Search Results (19)

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis. Methods: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined. Results: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial. Conclusions: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being. Full article

Background and Objectives: Bell’s palsy, characterized by acute idiopathic facial nerve paralysis, exhibits variable recovery outcomes influenced by treatment timing, modality, and patient comorbidities. This study aimed to compare the effectiveness of corticosteroid-based treatment (Ear, Nose, and Throat [ENT]), nerve blocks/physical therapy (Pain Medicine), and acupuncture/herbal medicine (Traditional Korean Medicine [KM]) and identify predictors of recovery and recurrence. This retrospective cohort study leverages South Korea’s pluralistic healthcare system, where patients choose specialties, to provide novel insights into departmental treatment outcomes. Materials and Methods: We analyzed 600 patients treated within 72 h of Bell’s palsy onset (2010–2024) at Wonkwang University Hospital, South Korea, using propensity score matching (PSM) (1:1:1) for age, sex, comorbidities, and initial House–Brackmann (HB) grade. The primary outcome was complete recovery (HB grade I) at 6 months; secondary outcomes included recovery time, recurrence, complications, and patient satisfaction. Multivariate logistic regression identified predictors. Results: The ENT group achieved the highest complete recovery rate (87.5%, phi = 0.18) versus Pain Medicine (74.0%) and KM (69.5%) (p < 0.001), with the shortest recovery time (4 weeks, Cohen’s d = 0.65 vs. KM). Synkinesis was lowest in the ENT group (6.0%). ENT treatment (OR: 1.75; 95% CI: 1.29–2.37) and early corticosteroid application (OR: 1.95; 95% CI: 1.42–2.68) predicted recovery. Hypertension (OR: 4.40), hyperlipidemia (OR: 8.20), and diabetes (OR: 1.40) increased recurrence risk. Subgroup analyses showed that ENT treatment was most effective for severe cases (HB grade IV: 90% recovery vs. 65% in KM, p < 0.01). Conclusions: Corticosteroid-based treatment (ENT) yielded superior recovery outcomes. Comorbidity management is critical for recurrence prevention. Early ENT referral and integrated care models are recommended to optimize outcomes in diverse healthcare settings. Full article

Biofeedback rehabilitation for facial palsy is not yet routinely available for patients. Methods: To improve evidence, the effect of an intensive two-week facial training combining electromyography (EMG) and visual biofeedback training of 30 patients (76.7% female; median age: 48.6 years) with post-paralytic facial synkinesis was objectively evaluated. At the beginning of each training day, EMG amplitudes of both halves of the face were recorded during relaxation using the EMG system that was synchronously used for the EMG biofeedback training. A single-factor analysis of variance was performed for the change over time, and a t-test was used to evaluate the side differences. Results: At the end of the training program, there was a significant decrease in the EMG amplitudes of both halves of the face (synkinetic side: p < 0.001; contralateral side p = 0.003), indicating an improved voluntary muscle relaxation. There was also a significant improvement in Sunnybrook Facial Grading System, Facial Disability Index and Facial Clinimetric Evaluation scores, which were assessed before the start of training and at the end (p < 0.001). Conclusion: Electrophysiological improvements can be objectively measured using surface EMG. Full article

Background: Peripheral facial paralysis (PFP) affects the facial nerve, the seventh cranial nerve. It has an incidence rate of 20–30 cases per 100,000 habitants. The diagnosis is clinical, though imaging tests may be required in some cases. The treatment protocol includes medication, physiotherapy, and, in certain cases, surgery. Proprioceptive neuromuscular facilitation (PNF) techniques and electrical stimulation have been shown to be significant for recovery. Although PFP has a high recovery rate, up to 40% of patients may experience permanent sequelae. Objective: to assess the efficacy of treatment based on electrical stimulation and/or PNF in patients affected by PFP. Methods: A systematic search was conducted across six databases (PubMed, Medline, SportDiscus, CINAHL, Scopus, and Web of Science) in November 2024. Randomized controlled trials were included. Results: Fourteen articles were analyzed, applying PNF and/or electrical stimulation methods, pharmacological treatment, low-level laser treatment, subcutaneous collagen injections, and physiotherapy protocols involving facial expression exercises, yielding evidence for the variables assessed. Conclusions: PNF and/or electrical stimulation treatment in patients with PFP can be effective when employed early with appropriate parameters, showing promising results in improving quality of life, facial movement quality, and CMAP and reducing both the incidence and degree of synkinesis. Full article

Objective: The aim of this observational retrospective study was to report quality of life (QoL) in patients with postoperative facial nerve (FN) palsy after vestibular schwannoma (VS) surgery, investigating clinical factors related to functional outcomes. Methods: Forty-eight consecutive patients (M:F 25:23; median age: 52.5 years) with facial palsy following surgery for sporadic VS were considered retrospectively. FN palsy was graded by using the Sunnybrook facial grading system (SBFGS), while postoperative QoL and subjective functional aspects were assessed by using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale, the Synkinesis Assessment Questionnaire, and questions on eating and drinking. Results: A significant correlation emerged between all Sunnybrook scores and median PANQOL domain regarding facial function. Increasing overall SBFGS scores were associated with reduced risk of slow chewing on the affected side (p = 0.004), lack of masticatory strength (p = 0.025), masticatory fatigue (p < 0.001), accumulation of food in the oral vestibule (p < 0.001), difficulty in drinking from a glass (p = 0.019), and fluid spillage while drinking (p = 0.016). Conclusions: This study suggests that the clinical evaluation of patients with FN palsy after VS surgery should be integrated with patient reports about functional outcomes and perceived QoL to help clinicians guide rehabilitation choices. Full article

Background: Facial palsy causes severe functional disorders and impairs quality of life. Disturbing challenges for patients with acute facial palsy, but also with those with chronic facial palsy with synkinesis, are the loss of the ability to smile and insufficient eyelid closure. A potential treatment for these conditions could be a closed-loop electro-stimulation system that stimulates the facial muscles on the paretic side as needed to elicit eye closure, eye blink and smile in a manner similar to the healthy side. Methods: This study focuses on the development and evaluation of such a system. An artificial intelligence (AI)-based auricular-triggered algorithm is used to classify the intended facial movements. This classification is based on surface electromyography (EMG) recordings of the extrinsic auricular muscles, specifically the anterior, superior, and posterior auricular muscle on the paretic side. The system then delivers targeted surface electrical stimulation to contract the appropriate facial muscles. Results: The evaluation of the system was conducted with 17 patients with facial synkinesis, who performed various facial movements according to a paradigm video. The system’s performance was evaluated through a simulation, using previously captured data as the inputs. The performance was evaluated by means of the median macro F1-score, which was calculated based on the stimulation signal (output of the system) and the actual movements the patients performed. Conclusions: This study showed that such a system, using an AI-based auricular-triggered algorithm, can support with a median macro F1-score of 0.602 for the facial movements on the synkinetic side in patients with unilateral chronic facial palsy with synkinesis. Full article

Long-standing facial palsy sequelae cause functional, aesthetic, and psychological problems in patients. Botulinum toxin is an effective way to manage them, but no standardized recommendations exist. Through this non-systematic review, we aimed to guide any practitioner willing to master the ins and outs of this activity. We reviewed the existing literature and completed, with our experience as a reference center, different strategies of botulinum toxin injections used in facial palsy patients, including history, physiopathology, facial analysis, dosages, injection sites, and techniques, as well as time intervals between injections. The reader will find all the theorical information needed to best guide injections according to the patient’s complaint, which is the most important information to consider. Full article

(1) Background: Sequels of facial palsy lead to major psychosocial repercussions, disrupting patients’ quality of life (QoL). Botulinum toxin (BoNT) injections can permit us to treat long-standing facial palsy, improving facial symmetry and functional signs including synkinesis and contractures. (2) Methods: The main aim of this study was to assess the evolution of the QoL for patients with long-standing facial palsy before, at 1 month, and at 4 months after BoNT injections by using three questionnaires (HFS-30, FaCE, and HAD). The other goals were to find clinical factors associated with the improvement in the QoL and to assess the HFS-30 questionnaire for patients with unilateral facial palsy (3) Results: Eighty-eight patients were included in this study. There was a statistically significant improvement in QoL at 1 month after injections, assessed using the three questionnaires. This improvement was sustained at 4 months after the injections, with a statistically significant difference for the HFS-30 and FaCE questionnaires. (4) Conclusions: This study showed that the BoNT injections lead to a significant increase in the QoL of patients with unilateral facial palsy. This improvement is sustained 4 months after the injections. Full article

Background: Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores. Methods: Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG synkinesis score (ESS, number of synkinesis per movement sequence)) were evaluated at the end of the follow-up. Results: In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5–3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman’s model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook synkinesis score (Spearman’s rho: 0.8268, p < 0.0001). Conclusions: We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG. Full article

Various methods have been used to improve function and manage facial nerve injury. Although electrical stimulation therapy is frequently used to treat facial paralysis, its effects have been found to vary and no clear standards have been developed. The current review describes the results of preclinical and clinical studies evaluating the effectiveness of electrical stimulation therapy in promoting the recovery of a peripheral facial nerve injury. Evidence is presented showing the efficacy of electrical stimulation in promoting nerve regeneration after peripheral nerve injuries in both animal models and human patients. The ability of electrical stimulation to promote the recovery of facial paralysis was found to depend on the type of injury (compression or transection), the species of animal tested, the type of disease, the frequency and method of electrical stimulation, and the duration of the follow-up. Electrical stimulation, however, can also have potential negative outcomes, such as reinforcing synkinesis, including mistargeted axonal regrowth via inappropriate routes; excessive collateral axonal branching at the lesion site; and multiple innervations at neuromuscular junctions. Because of the inconsistencies among studies and the low quality of evidence, electrical stimulation therapy is not currently regarded as a primary treatment of facial paralysis in patients. However, understanding the effects of electrical stimulation, as determined in preclinical and clinical studies, is important for the potential validity of future research on electrical stimulation. Full article

Surface electromyography (EMG) allows reliable detection of muscle activity in all nine intrinsic and extrinsic ear muscles during facial muscle movements. The ear muscles are affected by synkinetic EMG activity in patients with postparalytic facial synkinesis (PFS). The aim of the present work was to establish a machine-learning-based algorithm to detect eyelid closure and smiling in patients with PFS by recording sEMG using surface electromyography of the auricular muscles. Sixteen patients (10 female, 6 male) with PFS were included. EMG acquisition of the anterior auricular muscle, superior auricular muscle, posterior auricular muscle, tragicus muscle, orbicularis oculi muscle, and orbicularis oris muscle was performed on both sides of the face during standardized eye closure and smiling tasks. Machine-learning EMG classification with a support vector machine allowed for the reliable detection of eye closure or smiling from the ear muscle recordings with clear distinction to other mimic expressions. These results show that the EMG of the auricular muscles in patients with PFS may contain enough information to detect facial expressions to trigger a future implant in a closed-loop system for electrostimulation to improve insufficient eye closure and smiling in patients with PFS. Full article

Our aim was to analyze the phenotypic-genetic correlations in a patient diagnosed with early onset corticobasal syndrome with progressive non-fluent aphasia (CBS-PNFA), characterized by predominant apraxia of speech, accompanied by prominent right-sided upper-limb limb-kinetic apraxia, alien limb phenomenon, synkinesis, myoclonus, mild cortical sensory loss, and right-sided hemispatial neglect. Whole-exome sequencing (WES) identified rare single heterozygous variants in ATP7B (c.3207C>A), SORL1 (c.352G>A), SETX (c.2385_2387delAAA), and FOXP1 (c.1762G>A) genes. The functional analysis revealed that the deletion in the SETX gene changed the splicing pattern, which was accompanied by lower SETX mRNA levels in the patient’s fibroblasts, suggesting loss-of-function as the underlying mechanism. In addition, the patient’s fibroblasts demonstrated altered mitochondrial architecture with decreased connectivity, compared to the control individuals. This is the first association of the CBS-PNFA phenotype with the most common ATP7B pathogenic variant p.H1069Q, previously linked to Wilson’s disease, and early onset Parkinson’s disease. This study expands the complex clinical spectrum related to variants in well-known disease genes, such as ATP7B, SORL1, SETX, and FOXP1, corroborating the hypothesis of oligogenic inheritance. To date, the FOXP1 gene has been linked exclusively to neurodevelopmental speech disorders, while our study highlights its possible relevance for adult-onset progressive apraxia of speech, which guarantees further study. Full article

In “Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis—Machine Settings and Technical Aspects for Facial Surgeons”, Andreas Kehrer et al. present ultrasound (US) device settings for facial muscle examination to be used by facial surgeons to improve their workflow and enhance their image quality [...] Full article

Background: Synkinesis of the facial musculature is a detrimental sequalae in post-paralytic facial palsy (PPFP) patients. Detailed knowledge on the technical requirements and device properties in a high-resolution ultrasound (HRUS) examination is mandatory for a reliable facial muscle assessment in PPFP patients. We therefore aimed to outline the key steps in a HRUS examination and extract an optimized workflow schema. Methods: From December 2020 to April 2021, 20 patients with unilateral synkinesis underwent HRUS. All HRUS examinations were performed by the first author using US devices with linear multifrequency transducers of 4–18 MHz, including a LOGIQ E9 and a LOGIQ S7 XDclear (GE Healthcare; Milwaukee, WI, USA), as well as Philips Affinity 50G (Philips Health Systems; Eindhoven, the Netherlands). Results: Higher-frequency and multifrequency linear probes ≥15 MHz provided superior imaging qualities. The selection of the preset program Small Parts, Breast or Thyroid was linked with a more detailed contrast of the imaging morphology of facial tissue layers. Frequency (Frq) = 15 MHz, Gain (Gn) = 25–35 db, Depth (D) = 1–1.5 cm, and Focus (F) = 0.5 cm enhanced the image quality and assessability. Conclusions: An optimized HRUS examination protocol for quantitative and qualitative facial muscle assessments was proposed. Full article