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OBJECTIVE: To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS: Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.
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Paralisia Facial , Humanos , Paralisia Facial/fisiopatologia , Paralisia Facial/etiologia , Paralisia Facial/terapia , Brasil , Criança , Sociedades Médicas , Adulto , Comitês Consultivos , Medicina Baseada em EvidênciasRESUMO
Abstract Objective To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. Methods Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. Conclusions Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.
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Lyme disease (LD) is a highly prevalent infection in the northern hemisphere, with an estimated incidence of 450,000 new annual cases in the United States and 65,000 new annual cases in Europe. Transmitted by the bite of a tick contaminated with a spirochete, the disease has three distinct stages. In the second phase of the disease, there may be neurological impairment, and the involvement of cranial nerve pairs occurs in this phase. Neuropathy of the seventh cranial nerve can occur in around 10% of adults with neurological involvement by Borrelia; in children, this incidence can reach 50%. A 32-year-old female patient presented with an abrupt facial paralysis that evolved into a difficult-to-resolve condition. With the appearance of probable contralateral involvement, LD was diagnosed. After the established treatment, the patient presented a good evolution of the symptoms.
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Peripheral facial palsy (PFP) is an inflammation of the facial nerve, which paralyses the face unilaterally or bilaterally, causing pain and discomfort to the patient. PFP affects the lives of compromised individuals not only due to the loss of essential facial functions (smiling, blinking, talking) but also their emotional state. When the face is paralysed, the lost ability to animate the face can be devastating and is often associated with depression, social isolation, and reduced quality of life. Bilateral involvement is extremely rare and as it occurs in unilateral cases, a thorough clinical and laboratory evaluation must be carried out to determine the etiology of the disease, which can be idiopathic, infectious, neoplastic, traumatic, or iatrogenic. In addition to these, in times of the pandemic, coronavirus disease 2019 (COVID-19) and the vaccine against it should be considered as possible causal factors. Drug therapy and physiotherapy are indicated to recover facial movements. The aim of the present study was to report a case of bilateral peripheral facial palsy due to herpes simplex virus reactivation in a 20-year-old female patient.
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Laser acupuncture can be used to treat neurosensory alterations and motor disorders caused by dental treatments. This study aimed to review the existing literature on the effects of laser acupuncture on neuropathies in the context of dentistry and to search for treatment modalities in which this technique is used. This systematic review was conducted in accordance with the Cochrane Collaboration guidelines and the PICOS strategy. Randomized clinical trials that evaluated laser acupuncture as a primary intervention for facial neuropathy were included. We searched the database for relevant studies and manually searched the gray literature until April 2022, and finally included four studies. The study was considered eligible if it included patients with paresthesia, facial paralysis, or neuralgia, neuropathies within dentistry, and referred to the application of laser acupuncture as a treatment method. The risk of bias was assessed using the RoB 2 tool. It was observed that the recommended wavelengths ranged from 790 nm to 810 nm, with a frequency of at least two applications per week, and to a greater or lesser degree, all evaluated studies obtained an improvement in sensory or motor recovery of the facial nerves. The use of laser acupuncture presented itself as a viable alternative in dentistry for the treatment of paresthesia and facial paralysis due to its therapeutic potential in neuropathic treatment (CRD42022344339).
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Terapia por Acupuntura , Paralisia de Bell , Paralisia Facial , Humanos , Parestesia , Terapia por Acupuntura/métodos , Odontologia , LasersRESUMO
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, nâ¯=â¯33) and non-diabetic BP patients without any chronic disease (nonDM-BP, nâ¯=â¯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⯱â¯1.85 in BP patients and 1.69⯱â¯0.65 in the control group. The mean NLR was significantly higher in BP patients than healthy controls (pâ¯<â¯0.001). The mean NLR was 2.58⯱â¯1.83 in the nonDM-BP group, 3.23⯱â¯1.83 in the DM-BP group, and 1.69⯱â¯0.65 in the control group. The NLR was significantly higher in the nonDM-BP and DM-BP groups than in the control group (pâ¯<â¯0.05). The recovery was 90% according to the HBS. The optimal cut-off value was 2.41 (pâ¯=â¯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.
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Paralisia de Bell , Diabetes Mellitus , Paralisia Facial , Humanos , Neutrófilos , Prognóstico , Paralisia de Bell/diagnóstico , Volume Plaquetário Médio , LinfócitosRESUMO
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.
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Many complications can occur after the injection of local intraoral anesthetics (ILIA) before dental intervention. Facial paralysis (FP) is one of these complications. The purpose of this study was to systematically analyze the association between ILIA and FP. A systematic review was carried out taking into account the methodology of the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA statement. The search strategy used "Palsy AND Facial" and "Paralysis AND Facial" as search terms. The ScienceDirect, PubMed and Scopus databases were searched using the "dentistry journal" filter. The inclusion criteria included studies describing FP after or during ILIA that were published in dental journals. The CAse REports (CARE) checklist was applied in evaluating the methodological quality of case reports. A total of 2,462 articles (algorithm) were identified. After reviewing titles and abstracts, 18 articles were deemed relevant taking into account the objectives of this study. Only 13 of them, after reading the full text, met the inclusion criteria and were analyzed. Case reports on 18 cases of FP were analyzed, 12 of which described the early development of FP (onset within 24 h) and 6 the late development (onset after 24 h). Acceptable compliance with CARE guidelines was observed in the included studies . Early FP CRs presented the effect of the administered anesthetic on the facial nerve, and the vascular effect of the vasoconstrictor included in the anesthetic formula, while more recent FP CRs focused on the reactivation of herpes simplex virus type 1 (HSV-1), human herpesvirus 6 (HHV-6) or varicella-zoster virus (VZV).
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Anestésicos , Paralisia Facial , Herpesvirus Humano 1 , Humanos , Paralisia Facial/induzido quimicamente , Herpesvirus Humano 3/fisiologia , FaceRESUMO
OBJECTIVE: Herpes zoster virus can cause inflammatory neuropathy of the facial nerve. However, studies evaluating the prevalence of this agent in peripheral facial palsy are heterogeneous regarding sample group selection, laboratory analysis method and variables studied. In addition, there are a lack of epidemiological data in the Brazilian population on this serological phenomenon in peripheral facial palsy. This study estimated herpes zoster reactivation prevalence in serological samples through chemiluminescence immunoassay for quantitative determination of specific antibodies directed against the virus. METHODS: This cross-sectional study sought to determine the prevalence of viral reactivation by herpes zoster in subjects with idiopathic peripheral facial palsy through analysis of serological samples over a year. RESULTS: Forty-seven patients (32 females and 15 males) participated. Severe paralysis was more common in older patients (p = 0.017). Facial pain (p = 0.02) and vertigo (p = 0.001) were related to a worse evolution of facial palsy. The rate of serological reactivation of the virus was 12.76 per cent. CONCLUSION: The rate of serological reactivation of herpes virus in idiopathic peripheral facial palsy in our population is similar to foreign literature data, suggesting similar aetiological mechanisms in the genesis of this morbidity.
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Paralisia de Bell , Paralisia Facial , Herpes Zoster , Idoso , Anticorpos Antivirais , Paralisia de Bell/epidemiologia , Estudos Transversais , Paralisia Facial/epidemiologia , Feminino , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Herpes Zoster/epidemiologia , Herpesvirus Humano 3/fisiologia , Humanos , Masculino , PrevalênciaRESUMO
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.
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Humanos , Masculino , Feminino , Gravidez , Recém-NascidoRESUMO
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.
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Humanos , Terapia Miofuncional/métodos , Paralisia de Bell/reabilitação , Paralisia Facial/reabilitação , FonoaudiologiaRESUMO
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.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Terapia com Luz de Baixa Intensidade , Paralisia Facial/radioterapiaRESUMO
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)
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Humanos , Paralisia de Bell/terapia , Paralisia de Bell/epidemiologia , Acupuntura/métodos , Estudos Retrospectivos , Estudo ObservacionalRESUMO
COVID-19 pandemic revealed several neurological syndromes related to this infection. We describe the clinical, laboratory, and radiological features of eight patients with COVID-19 who developed peripheral facial palsy during infection. In three patients, facial palsy was the first symptom. Nerve damage resulted in mild dysfunction in five patients and moderate in three. SARS-Cov-2 was not detected in CSF by PCR in any of the samples. Seven out of eight patients were treated with steroids and all patients have complete or partial recovery of the symptoms. Peripheral facial palsy should be added to the spectrum of neurological manifestations associated with COVID-19.
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COVID-19/complicações , Paralisia Facial/virologia , Adulto , Anti-Inflamatórios/uso terapêutico , Nervo Facial/patologia , Paralisia Facial/tratamento farmacológico , Feminino , Humanos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Prednisona/uso terapêutico , SARS-CoV-2RESUMO
Bell's Palsy is the most frequent acute neuropathy of cranial nerves; it has been associated in various reports to herpes viruses. In a prospective study we searched the presence of DNA from five herpes viruses (HSV-1 and 2, VZV, EBV and HHV-6) in 79 patients at the acute phase of Bell's Palsy. Results were related with various parameters; age, gender and clinical outcome. We found the significant presence (pË0.001) of HSV-1 and VZV in 39% and 42% of patients. However, a large percentage of cases were negative. When comparisons were made between subgroups according to gender and age no differences were found with viral findings nor with clinical outcome of palsy, which was of clinical remission in most cases (78%). Our results suggest that herpes viruses might participate in the complex mechanisms of autoimmunity of Bell's Palsy but not as determinant etiological element.
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Corticosteroides/uso terapêutico , Antivirais/uso terapêutico , Paralisia de Bell/tratamento farmacológico , Herpesvirus Humano 1/genética , Herpesvirus Humano 3/genética , Aciclovir/uso terapêutico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Autoimunidade , Paralisia de Bell/imunologia , Paralisia de Bell/patologia , Paralisia de Bell/virologia , Estudos de Casos e Controles , DNA Viral/sangue , DNA Viral/genética , Nervo Facial/efeitos dos fármacos , Nervo Facial/imunologia , Nervo Facial/patologia , Nervo Facial/virologia , Feminino , Herpesvirus Humano 1/patogenicidade , Herpesvirus Humano 2/genética , Herpesvirus Humano 3/patogenicidade , Herpesvirus Humano 4/genética , Herpesvirus Humano 6/genética , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Indução de Remissão , Fatores Sexuais , Resultado do TratamentoRESUMO
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.
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Introduction The masseter nerve has been used as a donor nerve for facial reanimation procedures due to the multiple advantages it offers; it has been generally considered that sacrifice of the masseter nerve does not alter the masticatory apparatus; however, there are no objective studies to support this claim. Objective To evaluate the impact that the use of the masseter nerve in dynamic facial reconstruction has on the electrical activity of the masseter muscle and on bite force. Materials and Methods An observational and prospective longitudinal study was performed measuring bite force and electrical activity of the masseter muscles before and 3 months after dynamic facial reconstructive surgery using the masseter nerve. An occlusal analyzer and surface electromyography were employed for measurements. Results The study included 15 patients with unilateral facial paralysis, with a mean age of 24.06 ± 23.43. Seven patients were subjected to a masseter-buccal branch nerve transfer, whereas in eight patients, the masseter nerve was used as a donor nerve for gracilis free functional muscle transfer. Electrical activity of the masseter muscle was significantly reduced after surgery in both occlusal positions: from 140.86 ± 65.94 to 109.68 ± 68.04 ( p = 0.01) in maximum intercuspation and from 123.68 ± 75.64 to 82.64 ± 66.56 ( p = 0.01) in the rest position. However, bite force did not show any reduction, changing from 22.07 ± 15.66 to 15.56 ± 7.91 ( p = 0.1) after the procedure. Conclusion Masseter nerve transfer causes a reduction in electromyographic signals of the masseter muscle; however, bite force is preserved and comparable to preoperative status.
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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.
Assuntos
Paralisia de Bell , Terapia a Laser , Fonoaudiologia , Terapêutica , Paralisia Facial , LasersRESUMO
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.