Comparing the effectiveness of mime therapy and neuromuscular re-education in improving facial symmetry and function in acute Bell's palsy: a pilot randomised clinical trial

Background/aims Untreated Bell's palsy may lead to disability and reduced quality of life, while early intervention can improve prognosis. This pilot randomised clinical trial aims to compare the effectiveness of mime therapy and neuromuscular re-education in improving facial symmetry and function in patients with acute Bell's palsy. Methods A total of 20 patients diagnosed with Bell's palsy were included in this study after meeting the inclusion criteria. Patients were randomly divided into two groups of ten. Group A received mime therapy while group B received neuromuscular re-education. Each participant received 12 sessions of the respective treatment over 2 weeks and was assessed for facial symmetry and function using the Sunnybrook Facial Grading System and the Facial Clinimetric Evaluation Scale respectively. Results Although both mime therapy and neuromuscular re-education showed highly significant improvements within each group for both the Sunnybrook Facial Grading System (P=0.005) and Facial Clinimetric Evaluation Scale (P=0.005); they showed no difference between each group for the Sunnybrook Facial Grading System (P=0.212) and Facial Clinimetric Evaluation Scale (P=0.97). Conclusions Mime therapy and neuromuscular re-education are equally effective in the recovery of facial symmetry and function in acute Bell's palsy. Physiotherapists can choose between either technique based on their skills and preference or based on patient comfort and expectation.

Reconstruction of Complex Parotidectomy Defects Using the Lateral Arm Free Tissue Transfer

OBJECTIVES: The study goal was to show that the lateral arm flap is a viable reconstructive option for complex parotidectomy defects. STUDY DESIGN AND SETTING: We studied a case series at a tertiary care medical center from March 1997 to March 2002. The lateral arm flap was used to reconstruct parotidectomy defects that included a composite resection of adjacent tissue in 30 patients. There were 19 men and 11 women (mean age, 62 years; mean follow-up, 19 months). The mean flap area was 114 cm2, and the mean flap volume was 172 cm3. The posterior cutaneous nerve of the forearm (PCNF) was used as a facial nerve cable graft in 14 patients. Facial disability outcomes were measured using the Facial Clinimetric Evaluation scale. RESULTS: The major and minor complication rates with use of this reconstructive approach were low: 16.7% (5 of 30) and 26.7% (8 of 30), respectively. Donor site morbidity was minimal, with no patient having a major donor site complication and 23.3% (7 of 30) having minor complications. Functional recovery of the facial nerve occurred in 6 of 8 evaluable patients who underwent facial nerve grafting using the PCNF. Controlling for degree of facial nerve paralysis, Facial Clinimetric Evaluation scale scores of our patients were not statistically different than those of a historic population with a facial paralysis and no surgical defect. CONCLUSIONS: The lateral arm free flap effectively restores facial appearance when used for reconstruction of complex parotidectomy defects. The PCNF, a nerve harvested with the lateral arm flap, can be used as a facial nerve cable graft with a high rate of success. SIGNIFICANCE: The lateral arm flap is successful as a single donor site for reconstructing facial contour and the facial nerve after major ablative defects in the parotid region.