Photobiomodulation in the Treatment of Bell's Palsy: An Integrative Review / Fotobiomodulación en el Tratamiento de la Parálisis de Bell: una Revisión Integradora

Bell's palsy is defined as a lower motor neuron palsy that develops from a non-suppurative inflammation of the facial nerve at the stylomastoid foramen. The objective of this integrative review was to determine the effects of photobiomodulation as a therapeutic method for Bell's palsy. This qualitative study provided a broader understanding of the subject studied. Searches for articles were carried out in PubMed databases via Medline, LILACS, IBES, Scopus, Web of Science, Embase, and CENTRAL using MeSH and DeCS descriptors to determine the search terms. A total of 143 articles were found. After applying the inclusion and exclusion criteria, 7 articles were included. Therefore, it can be concluded that the application of low-level laser in the treatment of Bell's palsy is effective since the studies indicated significant and relevant improvements for the recovery of these patients when associating the laser with other types of treatments.

La parálisis de Bell se define como una parálisis de la neurona motora inferior que se desarrolla a partir de una inflamación no supurativa del nervio facial en el agujero estilomastoideo. El objetivo de esta revisión integradora fue determinar los efectos de la fotobiomodulación como método terapéutico para la parálisis de Bell. Este estudio cualitativo proporcionó una comprensión más amplia del tema estudiado. Las búsquedas de artículos se realizaron en las bases de datos PubMed a través de Medline, LILACS, IBES, Scopus, Web of Science, Embase y CENTRAL utilizando los descriptores MeSH y DeCS para determinar los términos de búsqueda. Se encontraron un total de 143 artículos. Después de aplicar los criterios de inclusión y exclusión, se incluyeron 7 artículos. Por tanto, se puede concluir que la aplicación de láser de baja intensidad en el tratamiento de la parálisis de Bell es eficaz debido a que los estudios indicaron mejoras significativas y relevantes para la recuperación de estos pacientes al asociar el láser a otro tipo de tratamientos.

Parálisis de Bell secundaria a vacuna Pfizer para COVID-19: reporte de caso / Bell's Palsy Secondary to COVID-19 Vaccine Pfizer: Case report

Introducción: la BNT162b2 (Pfizer-BioNTech) es una vacuna de ARNm modificado con nucleósidos y formulada con nanopartículas lipídicas para la prevención de la enfermedad covid-19 causada por la infección por SARS-CoV-2. A principios de diciembre del 2020, la BNT162b2 recibió una autorización para su uso de emergencia. Se han publicado datos iniciales de eficacia y seguridad, sin embargo las hojas de información para el consumidor/paciente para vacunas distribuidas en América del Norte no advierten sobre la parálisis de Bell como un posible efecto adverso. Informamos el caso de una mujer que desarrolló parálisis de Bell posterior a la aplicación de la primera dosis de la vacuna Pfizer-BioNTech.Caso clínico: mujer latina de 32 años que desarrolló parálisis facial derecha después de recibir la primera dosis de la vacuna ARNm BNT162b2 el 7 de abril de 2021; con paresia facial derecha, ausencia de arrugas en la frente, surco labio-bucal y pliegue nasolabial, así como espasmos de los músculos faciales y periorbitarios y dolor latero-cervical. Se descartaron posibles etiologías, se le indicó prednisona, gabapentina y topiramato, con TAC de cráneo simple sin alteraciones, logrando mejoría paulatina hasta la recuperación completa funcional a los 15 días, con evolución benigna, congruente con la evolución natural de la enfermedad, clasificándola como parálisis de Bell idiopática.Conclusiones: aunque no se puede establecer una relación causal, el momento y el modo de aparición de la parálisis sugieren fuertemente la relación con la aplicación de la vacuna BNT162b2. Dada la ecomendación de las autoridades sanitarias de vigilar los casos de parálisis de Bell, y la vigilancia de eventos upuestamente atribuibles a la vacunación (ESAVI), se trata del primer caso reportado en la literatura en población mexicana, por lo que consideramos que debe compartirse con la comunidad científica de manera oportuna.

Background: BNT162b2 (Pfizer-BioNTech) is a nucleosidemodified mRNA vaccine formulated with lipid nanoparticles for the prevention of COVID-19 disease caused by SARSCoV-2 infection. In early December 2020, BNT162b2 received an emergency use authorization, initial efficacy and safety data have been released, consumer / patient information sheets for vaccines distributed in North America do not warn of Bell's palsy as a possible adverse effect. We reported the case of a patient who developed Bell's palsy on the right side in less than 3 hours after the application of the first dose of the Pfizer-BioNTech COVID-19 vaccine. Clinical case: 32-year-old latina woman who developed right facial paralysis after receiving the first dose of the BNT162b2 mRNA vaccine on April 7, 2021; with right facial paresis, absence of forehead wrinkles, lip-buccal sulcus and nasolabial fold; spasms of the facial and periorbital muscles, laterocervical pain; possible etiologies were ruled out, prednisone, gabapentin and topiramate. CT without alterations, achieving gradual improvement; until full functional recovery after 15 days. With benign evolution, congruent with the natural history of the disease, classifying it as idiopathic Bell's palsy.Conclusions: Although a causal relationship cannot be established, the time and mode of appearance of the paralysis suggested a relationship with the application of the BNT162b2 vaccine. Given the recommendation of the health authorities to monitor the cases of Bell's palsy, and the surveillance of events upposedly attributable to vaccination (ESAVI) and as it is the first case reported in the literature, in the mexican population, we believe that this case should be shared with the scientific community in a timely manner.

Belleza mórbida de Landouzy o belleza tísica / Morbid beauty of Landousy or tisic beauty

Con frecuencia los profesionales de la medicina acuden en sus intercambios a imágenes de los textos clásicos, o estas son las que los profesores nos dejaron en algún momento como huellas indelebles, aunque tal vez no hayamos tenido en todas las ocasiones una representación exacta, de las terribles enfermedades que dieron origen a dichas sentencias, por ser ya poco frecuentes en nuestro ámbito.En la jerga médica, como en otras ciencias, se ha hecho costumbre añadir el nombre de los autores que describieron una enfermedad, un signo clínico, una técnica quirúrgica, o un tratamiento. Así se han etiquetado: parálisis de Bell, bacilo de Koch, posición de Fowler o pinza de Kelly(AU)

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)

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.

Bilateral Facial Nerve (Bell's) Palsy in a 24-Year-Old Woman: A Case Report

@#<p><strong>OBJECTIVE:</strong> To report a case of acute bilateral facial nerve palsy in a 24-year-old woman and to present the differential diagnoses, pathophysiology, management and prognosis.</p><p><strong>METHODS:</strong></p><p><strong> Design:</strong> Case study</p><p><strong>Setting:</strong> Tertiary Private Hospital</p><p><strong>Patient:</strong> One (1)</p><p><strong>RESULT:</strong> A 24-year-old woman with fever, joint pains, cough, chest pain, difficulty ambulating and progressive facial muscle weakness was diagnosed with rheumatic fever. Bilateral facial nerve paralysis was noted, and Electromyography-Nerve Conduction Velocity (EMG-NCV) testing with special facial nerve study revealed abnormal facial nerve and blink reflex studies while EMG-NCV of the upper and lower limbs were normal. Audiometry and MRI of the brain and facial nerve were normal while Schirmer's Test showed decreased tearing in both eyes. The rheumatic fever resolved within 5 days of antibiotics, while Prednisone and physiotherapy resulted in improvement of facial paralysis from House Brackmann V to House Brackmann II-III over a period of 6 months.</p><p><strong>CONCLUSION:</strong> Idiopathic facial paralysis or Bell's Palsy is the most common cause of acute unilateral facial paralysis while bilateral facial nerve paralysis is a rare condition. Patients with facial palsy should undergo appropriate diagnostics to determine the underlying condition and to facilitate prompt management.</p>

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.

Clinical observation on time-effect of electroacupuncture for idiopathic facial paralysis / 中国针灸

OBJECTIVE@#To observe the effect of different acupuncture frequency and duration of needle retention on idiopathic facial paralysis, and optimize the acupuncture treatment plan.@*METHODS@#A total of 140 patients were randomized into a group A (37 cases, 3 cases dropped off), a group B (35 cases, 3 cases dropped off), a group C (34 cases, 1 case dropped off) and a group D (34 cases, 1 case dropped off). Under the same basic treatment, acupuncture intervention time (day 8 of morbidity), acupoint selection [Cuanzhu (BL 2), Yangbai (GB 14), Taiyang (EX-HN 5), Yingxiang (LI 20), Jiache (ST 6), Dicang (ST 4) on the affected side, Chengjiang (CV 24) and Hegu (LI 4) on the unaffected side] and electroacupuncture intervention, different acupuncture interval time and duration of needle retention were applied. In the group A, the treatment was given 20 min once a day, while the group B 30 min once a day, the group C 20 min once every 2 days, the group D 30 min once every 2 days. Totally 20-day treatment were required. The House-Brackmann (H-B) facial nerve function grading system was used to evaluate the improvement of clinical symptom, the situation and latency periods of the R1 wave in blink reflex and facial nerve motor conduction before and after treatment were observed in the 4 groups.@*RESULTS@#After treatment, the cured rates in the 4 groups were 44.1% (15/34), 46.9% (15/32), 57.6% (19/33) and 51.5% (17/33), there was no significant difference among 4 groups (>0.05). The situation and latency periods of the R1 wave in blink reflex and latency periods and amplitude of facial nerve motor conduction after treatment were improved in the 4 groups (0.05).@*CONCLUSION@#Acupuncture 20 min once a day, 30 min once a day, 20 min once every 2 days and 30 min once every 2 days have significant effect on the recovery of idiopathic facial paralysis, and the effect is comparable.

Facial Nerve Decompression for Bell's Palsy: An Endless Debate

No abstract available.

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.

Intervenção fisioterapêutica no tratamento de paciente com paralisia facial periférica: estudo de caso / Physiotherapeutic intervention in the treatment of a patient with peripheral facial paralysis: a case study

Buscou-se no trabalho realizar um protocolo de intervenção fisioterapêutica no tratamento de paciente acometida pela Paralisia Facial Periférica (PFP) e verificar seus resultados, relacionando-o com a funcionalidade e influenciando na qualidade de vida, enquanto estudo de caso, realizado no Ambulatório de Neurologia da Faculdade Estácio Sergipe ­ Aracaju-SE. Como método avaliativo, foram utilizadas escalas de House-Brackmann e Visual Analógica para coleta de dados. Os atendimentos duraram oito semanas com seções de 50 minutos cada (total de 16 atendimentos) utilizando-se os seguintes recursos: crioestimulação, massagem excitatória, estimulação elétrica funcional (FES), facilitação neuromuscular proprioceptiva e mímica facial. Como resultados foi observada a redução de grau de disfunção na escala de House-Brackmann e de escore de dor na escala visual analógica (EVA). Houve reestabelecimento da simetria, propagação excitatória nervosa e efetiva contração muscular de face, sendo observados reintegração social e melhora da qualidade de vida da paciente. Contudo, faz-se necessária a produção de novos estudos, com maior aprofundamento e número de pacientes, para fundamentação e afirmação de futuros protocolos de intervenção fisioterapêutica no tratamento da PFP

A protocol for physiotherapeutic intervention in the treatment of a patient with peripheral facial paralysis (PFP) was prepared and its results were verified and related to functionality and influence on life quality. The case study was performed in the Neurology Clinic of the Faculdade Estácio Sergipe, in Aracaju SE Brazil. Protocol was evaluated by House-Brackmann scale and by Visual Analog scale for data retrieval. Attendance lasted eight weeks, with 50-min sessions (total 16 attendances), employing the following resources: cryo-stimulation, excitation massage, functional electrical stimulation, proprioceptive neuromuscular facilitation and facial mimics. Results show a decrease in the dysfunction degree within the House-Brackmann scale and pain score within the visual analog scale. Symmetry was established, propagation of nerve excitation and effective muscular contraction of the face, with social reintegration and improvement in the patient ´s life quality. However, further and more in-depth studies should be undertaken and more patients should be analyzed for the establishment of further protocols in the physiotherapeutic intervention in the treatment of PFP.

Correlation of the electric excitability treated with electroacupuncture at different acupoints and the prognosis of Bell's palsy / 中国针灸

OBJECTIVE@#To explore the correlation of the electric excitability treated with electroacupuncture (EA) at different acupoints and the prognosis of Bell's palsy, using the Logistic regression analysis.@*METHODS@#A total of 93 patients of Bell's palsy were collected in the retrospective analysis. Acupuncture was applied to Cuanzu (BL 2), Yangbai (GB 14), Yingxiang (LI 20), Dicang (ST 4), Xiaguan (ST 7) and Qianzheng (Extra point) on the affected side. The electric stimulation was added at the three pairs of points, named Cuanzu (BL 2) and Yangbai (GB 14) (A group), Yingxiang (LI 20) and Dicang (ST 4) (B group) and Qianzheng (Extra point) and Xiaguan (ST 7) (C group), continue wave, 1 Hz at current frequency, for 30 min in one treatment. EA was given once every two days. The endpoint outcome evaluation was conducted when the facial nerve function was recovered completely after treatment or in 16 weeks after onset. On the 8th day of onset, the prognosis-related indexes were collected, such as the electric excitability grade in the A, B and C groups, gender, age, the facial nerve lesion segment and type 2 diabetes mellitus (T2DM). The Logistic regression analysis was conducted on these indexes and the prognosis.@*RESULTS@#The single factor Logistic regression analysis showed that the gender, age and the electric excitability of the C group were negatively correlated with the prognosis statistically (>0.05). T2DM, the facial nerve lesion segment and the electric excitability of the A and B groups were positively correlated with the prognosis statistically (<0.05). The multivariate Logistic regression analysis indicated that the electric excitability in the A and B groups was the independent predictor of Bell's palsy prognosis (<0.05). values were 8.410 (1.176-60.113) and 12.589 (1.355-116.922) respectively.@*CONCLUSION@#The electric excitability of EA at the pairs of Cuanzu (BL 2) and Yangbai (GB 14), and of Yingxiang (LI 20) and Dicang (ST 4) is one of the indexes for the prognosis evaluation of Bell's palsy. It contributes to the early identification of the severity of facial nerve lesion, the regulation of the therapeutic regimen and the improvement of the clinical effects.

Comparison of conservative therapy and steroid therapy for Bell's palsy in children / 소아과

PURPOSE: Bell's palsy is characterized by sudden onset of unilateral facial weakness. The use of corticosteroids for childhood Bell's palsy is controversial. This study aimed to identify clinical characteristics, etiology, and laboratory findings in childhood Bell's palsy, and to evaluate the efficacy of corticosteroid treatment. METHODS: We conducted a retrospective analysis of children under 19 years of age treated for Bell's palsy between January 2009 and June 2017, and followed up for over 1 month. Clinical characteristics, neuroimaging data, laboratory findings, treatments, and outcomes were reviewed. Patients with Bell's palsy were divided into groups with (group 1) and without (group 2) corticosteroid treatment. Differences in onset age, sex, laterality, infection and vaccination history, degree of facial nerve palsy, and prognosis after treatment between the groups were analyzed. RESULTS: One hundred patients were included. Mean age at presentation was 7.4±5.62 years. A total of 73 patients (73%) received corticosteroids with or without intravenous antiviral agents, and 27 (27%) received only supportive treatment. There was no significant difference in the severity, laboratory findings, or neuroimaging findings between the groups. Significant improvement was observed in 68 (93.2%) and 26 patients (96.3%) in groups 1 and 2, respectively; this rate was not significantly different between the groups (P=0.48). CONCLUSION: Childhood Bell's palsy showed good prognosis with or without corticosteroid treatment; there was no difference in prognosis between treated and untreated groups. Steroid therapy in childhood Bell's palsy may not significantly improve outcomes.

Parálisis facial periférica. Incidencia y etiología / Peripheral facial paralysis. Incidence and etiology / Paralísia facial periferal. Incidência e etiologia

INTRODUCCIÓN: La parálisis facial periférica implica una disfunción del VII par. Predomina la forma idiopática o de Bell. Su tratamiento se basa en el uso de corticoides y en las demás causas depende de la patología de base. El presente estudio describe la incidencia, la etiología y el grado de afectación de la parálisis facial en la población del Hospital de Clínicas José de San Martín. MÉTODO: Revisión de historias clínicas de pacientes que concurrieron a la guardia del Servicio de Otorrinolaringología entre enero de 2013 y septiembre de 2017, y revisión bibliográfica...

INTRODUCTION: Peripheral facial paralysis implies a dysfunction of the seventh pair. The idiopathic or Bell form predominates. Its treatment is based on the use of corticosteroids; and in the other causes depends on the underlying pathology. The present study describes the incidence, etiology and degree of involvement of facial paralysis in the population of the Hospital de Clínicas José de San Martín. METHOD: Review of medical records of patients who attended the otorhinolaryngology service ward between january 2013 and september 2017, and literature review…

INTRODUÇÃO: A paralisia facial periférica implica uma disfunção do sétimo par. Predomina a forma idiopática ou de Bell. O seu tratamento baseia-se no uso de corticosteróides; e nas outras causas depende da patologia subjacente. O presente estudo descreve a incidência, etiologia e grau de envolvimento da paralisia facial na população do Hospital de Clínicas José de San Martín. MÉTODO: Revisão dos registros médicos de pacientes atendidos na sala de atendimento de Otorrinolaringologia entre janeiro de 2013 e setembro de 2017 e revisão da literatura...

Clinical Features and Practices of Bell Palsy of Children and Adolescent in a Single Center / 대한소아신경학회지

PURPOSE: Bell palsy is an idiopathic peripheral facial nerve paralysis of sudden onset. Though the incidence in children is relatively lower than adult population, it is not uncommon. Because of its' relative rarity and good prognosis, there have been few studies about clinical features and courses of Bell palsy in pediatric population. The aim of our study was to report the clinical characteristics and practices of Bell palsy in children and adolescent in a single center. METHODS: We reviewed medical records of 70 patients diagnosed as Bell palsy in Daegu Catholic University Medical Center from September 2006 to June 2017 retrospectively. We included only first episode. RESULTS: Of the 70 patients, 35 was male, 35 was females. Median age was 102 months. There was no seasonal difference. Median duration of palsy was 3 days. The first symptoms were auricular pain (14%), facial palsy (83%), eye pain (1%), and dysguesia (1%). Preceding viral infection was present in 49% of patients. 26% of patients were treated with steroid alone, and 74% of cases were treated with steroid plus acyclovir. Oriental medicine was accompanied in 14% of patients. Among 49 patients who were followed over 4 weeks, 44(90%) had complete recovery. The recovery rates were 68% (4 weeks), 91% (3months), and 100% (10 months). Recurrent rate was 4%. CONCLUSION: The prognosis of Bell palsy in pediatric population was good, and recovery rates were 68% within 4 weeks, and 100% by 10 months after palsy onset.

Hemiplegic Migraine Presenting with Unilateral Facial Palsy: A case report / 대한소아신경학회지

Hemiplegic migraine (HM) is a rare subtype of migraine with aura and is accompanied by a fully reversible motor aura. HM can occur in two forms: familial or sporadic. Currently, three genes are related to familial HM. Typically, HM occurs in the first or second decade of life and involves gradually progressing aura symptoms in succession, accompanied by headaches. The aura includes visual, sensory, motor, aphasic and often basilar-type symptoms. Motor aura (weakness) is related to the regions where the sensory aura is involved, and it usually starts at the hand before spreading to the arm and face. Aphasia is a common form of speech aura, but does not typically present as a difficulty in understanding. In this case report, the sensory-motor aura started at the right face and then gradually progressed to the right leg without any symptoms in the ipsilateral upper extremity. To the best of my knowledge, there has been no previous case report for the presentation of a hemiplegic migraine, as in this case report. As there is a possibility of misdiagnosis of Bell's palsy at the early stage of this case, this case report suggests that a physician should consider the rare possibility of stroke or HM when a patient presents with unilateral facial palsy.

Clinical Characteristics of Dizziness Associated with Acute Peripheral Facial Palsy

BACKGROUND AND OBJECTIVES: We aimed to assess the clinical significance of dizziness associated with acute peripheral facial palsy (APFP). SUBJECTS AND METHODS: Medical records of patients who visited an otorhinolaryngology clinic at a university hospital and were admitted for treatment of APFP between 2014 and 2016 were thoroughly reviewed. RESULTS: In total, 15.3% (n=15) of patients had dizziness. Continuous, rotatory dizziness without exacerbating factors was most common and frequently accompanied by nausea/vomiting. Dizziness disappeared within 1 week during the hospitalization period. Patients with Ramsay Hunt syndrome (31.0%) had dizziness more frequently than those with Bell’s palsy (8.7%). In addition, higher hearing thresholds and pain around the ear was reported more often in dizzy patients (p < 0.05). Logistic regression analysis revealed that the initial House-Brackmann grade of facial paralysis was solely associated with final recovery, but dizziness was not associated with prognosis. CONCLUSIONS: Patients with APFP may have transient dizziness in the early stage, which may be more frequently accompanied by worse hearing thresholds and/or pain around the ear. However, these symptoms including dizziness seem to be unrelated to final prognosis.