio (NLR) and the severity of and recovery from Bell's palsy. METHODS: This retrospective study included 51 patients who were hospitalized with Bell's palsy from 2015 to 2017. Degree of paralysis was assessed by House-Brackmann (H-B) grade. Patients with H-B grades 2–4 were classified as having mild to moderate palsy and patients with H-B grade 5 or 6 were classified as having severe palsy. Patients were evaluated for obesity, hypertension and diabetes mellitus, and blood tests were performed to determine NLR and platelet to lymphocyte ratio. Patients were treated with steroids and antiviral agents. H-B grade was assessed 1 week, 1 month, and 3 months after treatment. RESULTS: NLR was significantly higher in patients with severe than with mild to moderate palsy (P=0.048). Recovery time was significantly longer in patients with high NLR than low NLR (P=0.045). CONCLUSION: Higher NLR in patients with Bell's palsy was associated with longer recovery time. NLR may be prognostic of recovery time in patients with Bell's palsy.

Ophthalmologic Clinical Features of Facial Nerve Palsy Patients

PURPOSE: To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who were referred to an ophthalmic clinic for various conditions like Bell's palsy, trauma, and brain tumor. METHODS: A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited a clinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed. RESULTS: The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ± 37.5 months. The causes of facial palsy were as follows: Bell's palsy, 13 cases; trauma, six cases; brain tumor, five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos, 24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12 eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including the third, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) were conducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin type A injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated using invasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos, 90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement for all signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy. CONCLUSIONS: The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition, and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixty cranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facial palsy. Understanding these differences will help the ophthalmologist take care of patients with facial nerve palsy.

Comparison of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis / 中国基层医药

Objective@#To compare the clinical effects of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis.@*Methods@#From March 2014 to March 2016, 80 patients with acute idiopathic facial neuritis admitted in the department of neurology of Luzhong Hospital were randomly divided into treatment group and control group according to the admission sequence, with 40 cases in each group.The two groups were given basic treatment (mecobalamine intramuscular injection + clonazepam and continuous application for 15d), and the treatment group was excluded from the corticosteroid application.On this basis, ganciclovir combined with dexamethasone was applied in the treatment group, and ganciclovir was applied in the control group.Both two groups had a course of 15 days.All the patients were graded by Portmann simple scale before treatment and at 7 days and 15 days after treatment, and statistical significance of SPSS13.0 software was adopted.@*Results@#Intra-group comparison: after treatment of 7d, the score of the treatment group was (10.11±3.62)points, which was significantly higher than (2.60±2.22)points before treatment(t=1.432, P<0.05). The score had no statistically significant difference between 7d after treatment[(10.11±3.62)points] and 15d after treatment[(11.82±3.02)points] in the treatment group (t=1.582, P>0.05). In the control group, the score had no statistically significant difference between 7d after treatment[(3.22±3.12)points] and before treatment[(2.70±2.30)points] (t=0.923, P>0.05). Comparison between the two groups: there was no statistically significant difference in pre-treatment score between the two groups (P>0.05). The score of the treatment group at 7d after treatment[(10.11±3.62)points] was significantly different from that of the control group[(3.22±3.12)points](t=1.633, P<0.05). There was no statistically significant difference in scores between the two groups at 15d after treatment (P>0.05).@*Conclusion@#Ganciclovir combined with dexamethasone and ganciclovir alone are effective in the treatment of acute idiopathic facial neuritis.Although the improvement effect of the combined treatment is earlier than that of single use, there is no significant difference in the total effective rate between the two treatments.

Comparison of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis / 中国基层医药

Objective To compare the clinical effects of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis.Methods From March 2014 to March 2016,80 patients with acute idiopathic facial neuritis admitted in the department of neurology of Luzhong Hospital were randomly divided into treatment group and control group according to the admission sequence,with 40 cases in each group.The two groups were given basic treatment (mecobalamine intramuscular injection + clonazepam and continuous application for 15d),and the treatment group was excluded from the corticosteroid application.On this basis,ganciclovir combined with dexamethasone was applied in the treatment group,and ganciclovir was applied in the control group.Both two groups had a course of 15 days.All the patients were graded by Portmann simple scale before treatment and at 7 days and 15 days after treatment,and statistical significance of SPSS13.0 software was adopted.Results Intra-group comparison:after treatment of 7d,the score of the treatment group was (10.11 ± 3.62) points,which was significantly higher than (2.60 ± 2.22) points before treatment (t =1.432,P ＜ 0.05).The score had no statistically significant difference between 7d after treatment [(10.11 ± 3.62)points] and 15d after treatment [(11.82 ±3.02) points] in the treatment group (t =1.582,P ＞ 0.05).In the control group,the score had no statistically significant difference between 7 d after treatment [(3.22 ± 3.12) points] and before treatment [(2.70 ± 2.30) points](t =0.923,P ＞0.05).Comparison between the two groups:there was no statistically significant difference in pretreatment score between the two groups (P ＞ 0.05).The score of the treatment group at 7d after treatment [(10.11 ±3.62) points] was significantly different from that of the control group[(3.22 ± 3.12)points] (t =1.633,P ＜ 0.05).There was no statistically significant difference in scores between the two groups at 15d after treatment (P ＞ 0.05).Conclusion Ganciclovir combined with dexamethasone and ganciclovir alone are effective in the treatment of acute idiopathic facial neuritis.Although the improvement effect of the combined treatment is earlier than that of single use,there is no significant difference in the total effective rate between the two treatments.

Childhood Sarcoidosis Presenting as Recurrent Facial Palsy

Background: Recurrent facial palsy in a patient merits investigation for underlying etiology.Case characteristics: 8-year-old boy with erythematous itchy skin lesion and recurrentfacial palsy. Observation: He had a past history of aseptic meningitis andnephrocalcinosis. Raised angiotensin converting enzyme levels, interstitial lung disease onCT chest, and non caseating granulomas on skin biopsy clinched the diagnosis ofsarcoidosis. Message: Multisystem involvement and recurrent lower motor facial nervepalsy is a clinical clue for sarcoidosis.