Clinical study of facial paralysis

( Jin Dong-eun ) 대구한의대학교 제한동의학술원 2022 제한동의학술원논문집 Vol.20 No.1

Objective Based on classic oriental medicine literature, we set up the pathogenesis for facial paralysis, and retrospectively analyzed various clinical characteristics of patients who visited to hospital with facial paralysis. Through this, the pathogenesis of the disease was statistically identified from the perspective of oriental medicine, and based on this, the effect of oriental medicine treatment for treating facial paralysis was presented to provide clinical data that would help improve the provision of Korean medicine for facial paralysis. Method From 2004 to 2019, among the 8oo patients with facial paralysis who visited Department of Internal Medicine 3, Daegu Haany University Oriental Medicine Hospital (Pohang) for 16 years, medical record of patients with objective facial paralysis were collected. Demographic variables, clinical characteristics, and treatment results were statistically analyzed using IBM SPSS 26.0. Results 1. As a result of examining the distribution of clinical characteristics of subjects, the main risk factors for facial paralysis are obesity (59.8%),overwork (33.0%),stress (24.8%),exogenous factors (20.0%), and gastrointestinal disorders (12.2%). In particular, obesity is significantly higher than the prevalence of obesity in Koreans (32.8%) calculated from The Korea National Health and Nutrition Examination Survey, and a statistically significant difference was shown in recovery speed according to the stress. 2. During the average observation period of 25.2 days, the complete recovery of facial paralysis was 55.8%, and the overall improvement was 84.2%. Furthermore, recovery began within an average of 13.1 days after onset and 90.5% of patients began recovery within 3 weeks. Conclusions 1. Based on the descriptions related to facial paralysis in classic literature of oriental medicine, the pathogenesis of facial paralysis in Korean medicine is depression of the Lei Yang-ming meridian, and the causes are interpreted as overwork, gastrointestinal disorders, stress, obesity, and external factors. The results of this study was consistent with above pathogenesis of facial paralysis originated from literature, and supported the content of the literature clinically and statistically. 2. Although it was difficult to make a strict comparison due to the difference of observation period, the treatment results of our study, which showed a complete recovery rate of 55.8% and the overall improvement of 84.2% for an average of 25.2 days were far superior to both the natural course, which showed a 71% complete recovery rate during the 6 month observation period, and the treatment results of using steroids, which showed a complete recovery rate of 83.0% for 3 months.

안면신경 마비의 재건

박호진(Hojin Park),오태석(Tae Suk Oh) 대한두개저학회 2021 대한두개저학회지 Vol.16 No.1

Facial paralysis can cause functional, social, and aesthetic problems, and facial reanimation is challenging in patients with facial paralysis. Facial paralysis is mainly approached by two methods, depending on the paralysis onset and muscle fibrosis degree. Recent-onset facial paralysis without muscle fibrosis is reconstructed by a nerve transfer. If the affected facial nerve is intact on the proximal side, nerve graft can be performed. New nerve sources, including hypoglossal and masseter nerve, are transferred if the affected facial nerve is damaged. In long-standing facial paralysis, wherein facial muscle fibrosis progresses, it is difficult to expect a facial movement even when new nerve signals are transferred. Therefore, it is reanimated by transplanting the muscle flap with new neural input. The free flap is more advantageous for natural restoring facial symmetry or facial movement than the local flap procedure. However, it needs a long operation time and recovery period. There are many ways to reconstruct facial paralysis. Various reconstruction methods have their pros and cons. Since the degree of facial paralysis is very diverse, it is necessary to understand the various reconstruction methods and apply them to the patients.

경혈탐측기를 이용한 말초성 안면신경마비환자의 족부반사구 변화에 대한 임상적 고찰

왕개하,이은솔,황지후,김유종,김경호,김승현,윤인애,조현석 대한침구의학회 2012 대한침구의학회지 Vol.29 No.1

Objectives : We investigate the characteristics of foot reflex zone acupoint of facial paralysis patients. Methods : In order to make a comparison between facial nerve paralysis patient group and non-facial paralysis group, we measured foot reflex zone acupoint detection in both group of 18 patients who were diagnosticated to facial nerve paralysis and 18 persons who were not. Results :1. In comparing the means of the foot reflex zone, the measurements of facial nerve paralysis group is different significantly from non-facial paralysis group(p<0.05). 2. The measurement of detection of foot reflex zone acupoints, such as hypophysis(垂體), nose(鼻), cerebrum(大腦), neck(頸項), Trapezius muscle(僧帽筋), eye(眼) and ear(耳) of the facial nerve paralysis group is different significantly in comparison with non-facial paralysis group(p<0.05). But the measurement of detection of foot reflex zone acupoints, such as trigeminal nerve(三叉神經), cerebellum(小腦), kidney(腎), ureter(輸尿管) and urinary bladder(膀胱) of the facial nerve paralysis group is not defferent significantly in comparison with non-facial paralysis group(p>0.05). Conclusions : The results suggest that foot reflex zone can be used in the diagnosis and treatment of facial nerve paralysis.

Characteristic facial expressions in chronic facial paralysis suggest an incidental finding of an intratemporal mass

김주현,김진 대한두개저학회 2022 대한두개저학회지 Vol.17 No.1

Background : The objective of this study was to analyze the characteristics of facial expressions by their pathogenesis in subjects with chronic facial paralysis and to describe the partial defect of facial function in elucidating the etiology of facial paralysis. Materials and Methods : The etiology of chronic facial paralysis could be categorized into 3 groups: Group I, total resection without any reanimation surgery; Group II, acute facial nerve injury such as Bell’s palsy, and Group III, facial nerve resection and anastomosis. There was a total number of 104 subjects included in this study. Each subject with chronic facial paralysis and were investigated based on the severity of synkinesis, regression of muscular volume, latency and amplitude in electromyography, and facial movement by House-Brackmann grade system. Results : Subjects from the Group I had no synkinesis with profound regression of muscular volume, H-B grade 5.7 ± 0.34. Subjects from the Group II had moderate to severe synkinesis with moderate to severe regression of muscular volume, H-B grade 3.4 ± 0.96. In this group, thirteen subjects with atypical facial expression also had an incidental finding of a hidden mass in the intratemporal area. Lastly, subjects from the Group III had severe synkinesis without regression of muscular volume, H-B grade 3.7 ± 0.76. Conclusions : With careful examination of facial expression, a crucial point for elucidating the pathogenesis of facial paralysis may be provided. Severe facial palsy without muscular regression may indicate an incidental finding of a hidden mass in the intratemporal area.

What Causes Incomplete Facial Function Recovery in Patients with Immediate Facial Paralysis Following Vestibular Schwannoma Surgery?

김진,김주현,See Young Park,Hyo Jin Chung,Won Sang Lee 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.2

Facial paralysis;Vestibular schwannoma;Surgery. Background and Objectives: Preservation of facial nerve function in vestibular schwannoma (VS) surgery is still a significant operative challenge. Several prognostic factors correlate with postoperative facial nerve function. Most partial facial nerve damage can recover completely without functional defect. However, recovery of the facial nerve in some patients is either incomplete or non-existent. To evaluate the cause of incomplete facial function recovery at long term follow-up (≥1 year), we analyzed the factors that influenced facial function recovery in a consecutive series of patients that had immediate post-operative, partial paralysis after VS surgery with preservation of neural integrity. Materials and Methods: We conducted a retrospective review of 143 cases of VS surgery that occurred between January 1994 and December 2008. Twenty-seven patients that had immediate, postoperative partial facial paralysis and normal preoperative facial function with intact nerve after tumor excision were analyzed with regards to age, sex, tumor size, tumor location, internal auditory canal (IAC) widening, duration of surgical procedure, postoperative complication, and facial function after a postoperative follow-up period of≥1 year by the House-Brackmann (HB) grading system. Results: Of the 143 patients that underwent VS surgery, 27 (18.8%) patients had immediate, postoperative partial facial paralysis. At long-term follow-up, there were 11 (7.6%) patients with incomplete facial recovery. Facial function recovery after facial nerve injury did not show a significant difference in tumor size, surgical approach, or tumor location. However, preoperative IAC widening and the duration of the procedure were related to facial restoration after surgery. Conclusions: The injured facial nerve during VS surgery showed incomplete recovery in many cases. Chronic compression of the facial nerve, together with IAC widening preoperatively, led to incomplete restoration of injured facial nerves.

한국에서의 급성 안면마비 환자에 대한 조기 스테로이드치료의 의미와 중요성

김명우,김진 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.5

Facial nerve paralysis is an unexpected or embarrassed disease which unilateral facial musculatures are suddenly or gradually paralyzed by various causes. However, the most common cause of acute facial paralysis is known to be Bell’s palsy. Until now, various treatments are recommended to patients with acute facial paralysis. Especially in Asian countries such as Korea, Japan, and China, there are so many patients who be managed by acupuncture therapy as the initial treatment, even if there exists clearly proven steroid therapy that minimizes neural damage and the incidence of permanent facial complications could be reduced. In Korea, various procedures not clearly unverified or unproven such as acupuncture treatment, massage therapy and thermotherapy are performed without standards regimen instead of administering steroid to patients with acute facial paralysis in the early stages. It has been already known that any initial trials with un-established treatment without full understanding of pathophysiology of facial nerve injury worsen prognosis after acute facial paralysis. There are reports showing that the prognosis of Korean patients with Bell’s palsy is worse than globally known prognosis of patients with Bell’s palsy. Such reports may reflect unverified procedures and consequently putting off steroid treatment in the early stages. Therefore, this is a paper intended to investigate issues occurring in treating a patient with acute facial paralysis in Korea in order to prepare the medical guidelines for the better solution. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(5):346-52

자동 미세침이 말초성 안면마비 환자의 증상 정도 및 안전성에 미치는 영향에 대한 임상 관찰

이웅인,권유정,김현호,유제혁,김경욱,강중원,이상훈 대한침구의학회 2012 대한침구의학회지 Vol.29 No.4

Objectives : This study was to observe clinical application of auto-microneedle therapy system (AMTS) in patients with peripheral facial paralysis. Methods : 27 peripheral facial paralysis patients were observed after taking AMTS at Facial Palsy Center, Kyung Hee University Oriental Medicine Hospital from March 1, 2011 to January 9, 2012. We assessed the symptoms of facial paralysis with Yanagihara unweighted grading system, Sunnybrook facial grading system(SBGS) and facial disability index(FDI), and observed adverse events and total safety of the treatment. Results : The scores of facial palsy scales increased after AMTS in Yanagihara grading system and Sunnybrook facial grading system. AMTS-related adverse events were mild pain(5.9%) and fatigue(3.5%), which needed no extra treatment. The total safety evaluation was between ‘safe’ and ‘nearly safe’ level. There were no other serious adverse events. In addition, patients were satisfied with subjective improvement including facial tingling and numbness. Conclusions : AMTS can be applied as an adjunctive treatment for patients with peripheral facial paralysis due to its safety and clinical usefulness. It is easier to stimulate wide skin area in a short time. Further clinical research is required to investigate the effectiveness of ATMS in a more rigorous RCTs.

Statistical Analysis of Pure Tone Audiometry and Caloric Test in Herpes Zoster Oticus

김진,이원상,문인석,이호기,정진세 대한이비인후과학회 2008 Clinical and Experimental Otorhinolaryngology Vol.1 No.1

Objectives. Pure tone audiometry and caloric test in patients with herpes zoster oticus were performed to determine the biologic features of the varicella zoster virus (VZV) and the pathogenesis of vestibulocochlear nerve disease in herpes zoster oticus. Study Design. A retrospective chart review of 160 patients with herpes zoster oticus was designed in order to determine the classic characteristics of vestibulocochlear nerve disease associated with the syndrome. Speech frequency and isolated high frequency acoustic thresholds were analyzed based on severity of facial paralysis and patient age. Patients without cochlear symptoms were selected randomly, and audiological function was evaluated. Patients with symptoms of vestibular dysfunction underwent the caloric test, and canal paresis was analyzed according to the severity of facial paralysis and the age of each patient. Results. Among the 160 patients, 111 exhibited pure tone audiometry; 26 (79%) of the patients with cochlear symptoms and 44 (56%) of the patients without cochlear symptoms had abnormal audiological data. Among the patients without cochlear symptoms, 15 (19%) had hearing loss at speech frequency, and 42 (54%) had hearing loss isolated to high frequency. The incidence of cochlear symptoms in herpes zoster oticus was not related to the severity of facial paralysis. The incidence of patients with isolated high frequency hearing loss statistically increased with age, however the incidence of patients with speech frequency hearing loss did not increase. Thirteen patients complained vertigo, and the incidence of vestibular disturbances and the value of canal paresis in the caloric test increased to statistical significance in parallel with increasing severity of facial paralysis. Conclusion. Mild or moderate cochlear symptoms with high frequency hearing loss were related to age, and severe vestibular symptoms were related to the severity of facial paralysis after onset of herpetic symptoms. This study might suggest us a clue to the pathogenesis of vestibulocochlear nerve disease in herpes zoster oticus. Objectives. Pure tone audiometry and caloric test in patients with herpes zoster oticus were performed to determine the biologic features of the varicella zoster virus (VZV) and the pathogenesis of vestibulocochlear nerve disease in herpes zoster oticus. Study Design. A retrospective chart review of 160 patients with herpes zoster oticus was designed in order to determine the classic characteristics of vestibulocochlear nerve disease associated with the syndrome. Speech frequency and isolated high frequency acoustic thresholds were analyzed based on severity of facial paralysis and patient age. Patients without cochlear symptoms were selected randomly, and audiological function was evaluated. Patients with symptoms of vestibular dysfunction underwent the caloric test, and canal paresis was analyzed according to the severity of facial paralysis and the age of each patient. Results. Among the 160 patients, 111 exhibited pure tone audiometry; 26 (79%) of the patients with cochlear symptoms and 44 (56%) of the patients without cochlear symptoms had abnormal audiological data. Among the patients without cochlear symptoms, 15 (19%) had hearing loss at speech frequency, and 42 (54%) had hearing loss isolated to high frequency. The incidence of cochlear symptoms in herpes zoster oticus was not related to the severity of facial paralysis. The incidence of patients with isolated high frequency hearing loss statistically increased with age, however the incidence of patients with speech frequency hearing loss did not increase. Thirteen patients complained vertigo, and the incidence of vestibular disturbances and the value of canal paresis in the caloric test increased to statistical significance in parallel with increasing severity of facial paralysis. Conclusion. Mild or moderate cochlear symptoms with high frequency hearing loss were related to age, and severe vestibular symptoms were related to the severity of facial paralysis after onset of herpetic symptoms. This study might suggest us a clue to the pathogenesis of vestibulocochlear nerve disease in herpes zoster oticus.

말초성 안면마비에서 중두개와 접근법에 의한 안면신경 감압술 : 3례 보고

조준,박성호,김재영,Cho, Joon,Park, Sung-Ho,Kim, Jae-Young 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Objective : Several conservative treatments have been tried in peripheral facial nerve paralysis, because 80% of patients recover spontaneously. Surgical decompression may be helpful to the residual, medically intractable patients. We present here our experiences of facial nerve decompression via middle fossa approach, which seems to be one of good surgical therapeutic options for medically refractory peripheral facial nerve paralysis. Method : Three cases of medically intractable peripheral type facial paralysis were microscopically operated via middle cranial fossa approach to decompress the labyrinthine segment of the facial nerve and geniculate ganglion by searching landmarks of middle meningeal artery, greater superficial petrosal nerve and facial hiatus. Results : After operation, two cases of Bell's palsy improved substantially and one case of post-traumatic facial paralysis improved partially. Conclusion : This report is presented to describe the surgical facial nerve decompression via middle fossa for early control of peripheral type facial paralysis. Surgical decompression of edematous peripherally paralysed facial nerve could be preferred to conservative treatment in some patients although more surgical experience should be required.

안면신경 절단 후 설하-안면신경 접합술

김진(Jin Kim) 대한두개저학회 2018 대한두개저학회지 Vol.13 No.1

The facial nerve reconstruction after facial nerve transection is a hard mission to the clinician. All of the patients who suffer from severe facial paralysis want to have their original facial function even if they had tremendous aggressive disease or surgery. One of the surgical technique for facial reconstruction after facial nerve transection is the hypoglossal-facial anastomosis. This surgical technique provides favorable facial function even after aggressive tumor surgery. But this surgical technique also has a critical defects on tongue movement. The use of hypoglossal nerve could induce other problem in terms of quality of life including dis-articulation, leakage on oral feeding and/or biting of their tongue. Another variation techniques rather than classical XII-VII could be recommended for minimizing the hemi-tongue paralysis. Split XII-VII technique, Jump graft XII-VII technique, ansa-facial anastomosis are known to be variation technique that have been developed for reducing such a complication after surgery. In this paper, this author introduces details of surgical techniques and results for maximize the facial function and minimize the hemi-tongue paralysis.