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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(05): 633-641
DOI: 10.1055/s-0042-1756352
Pediatric/Craniomilofacial/Head & Neck: Original Article

Comparative Study of Multimodal Therapy in Facial Palsy Patients

Catriona Neville 
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Tamsin Gwynn 
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Karen Young 
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Elizabeth Jordan 
2   Department of Psychological Therapy, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Raman Malhotra 
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
3   Department of Oculoplastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Charles Nduka 
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
,
Ruben Yap Kannan 
1   Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
› Author Affiliations Funding None.
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Abstract

Introduction In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes.

Methods Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale.

Results FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, –24.51 to –14.66, p < 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly (p < 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment (p < 0.01), more chemodenervation episodes (p < 0.01), increased doses of botulinum toxin (p < 0.001), and having higher EGGS score (p < 0.001).

Conclusions This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.

Keywords

facial paralysis - synkinesis - botulinum toxins-type A - physical therapy modalities - surgery - plastic

Authors' Contributions

C.N.: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, visualization, writing – original draft, review and editing. T.G.: Data curation, investigation, project administration, resources. K.Y.: Data curation, investigation, project administration, resources. E.J.: Data curation, investigation, project administration, resources. R.M.: Resources, supervision, validation, writing – review and editing. C.N.: Resources, supervision, validation, writing – review and editing. R.Y.K.: Conceptualization, formal analysis, methodology, resources, supervision, visualization, writing – review and editing.


Ethical Approval

This study adheres to the Strengthening The Reporting of OBservational Studies in Epidemiology (STROBE) guidelines, conforms to the Helsinki guidelines on ethics, and was registered with and approved by the institutional review team from the Research and Development Department at The Queen Victoria Hospital NHS Foundation Trust prior to being conducted (IRB No.1286).


Patient Consent

Patients gave their informed consent for their images to be shared.




Publication History

Received: 28 December 2021

Accepted: 07 July 2022

Article published online:
23 September 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Proske U, Morgan DL, Gregory JE. Thixotropy in skeletal muscle and in muscle spindles: a review. Prog Neurobiol 1993; 41 (06) 705-721
    CrossrefPubMedGoogle Scholar
  • 2 Aramideh M, Koelman JHTM, Devriese PP, VanderWerf F, Speelman JD. Thixotropy: a novel explanation for the cause of lagophthalmos after peripheral facial nerve palsy. Br J Ophthalmol 2002; 86 (08) 839
    CrossrefPubMedGoogle Scholar
  • 3 Aramideh M, Koelman JHTM, Devriese PP, Speelman JD, Ongerboer de Visser BW. Thixotropy of levator palpebrae as the cause of lagophthalmos after peripheral facial nerve palsy. J Neurol Neurosurg Psychiatry 2002; 72 (05) 665-667
    CrossrefPubMedGoogle Scholar
  • 4 Walker DT, Hallam MJ, Ni Mhurchadha S, McCabe P, Nduka C. The psychosocial impact of facial palsy: our experience in one hundred and twenty six patients. Clin Otolaryngol 2012; 37 (06) 474-477
    CrossrefPubMedGoogle Scholar
  • 5 Hotton M, Bogart K, Briegel W. et al. Recommendations for Supporting the Psychological Well-being of Children and Adults with Facial Palsy. Facial Palsy UK International Consensus Document; 2021
    Google Scholar
  • 6 Angelov DN, Ceynowa M, Guntinas-Lichius O. et al. Mechanical stimulation of paralyzed vibrissal muscles following facial nerve injury in adult rat promotes full recovery of whisking. Neurobiol Dis 2007; 26 (01) 229-242
    CrossrefPubMedGoogle Scholar
  • 7 Malhotra R, Ziahosseini K, Poitelea C, Litwin A, Sagili S. Platinum segments: a new platinum chain for adjustable upper eyelid loading. Br J Ophthalmol 2015; 99 (12) 1680-1685
    CrossrefPubMedGoogle Scholar
  • 8 van Landingham SW, Diels J, Lucarelli MJ. Physical therapy for facial nerve palsy: applications for the physician. Curr Opin Ophthalmol 2018; 29 (05) 469-475
    CrossrefPubMedGoogle Scholar
  • 9 Shokri T, Patel S, Ziai K, Harounian J, Lighthall JG. Facial synkinesis: a distressing sequela of facial palsy. Ear Nose Throat J 2021; DOI: 10.1177/01455613211054627.
    CrossrefPubMedGoogle Scholar
  • 10 Azizzadeh B, Nduka C. Management of Post-Facial Paralysis Synkinesis. Elsevier; ; New York: : 2021
    Google Scholar
  • 11 Azizzadeh B, Irvine LE, Diels J. et al. Modified selective neurectomy for the treatment of post-facial paralysis synkinesis. Plast Reconstr Surg 2019; 143 (05) 1483-1496
    CrossrefPubMedGoogle Scholar
  • 12 Diels HJ. Facial paralysis: is there a role for a therapist?. Facial Plast Surg 2000; 16 (04) 361-364
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002; (549) 4-30
    CrossrefPubMedGoogle Scholar
  • 14 Engström M, Berg T, Stjernquist-Desatnik A. et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2008; 7 (11) 993-1000
    CrossrefPubMedGoogle Scholar
  • 15 Marsk E, Bylund N, Jonsson L. et al. Prediction of nonrecovery in Bell's palsy using Sunnybrook grading. Laryngoscope 2012; 122 (04) 901-906
    CrossrefPubMedGoogle Scholar
  • 16 Brach JS, VanSwearingen JM. Physical therapy for facial paralysis: a tailored treatment approach. Phys Ther 1999; 79 (04) 397-404
    CrossrefPubMedGoogle Scholar
  • 17 Cabrol C, Elarouti L, Montava AL. et al. Sunnybrook Facial Grading System: intra-rater and inter-rater variabilities. Otol Neurotol 2021; 42 (07) 1089-1094
    CrossrefPubMedGoogle Scholar
  • 18 VanSwearingen JM, Brach JS. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther 1996; 76 (12) 1288-1298 , discussion 1298–1300
    CrossrefPubMedGoogle Scholar
  • 19 Kahn JB, Gliklich RE, Boyev KP, Stewart MG, Metson RB, McKenna MJ. Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale. Laryngoscope 2001; 111 (03) 387-398
    CrossrefPubMedGoogle Scholar
  • 20 Texeira LJ, Valbuza JH, Prado GF. Physical therapy for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2011; 12: CD0006283
    Google Scholar
  • 21 Arslan F, Gökgöz MC, Binar M, Aydemir E, Durmaz A. Anxiety, depression, and hopelessness in patients before and after treatment for peripheral facial paralysis. Ear Nose Throat J 2018; 97 (4-5): E1-E4
    PubMedGoogle Scholar
  • 22 Robinson MW, Baiungo J. Facial rehabilitation: evaluation and treatment strategies for the patient with facial palsy. Otolaryngol Clin North Am 2018; 51 (06) 1151-1167
    CrossrefPubMedGoogle Scholar
  • 23 Cooper L, Lui M, Nduka C. Botulinum toxin treatment for facial palsy: a systematic review. J Plast Reconstr Aesthet Surg 2017; 70 (06) 833-841
    CrossrefPubMedGoogle Scholar
  • 24 Karp E, Waselchuk E, Landis C, Fahnhorst J, Lindgren B, Lyford-Pike S. Facial rehabilitation as noninvasive treatment for chronic facial nerve paralysis. Otol Neurotol 2019; 40 (02) 241-245
    CrossrefPubMedGoogle Scholar