Current opinion on laryngeal electromyography.

PURPOSE: This study evaluates expert opinion on laryngeal electromyography (LEMG). METHODS: A cross-sectional design was used to conduct an online survey of LEMG experts in 2021. They were questioned about the number LEMG performed annually, type of electrodes used, sector worked in, pain during the test, placement of the needle electrodes, interpretation of electrical muscle parameters, diagnosis of neuromuscular injury, prognostic sensitivity in vocal fold paralysis (VFP), laryngeal dystonia, tremor and synkinesis and quantifying LEMG. RESULTS: Thirty-seven professionals answered (23 Spanish and 14 from other countries), with a response rate of 21.56%. All physicians used LEMG. 91.9% had one- or two-years' experience and 56.8% performed 10-40 LEMG per year. 70.3% were otolaryngologists and 27%, neurologists. In 89.1% of cases, a team of electrodiagnostic physician and otolaryngologist performed LEMG. 91.3% of Spanish respondents worked in Public Health, 7.14% of other nationalities; 37.8% in a university department. Bipolar concentric needles electrodes were used by 45.9% and monopolar concentric by 40.5%. 57% professionals considered good patients' tolerance to the test. LEMG sensitivity was regarded as strong, median and interquartile range were 80.0 [60.0;90.0] to diagnose peripheral nerve injuries, less for other levels of lesions, and strong to evaluate prognosis, 70.0 [50.0;80.0]. Respondents believe locate the thyroarytenoid and the cricothyroid muscles with the needle, 80.0 [70.0;90.0], as opposed to 20.0 [0.00;60.0] the posterior cricoarytenoid. The interpretation of the electrical parts of the LEMG was strong, 80.0 [60.0;90.0]. LEMG identify movements disorders, 60.0 [20.0;80.0], and synkinesis, 70.0 [30.0;80.0]. The professionals prefer quantitative LEMG, 90.0 [60.0;90.0]. CONCLUSIONS: The experts surveyed consider LEMG that is well tolerated by patients. The insertional and spontaneous activity, recruitment and waveform morphology can be assessed easily. LEMG is mainly useful in the study of peripheral nerve injuries, and its value in VFP prognosis is considered strong.

Efecto de la toxina botulínica tipo A en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica / Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae

Objetivo: Valorar el efecto del tratamiento con infiltraciones de toxina botulínica tipo A (TXB-A) en la funcionalidad facial, las sincinesias y la calidad de vida en pacientes con secuelas de parálisis facial periférica (PFP). Material y métodos: Presentamos un estudio prospectivo con una muestra de 20 pacientes con secuelas de PFP (15 mujeres, 5 varones) a los que se infiltró TXB-A (Botox® o Xeomin®). Todos los pacientes realizaron previamente un tratamiento personalizado basado en la reeducación neuromuscular. Se realizó una evaluación clínica previa a las infiltraciones y otra al cabo de 4 semanas. El efecto de las infiltraciones sobre la funcionalidad facial fue valorado mediante la escala Sunnybrook Facial Grading System (SFGS); el efecto sobre la calidad de vida se evaluó a través del cuestionario Facial Clinimetric Evaluation Scale (FaCE), y el efecto sobre la reducción de sincinesias se estudió utilizando el Synkinesis Assessment Questionnaire (SAQ). Resultados: La media de los valores del SFGS se incrementó tras el tratamiento con TXB-A, de 64,8 a 69,9 (p = 0,004). También se incrementó la media de los valores del FaCE Total, de 52,42 a 64,5 (p < 0,001), y la media de la subescala Social del FaCE, de 61,15 a 78,44 (p < 0,001). La media de los valores del SAQ disminuyó con las infiltraciones de TXB-A, de 46,22 a 37,55 (p = 0,001). Conclusiones: Las infiltraciones de TXB-A incrementan la funcionalidad facial, mejoran la calidad de vida y reducen las sincinesias en pacientes con secuelas de PFP.(AU)

Objectives: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). Material and methods: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. Results: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P = .004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P < .001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P < .001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P = .001). Conclusions: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.(AU)

Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae.

OBJECTIVES: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox© or Xeomin©) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.

Varied presentations of congenital ocular synkinesis: do they all fit congenital cranial dysinnervation disorder spectrum? / Apresentações variadas de sincinesias oculares congênitas: todas elas se enquadram ao espectro das desordens congênitas da desnervação craniana?

ABSTRACT Purpose: Synkinesis results from nerve miswirings and causes aberrant movements of the affected muscles. We present a series of cases of rare congenital ocular synkinesis involving the extraocular muscles and the levator palpebrae superioris and speculate the possibility of classifying these entities in the spectrum of congenital cranial dysinnervation disorder. Methods: Records of patients with the diagnosis of congenital ocular synkinesis were analyzed retrospectively. We analyzed the sex, laterality, and complete features of the ocular motility of each patient. Results: Nine patients with congenital ocular synkinesis were included. A slight predominance of women was noted. In terms of laterality, four patients had only the right eye involved, four had only the left eye, and one had both eyes involved. Notably, 55.5% were orthotropic in the primary position. The third, fourth, and sixth cranial nerves were involved in the miswiring in 100%, 44.4%, and 11.1% of the cases, respectively. Conclusions: Congenital synkinesis might present in a very eclectic and uncommon fashion. The aberrant innervation in these cases classifies them into the group of congenital cranial dysinnervation disorders.

RESUMO Objetivo: Sincinesias são resultado de inervações anômalas e ocasionam movimentos aberrantes dos músculos envolvidos. Apresentamos uma série com casos raros de sincinesias oculares congênitas dos músculos extraoculares e do levantador da pálpebra superior e especulamos a possibilidade de classificá-las dentro do espectro das desordens congênitas da desnervação cranianana. Métodos: Prontuários de pacientes com diagnóstico de sincinesia ocular congênita foram estudados retrospectivamente. Analisamos sexo, lateralidade e as características completas do exame de motilidade de cada paciente. Resultados: Nove pacientes com sincinesias oculares congênitas foram incluídos. Houve discreta predominância no sexo feminino. Em termos de lateralidade, o olho direito foi o único envolvido em 4 casos, o olho esquerdo também em 4 casos e 1 caso apresentou acometimento bilateral. 55,5% dos pacientes eram ortotrópicos na posição primária. Os III, VI e IV nervos participaram da sincinesia em 100%, 44,4% e 11,1% dos casos, respectivamente. Conclusões: Sincinesias oculares congênitas podem se apresentar de modo bastante eclético e incomum. A inervação aberrante presente em cada um desses casos os coloca na lista de candidatos a integrar o grupo das desordens congênitas da desenervação craniana.

Effect of botulinum toxin typeA in functionality, synkinesis and quality of life in peripheral facial palsy sequelae. / Efecto de la toxina botulínica tipoA en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica.

OBJECTIVES: This study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). MATERIAL AND METHODS: We present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox® or Xeomin®) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. RESULTS: Mean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). CONCLUSIONS: BTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.

Síndrome de Marcus-Gunn / Marcus Gunn syndrome

Introducción: El síndrome de Marcus-Gunn se manifiesta con retracción o elevación del párpado ptótico ante la estimulación del músculo pterigoideo del mismo lado y el término "guiño mandibular" es inapropiado ya que el párpado no siempre desciende. Puede producirse en la apertura bucal, masticación, avance mandibular, al sonreír, silbar, bruxar, sacar la lengua, deglutir, chupar, cantar, en la contracción esternocleidomastoidea, maniobra de Valsalva, respirar o inhalar. Es congénito y de modalidad rara y autosómica dominante. Objetivo: Contribuir al conocimiento de esta rara enfermedad y a su relación con el ámbito odontológico. Presentación del caso: Se trata de un niño de 3 años diagnosticado de síndrome de Marcus-Gunn en el periodo neonatal, por la observación de la madre de una apertura palpebral izquierda durante la succión nutritiva. No presenta otras enfermedades ni antecedentes de interés. En la exploración extraoral se advierte una ptosis palpebral derecha y apertura palpebral izquierda en los movimientos mandibulares y deglución. La intensidad del reflejo se incrementa en estados de ansiedad derivados del tratamiento dental. Conclusiones: el síndrome de Marcus-Gunn es una entidad rara en pediatría, en la cual sus hallazgos clínicos determinan el diagnóstico. Teniendo en cuenta que en ocasiones presentan alteraciones oculares, nada nos hace sospechar la presencia de una enfermedad oral específica(AU)

Introduction: Marcus Gunn syndrome manifests with retraction or elevation of the eyelid ptotico while stimulation of the pterygoid muscle on the same side and the term jaw-winking is inappropriate because the eyelid does not always goes down. It can occur during mouth opening, mastication, mandibular advancement, while smiling, whistling, bruxing, sticking out the tongue, swallowing, sucking, singing, during the sternocleidomastoid contraction, the Valsalva maneuver, breathing or inhaling. This syndrome is congenital and rare, and of autosomal dominant modality. Objective: To contribute to the knowledge of this rare disease and its relationship with the odontologic field. Presentation of the case: 3 years old boy diagnosed with Marcus Gunn syndrome in the neonatal period by the observation of the mother of a left palpebral opening during the nutritive sucking. He does not present other diseases or a background of interest. In the extraoral exploration, it is noticed a right palpebral ptosis and a left palpebral opening in the jaw movements and in swallowing. The intensity of the reflex increases in anxiety states arising from the dental treatment. Conclusions: Marcus Gunn syndrome is a rare entity in pediatrics, in which its clinical findings determine the diagnosis. Taking into account that sometimes it presents ocular alterations, nothing makes us suspect the presence of a specific oral disease(AU)

Trochlear-oculomotor synkinesis: another congenital cranial dysinnervation disorder? / Sincinesia troclear-oculomotora: outro distúrbio congênito de denervação craniana?

ABSTRACT This report documents an unusual phenomenon. A 6-year-old girl with trochlear-oculomotor synkinesis presented with superior oblique and palpebral levator co-contraction. The literature was reviewed and the possibility of classifying this entity as a congenital cranial dysinnervation disorder was speculated.

RESUMO Este relato descreve um fenômeno incomum. Uma menina de 6 anos com sincinesia troclear-oculomotora apresentou co-contração do oblíquo superior e do levantador da pálpebra. A literatura foi revisada e especulou-se a possibilidade de classificar essa desordem como um distúrbio da congenital cranial dysinnervation disorder.

Grau de percepção e incômodo quanto à condição facial em indivíduos com paralisia facial periférica na fase de seqüelas / Degree of perception and discomfort regarding facial condition in subjects with peripheral facial paralysis in sequelae stage

OBJETIVO: Correlacionar a auto-avaliação da condição facial do paciente, o grau de incômodo quanto às seqüelas e de prejuízo em atitudes diárias com os dados encontrados na avaliação fonoaudiológica. MÉTODOS: Participaram da pesquisa 29 indivíduos, de ambos os sexos, média de idade de 46 anos, com média de 5,9 sessões de fonoterapia. Realizou-se avaliação fonoaudiológica da simetria e da movimentação da face e verificou-se a presença de sincinesias e contraturas por meio de instrumento publicado e padronizado. Além disso, realizou-se uma entrevista por meio de perguntas fechadas que permitiram a graduação da opinião do paciente quanto à sua própria face e influência desse problema em suas atividades sociais e profissionais. RESULTADOS: Encontrou-se concordância quanto à auto-avaliação do paciente e a avaliação fonoaudiológica (p=0,0029), porém essa correlação não esteve presente em pacientes com menos de três sessões de fonoterapia. Não houve correlação significante entre o grau de sincinesia/contratura e o grau de incômodo referido pelo paciente, assim como o prejuízo em atividades sociais e profissionais não foi associado ao grau de paralisia, sincinesia, ou contratura. No entanto, houve correlação fraca com tendência à significação (r=-0,3250/p=0,085) quando comparou-se a auto-avaliação do paciente com o grau de prejuízo referido. CONCLUSÕES: A autopercepção da condição facial nem sempre é concordante entre o profissional e o paciente, sendo que essa concordância aumenta em pacientes com maior tempo de terapia. Por outro lado, o impacto da condição facial na vida do paciente parece não depender do grau das seqüelas.

PURPOSE: To correlate the self-evaluation of patients with facial paralysis regarding their facial condition, the level of sequelae discomfort and the negative consequences in daily activities, with the results found in clinical assessment. METHODS: Twenty-nine subjects of both genders, with average age of 46 years and an average of 5.9 therapy sessions participated in this study. A clinical evaluation of facial symmetry and movement was carried out, verifying the presence of synkinesis and contractures using a facial grading system proposed by a standardized and published instrument. Moreover, an interview with closed questions was carried out, in order to measure the patient's opinion regarding how his own face influences his professional and social activities. RESULTS: There was an accordance regarding the patient's self evaluation and the clinical assessment (p=0,0029), but this correlation was not found in patients with less than three sessions of the speech therapy. No significant correlation was found between the degree of synkinesis/contracture and the level of discomfort reported by the patient. Furthermore, the negative consequences in professional and social activities were not associated to the degree of facial paralysis, synkinesis or contracture. However, there was a weak correlation tending to significance (r=-0,3250/p=0,085) when the self evaluation was compared to the reported negative consequences. CONCLUSIONS: The patient's self perception of the facial condition is not always in agreement with the professional's assessment, although this agreement increases in patients with longer intervention periods. On the other hand, the impact of the facial condition in the patient's life does not depend on the degree of sequelae.