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.

Evaluation and Management of Facial Nerve Schwannoma.

Facial nerve schwannomas are benign peripheral nerve sheath tumors that arise from Schwann cells, and most commonly present with facial paresis and/or hearing loss. Computed tomography and MRI are critical to diagnosis. Management decisions are based on tumor size, facial function, and hearing status. Observation is usually the best option in patients with good facial function. For patients with poor facial function, the authors favor surgical resection with facial reanimation. There is growing evidence to support radiation treatment in patients with progressively worsening moderate facial paresis and growing tumors.

Patient- versus physician-reported facial disability in vestibular schwannoma: an international cross-sectional study.

OBJECTIVE Patient-reported outcomes are increasingly used in studies of vestibular schwannoma (VS); however, few studies have examined self-evaluated facial nerve function and its relation to physician-reported outcomes. The primary objective of this study was to compare patient self-evaluations of facial disability with physician-evaluated facial nerve status and with self-evaluations of a healthy control group. The second objective was to provide insight into the controversial subject of the optimal initial management of small- and medium-sized VSs; consequently, the authors compared patient-reported facial nerve disability following treatment via observation (OBS), Gamma Knife surgery (GKS), or microsurgery (MS). Lastly, the authors sought to identify risk factors for facial nerve dysfunction following treatment for small- and medium-sized VSs. METHODS All patients with a VS 3 cm or smaller that was singly treated with OBS, GKS, or MS at either of 2 independent treatment centers between 1998 and 2008 were retrospectively identified. Longitudinal facial nerve measures and clinical data, including facial nerve evaluation according to the House-Brackmann (HB) grading system, were extracted from existing VS databases. Supplementing the objective data were Facial Disability Index (FDI) scores, which were obtained via survey of patients a mean of 7.7 years after initial treatment. RESULTS The response rate among the 682 eligible patients was 79%; thus, data from a total of 539 patients were analyzed. One hundred forty-eight patients had been managed by OBS, 247 with GKS, and 144 with MS. Patients who underwent microsurgery had larger tumors and were younger than those who underwent OBS or GKS. Overall, facial nerve outcomes were satisfactory following treatment, with more than 90% of patients having HB Grade I function at the last clinical follow-up. Treatment was the major risk factor for facial nerve dysfunction. Almost one-fifth of the patients treated with MS had an objective decline in facial nerve function, whereas only 2% in the GKS group and 0% in the OBS cohort had a decline. The physical subscale of the FDI in the VS patients was highly associated with HB grade; however, the social/well-being subscale of the FDI was not. Thus, any social disability caused by facial palsy was not detectable by use of this questionnaire. CONCLUSIONS The majority of patients with small- and medium-sized VSs attain excellent long-term facial nerve function and low facial nerve disability regardless of treatment modality. Tumor size and microsurgical treatment are risk factors for facial nerve dysfunction and self-reported disability. The FDI questionnaire is sensitive to the physical but not the social impairment associated with facial dysfunction.

Radiofrecuencia vs Corriente Farádica en la rehabilitación funcional de pacientes con parálisis facial periférica / Radiofrequency vs muscular Faradization to functional rehabilitation of peripheral facial paralysis patients

Introducción: La radiofrecuencia es una técnica nueva, que ha teniendo grandes resultados en la rehabilitación funcional de otras patologías neurológicas. Objetivo: Comparar la eficacia de la radiofrecuencia y la corriente farádica, en el manejo fisioterapéutico de la parálisis facial aguda periférica. Materiales y métodos: Se realizó un estudio ensayo clínico aleatorizado de verificación de equivalencia terapéutica entre la Radiofrecuencia versus la Corriente Farádica, en la rehabilitación funcional de la parálisis facial periférica; con una muestra compuesta por 60 personas entre 20 y 40 años de ambos sexos; divididos aleatoriamente en 2 grupos homogéneos, de 30 pacientes por grupo; utilizándose la Radiofrecuencia (dosificación G2 y G3) en uno de ellos y las Corrientes farádicas (intensidad de tolerancia del paciente de 5 a 35 HZ) en el otro. Resultados: El 94% de los signos propios de la parálisis facial desaparecieron con la radiofrecuencia, y solo el 66% con corrientes farádicas. En todos los casos las diferencias estadísticas fueron significativas con un valor de p=<0001, evaluados mediante la prueba deT de Student. Conclusiones: La técnica de radiofrecuencia es de mayor eficacia en relación con las corrientes farádicas aplicada en pacientes con parálisis facial periférica.

Introduction: Radiofrequency is a new technique, which has had great results in the functional rehabilitation of other neurological pathologies. Objective: To compare of radiofrequency and muscular faradization efficacy; in the physiotherapeutic functional rehabilitation for acute peripheral facial paralysis. Materials and methods: We conducted a randomized clinical trial of therapeutic equivalence verification, between Radiofrequency versus muscular faradization, in the functional rehabilitation of peripheral facial paralysis; With a sample composed of 60 people, between 20 and 40 years of both sexes; Divided randomly into 2 homogeneous groups of 30 patients per group; Using Radiofrequency (G2 and G3 dosing) in one, and muscular faradization (patient tolerance intensity of 5 to 35 HZ) in the other. Results: 94% of signs to facial paralysis disappeared with radiofrequency, and only 66% with muscular faradization. In all cases the statistical differences were significant with a p-value= <0001, evaluated by t-Student test. Conclusions: Radiofrequency technique is more effective in relation to muscular faradization applied in patients with peripheral facial paralysis.