Mirror Book Therapy for the treatment of Idiopathic Facial Palsy

Objective: To determine the utility of treating facial palsy with mirror book therapy in conjunction with facial physical rehabilitation. Methods: We randomly selected and reviewed the charts of 25 patients with idiopathic facial palsy. 10 of these patients received facial physical rehabilitation including manual therapy and postural exercises. 15 of these patients received mirror book therapy in conjunction with standard facial rehabilitation. Before and after treatment, patients in both groups were rated using the Facial Grading System (FGS) score, the Facial Disability Index--Physical (FDIP) score, and the Facial Disability Index--Social (FDIS) score. Differences in response to therapy were analyzed. Results: Patients in the facial physical rehabilitation group without mirror book therapy group showed on average a 20.8% increase in the FGS score, a 19% increase in the FDIP score, and a 14.6% increase in the FDIS score. Patients in the mirror book therapy group showed an average of 24.9% increase in the Facial Grading System (FGS) score, a 21.6% increase in the Facial Disability Index--Physical (FDIP) score, and a 24.5% increase in the Facial Disability Index--Social (FDIS) score. Conclusion: The addition of mirror book therapy to standard facial rehabilitation treatments does significantly improve outcomes in the treatment of idiopathic facial palsy.

Predictive Value of VIBE using Subtraction to Evaluate Idiopathic Facial Palsy after Starting Therapy

Purpose To determine the predictive value of 3-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction to evaluate the short-term effect of therapy for facial palsy. Materials and Methods We included 97 patients with idiopathic facial palsy (52 male, 45 female; aged 50.7 ± 19.4 years) who underwent MR imaging with a contrast agent after starting therapy. The mean interval between onset and therapy was 1.55 ± 1.69 days, between therapy and MR imaging was 3.19 ± 2.78 days, and between MR imaging and assessment of the therapeutic effect was 3.50 ± 0.71 days. The degree of therapeutic effect was determined using a 4-grade scale based on the House–Brackmann scale for grading facial nerve function. Two radiologists reviewed VIBE with pre- and postcontrast subtraction using the 4-point scale. We evaluated the diagnostic performance and compared the degree of therapeutic effect and enhancement of facial nerves that were divided into 5 segments bilaterally. Results We identified 98 facial palsy initially and significant enhancement in 55 facial nerves after the start of therapy and residual palsy in 87. Sensitivity for all facial palsy was 62.0 %, specificity was 90.9 %, positive predictive value was 98.2 %, negative predictive value was 23.3 %, and accuracy was 65.3 %. Eleven patients recovered completely, 1 showed significant enhancement, and the remaining 10 did not show significant enhancement of the facial nerve. Conclusion VIBE has a potential to predict the prognostic outcome and assess facial palsy after the start of therapy. Key points: Citation Format

Clinical Analysis of 757 Cases of Facioplegia

Objective: To explore the etiology, age, diagnosis, treatment and prognosis of facioplegia. Methods: A retrospective etiology and epidemiological survey of 757 patients with facioplegiaadmitted to the People's Hospital of Shaanxi Province from January 2015 to October 2017 was conducted to analyze their clinical features. Results: The primary incidence was the highest, accounting for 40% of the total incidencerate, the highest incidence of 19-60 years old, accounting for 48% of the total morbidity,the highest incidence of retirees, accounting for 43% of the total incidence rate,11% of patients cured at discharge, 83% improved. Conclusion: The etiology of facial paralysis is complicated, the incidence rate of adults is higher than that of children. The incidence rate of 41-60 years old is the highest, and the hospitalization days are mostly 8-14 days. For patients with facioplegia, early diagnosis, timely and reasonable treatment, most of the prognosis is good.Facioplegia, also known as facial paralysis, is mainly characterized by facial expression muscle group dyskinesia,clinical manifestations include oblique mouth and eye, mouth angle drooping of the affected side after shutting up, closing eyes, raising eyebrows, bulging gills, baring teeth cannot be completed, is a common clinical disease can occur all year round and in any age group. It is most common in adults and more male than female. Its etiology is complex,also still unknown, and this disease often due to buccal facial feelings of cold or wind and heat after the attack. The onset is rapid, mostly are delayed paralysis of one side muscle.Taking effective treatment measures in time is very beneficial to the recovery and prognosis of the disease. Since January 2015 to October 2017, 757 patients with facioplegia have been hospitalized in our hospital.The overall rate of complete recovery was 97.6% with significantly faster recovery in younger children and in patients with NB as compared to idiopathic facial palsy. Both patients with incomplete recovery were at least 14 years old and presented late in the course of the disease [Andreas ChristophJenkeet’al 3 May,2011]. The analysis is as follows:

Incidence and characteristics of Lyme neuroborreliosis in adult patients with facial palsy in an endemic area in the Netherlands

Making a distinction between facial palsy due to Lyme neuroborreliosis (LNB) and idiopathic facial palsy (IFP) is of importance to ensure timely and adequate treatment. The study objective was to assess incidence and patient characteristics of facial palsy due to LNB. Hospital records were reviewed of adult patients with facial palsy visiting the departments of neurology and/or otorhinolaryngology of Gelre hospitals between June 2007 and December 2017. Gelre hospitals are located in an area endemic for Lyme borreliosis. Patients with LNB had pleocytosis and intrathecal antibody production or pleocytosis with positive IgG serology. Patients with IFP had negative serology. Clinical characteristics were compared between patients with LNB and patients with IFP. Five hundred and fifty-nine patients presented with facial palsy, 4.7% (26) had LNB and 39.4% (220) IFP. The incidence of facial palsy due to LNB was 0.9/100 000 inhabitants/year. Over 70% of patients with facial palsy due to LNB did not report a recent tick bite and/or erythema migrans (EM). Patients with facial palsy due to LNB presented more often in July to September (69.2% vs. 21.9%, P < 0.001), and had more often headache (42.3% vs. 15.5%, P < 0.01). To reduce the risk of underdiagnosing LNB in an endemic area, we recommend testing for LNB in patients with facial palsy in summer months especially when presenting with headache, irrespective of a recent tick bite and/or EM.

Oculostapedial synkinesis following idiopathic facial palsy: something to listen out for

ObjectiveThis paper presents a rare case of oculostapedial synkinesis.Case reportAfter partial resolution of an idiopathic facial palsy, a male patient presented with persistent distortion of hearing when blinking and closing his eye. Audiometry findings were unremarkable, and cross-sectional imaging of the facial nerve revealed no abnormalities apart from an incidental contralateral meningioma. Initial conservative management, with referral to a specialist physiotherapist, failed to resolve the symptoms. The patient subsequently opted for surgical intervention, and underwent a transmeatal tympanotomy and transection of the stapedial tendon. Following this, he had complete resolution of symptoms.ConclusionOculostapedial synkinesis is a rare complication of facial palsy, but is recognised in the literature. Given its unusual presentation, it can be overlooked, especially by more junior team members. This case highlights the need to pay careful attention to patients' symptoms and listen out for the description of hearing distortion on facial movement.

Bell's Palsy: A Need for Paradigm Shift?

Introduction Bell's palsy (BP) is considered to be idiopathic facial palsy. Some schools of thought believe it to be a part of polyneuropathy, whereas other scientists have other plausible explanations for the condition and all these were reviewed. Methods The literature on BP was retrieved using the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar. Keywords and phrases used during the search included “Bell's palsy,” “polyneuropathy,” “anatomical factors,” and “autoimmunity.” Results There are only few studies that have tried to find out the association of BP with peripheral nerve conduction abnormalities. In most studies conducted, positive correlation was found. There are many theories of its etiology, with the reactivation of herpes simplex virus isoform 1 and/or herpes zoster virus (HZV) from the geniculate ganglia being the most strongly suspected cause. Conclusion In the future, large studies will be required to determine the association between peripheral neuropathy and BP and elucidate the real etiology in every case. There will also be a need to determine whether BP should still be considered idiopathic and isolated.