Académique Documents
Professionnel Documents
Culture Documents
Objective
s
1.Update knowledge
on facial palsy
2.Understanding the
chronic facial palsy
3.Critically review the
treatment options
Pa
rt
I
Facial functions
Facial functions are
multidimensional, serving
emotional, social and physical
aspects of an individuals health.
The primary functions of the face
include displaying affective
emotions, identifying and
communicating with other human
beings.
Sensory- motor function
Communication function
We communicate and
with facial expression
Display affective
emotion
Emotions are
contextual in turn
facial expression are
also
Emotion determine
facial muscle activity
Facial muscle activityemotion
Attractiveness- symmetry
communication
Conte
xt
Example Smile
Fake smiles can be
performed at will,
because the brain
signals that create
them come from the
conscious part of the
brain and prompt the
zygomaticus major
muscles in the cheeks
to contract.
Muscles pull the corners
of the mouth outwards.
I
Pa
rt
I
Central lesions-Supra-nuclear
lesions
LMN lesion of
the facial nerve
Trauma,
Hypertension,
Eclampsia,
Lyme disease,
Sarcoidosis,
Diabetes mellitus,
Ramsay hunt syndrome
Sjogrens syndrome,
Tumours of the parotid
gland,
10. Amyloidosis, or
11. Complication of intranasal
influenza vaccine.
Bells palsy
Bells palsy
The incidence of Bells palsy is 20 to
30 cases per 100,000 people per
year
60 to 75 percent of all cases of
unilateral facial paralysis.
Most recover fully- 70- 80%
the spontaneous course of 2,500 peripheral facial nerve palsies of diff erent etiologies. Acta
Otolaryngol 2002; 549 (suppl): 430.
Viral infection,
Vascular
Ischemia
Autoimmune diseases
older age,Hauser WA, Karnes WE, Annis J, Kurland LT. Incidence and prognosis of
Bells palsy in the population of Rochester, Minnesota. Mayo Clin Proc 1971;46:258-64.
Hypertension
impairment of taste,
Pathology of
bells palsy
The facial nerve to
swelling
Inflamed in reaction to
the infection?
Swelling can cause the
nerve to become pinched
in the bony canal
Death of nerve cells due
to insufficient blood or
oxygen supply
Symptoms
Classic presentation of Bell's palsy is weakness
on one side of the face.
Drooling after brushing the teeth or when
drinking,
An asymmetrical appearance of the mouth
noticed in the mirror
Drooping of the face, such as the eyelid or
corner of the mouth
Hard to close one eye
Problems smiling, grimacing, or making facial
expressions
Symptoms
Twitching or weakness of the muscles
in the face
An inability to whistle, or excessive
tearing in one eye.
Unable to blow out his cheeks when
shaving
Synkinesis
Symptoms
Pain in or behind the
ear,
Numbness or
tingling in the
affected side of the
face usually without
any objective deficit
on neurological
examination,
Hyperacusis
Disturbed taste on
the ipsilateral
LATER SYMPTOMS
Persistent Asymmetry
Hemispasms
Synkinesis
Psychological and social issues
Synkinesis
Most distressing consequences of
facial paralysis.
Synkinesis refers to the abnormal
involuntary facial movement that
occurs with voluntary movement of a
different facial muscle group.
Abnormal regeneration of facial nerve
fibers to the facial muscle groups
Synergy lookout
for closure of the
eyes while
attempting facial
expression
Positive coping
Crocodile
tears
After acute facial
paralysis, preganglionic
parasympathetic fibers
that previously projected
to the submandibular
ganglion may regrow
and enter the major
superficial petrosal
nerve.
Such aberrant
regeneration may lead
to lacrimation after a
salivary stimulus (the
syndrome of crocodile
tears).
Persistent asymmetry
Asymmetrical face
Symmetrical face
Electrotherapy,
Biofeedback,
Transcutaneous electrical nerve stimulation
(TENS)
Thermal methods or massage, alone or in
combination with any other therapy.
Exercise therapy
MIME
sample
Title
Metho
d
Outcome
Result/
conclusion
Otol Neurotol.2003
Jul;24(4):677-81. Positive
RCT
50 patients
HouseBrackmann
score of
Grade IV.
Facial
Disability
Index
Facial
Disability
Index
improved
substantially
Follow
up of
the
above
RCT
48
9 months
majority
absence of
deterioration
RCT
50
Sunnybroo
k Facial
Grading
Improvement
in symmetry
effects of mime
therapy on sequelae
of facial paralysis:
stiffness, lip mobility,
and social and
physical aspects of
facial disability.
Otol Neurotol.2006
Oct;27(7):1037-42.
Stability of benefits of
mime therapy in
sequelae of facial
nerve paresis during a
1-year period.
Aust J
Physiother.2006;52(3):177-83.
Mime therapy
Functional exercise
Developed as a multi dimensional
and patient-centered approach to
rehabilitation of individuals with
facial paralysis Prakash V, Hariohm K, Vijayakumar P, Thangjam
Bindiya D. Functional training in the management of chronic facial paralysis. Phys
Ther. 2012;92:605613.
Functional training
Functional
training
Patient education
Complimentary
exercise
Functional training
To facilitate context specific spontaneous
and voluntary emotions
1. Watch movies, television programs and
funny videos.
2. Narrate them during the treatment session
in the clinic.
3. Think about the funny incidents that had
happened in your life or the jokes you
heard or read recently and share it with
friends or family members.
Functional training
To facilitate motor functions of facial muscles
around the eyes, lips and mouth.
1. Hum or sing songs that you like as frequently as
possible
2. Play games like peek -a- boo, blowing bubbles
with your kids.
3. Rinse the mouth and spit the water down slowly.
4. Blow a pipe while imagining that you are
cooking in the kitchen and suddenly the fire puts
off in the wood stove; you have to blow the pipe
to make the fire again.
Functional training
Still no clinical trial to prove
effectiveness
Electrical
stimulation
Design
Sample
Outcome Effect /
size
Physiotherapy for
Bell's palsy.British
Medical
Journal1958;2(5097):67
5-7
RCT
Exp- ES
Conmassage
83
N= 43
(exp)
N=40
(con)
Tratamiento de la
parlisis facial
perifrica idioptica:
terapia fsica versus
prednisona Revista
mdica del Instituto
Mexicano del Seguro
Social1998;36(3):21721.
RCT
149
Group1- ES n-=76
Group2prednisone
review
294
participan
ts
result
1 year
follow up
No
significant
advantage
May scale
No
difference at
3 months
Electrical
stimulation
Title and author
Design
Sample Outcome Effect /
size
measure
result
Effects of electrical
stimulation on HouseBrackmann scores in
early Bell's palsy. Rev
Med Inst Mex Seguro
Soc. 2009 JulAug;47(4):413-20
A pretest
posttest
control vs.
experimental
groups design
N=8 in
each
group
HouseNo
Brackman significant
n scores
difference
RCT
N=138
EC No
Therapeuti
c effect on
Bell palsy.
Effect of facial
neuromuscular reeducation on facial
RCT
Group1exercise & ES
59
n-=30
N=29
Facial
Grading
Scale
No
difference
at 3
Compared with
prednisone etc
Electrotherapy ES
May have an adverse effect on
recovery
Avoid in acute stage
Poor evidence to show it may be
helpful in chronic facial paralysis.
Feedback
Mirror feedback
EMG feedback
Lack of proprioceptors
Evidence Summary
Strapping ?!
Coping strategies
To change the way one think tofeel /
act better even if the situation does
not change.
To reconstruct ones thoughts and
perception of the problem like
negative self-perception of facial
attractiveness (body image),
interpretation of others/societys
views towards ones disability etc...
Synkinesis
Most common
areas of injection
are eye muscles
(orbicularis), neck
bands (platysma),
and chin dimpling
(mentalis).
Outcome measures
Outcome measures
Content- all dimensions of the
functions of the face
Disability after loss of facial function
House-Brackmann Scale
House, J.W. and Brackmann, D.E. (1985) Facial nerve grading system.Otolaryngol.
Head Neck Surg.,93, 146147
Conclusion
About 20- 23% of people with Bell's
palsy are left with either moderate to
severe symptoms
Dont just think of it as a motor
problem
Intervention needed to concentrate
on all aspects of the disability
Update the interventional strategies
Thank you