Bell's palsy-induced blepharospasm
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Blepharospasm
Lagophthalmos
Hemifacial spasm
Blepharospasm
Lagophthalmos
Hemifacial spasm
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Hemifacial spasm
Blepharospasm
Apraxia
Lagophthalmos
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Concerning the above article (Facial Plast Surg 2015;31(02):145–151; doi: 10.1055/s-0035-1549037), the Editors have been made aware of a significant overlap with another article “Advances in Facial Reanimation” by Tate and Tollefson published in Current Opinion in Otolaryngology & Head and Neck Surgery (2006;14(04):242–248; doi: 10.1097/01.moo.0000233594.84175.a0).
Orbicularis oculi muscle
Facial paralysis
Facial muscles
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An electrophysiological study of Bell's palsy in children was reported. Direct response to facial nerve stimulation was tested in 28 patients. Of these, 17 patients were further tested for electrically elicited blink reflex. The reduction in amplitude of direct response on affected side was characteristic of Bell's palsy. The direct response was evoked on affected as well as nonaffected side. The amplitude of the direct response on the affected side was expressed as percentage of that on the nonaffected side (ratio of M response amplitude:RMA). 13 patients showed incomplete recovery after 3 months, and RMA of the 11 patients of them were reduced below 30%. In the patients showing good clinical recovery within 2 months, RMA returned to normal promptly. In the blink reflex, R1 R2 components were found to be persistent on the first examination, suggesting a satisfactory functional outcome in Bell's palsy. As these electrophysiological methods are conventional assessing facial nerve function, it seemed to be valuable for the follow up of children with Bell's palsy.
Electroneuronography
Bell Palsy
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Twelve patients with involuntary synkinetic eyelid closure were given 40 injections of botulinum A toxin. Temporary improvement in involuntary eyelid closure was observed in all 12 patients. Eleven of the 12 patients desired repeated injections. Dose requirements for this indication were compared with doses used in 697 injections in 112 patients with essential blepharospasm and Meige syndrome. Additionally, dose comparisons were made with 269 injections in 71 patients with hemifacial spasm. Dose requirements needed to treat aberrant regeneration of the facial nerve were substantially less than needed to treat blepharospasm and Meige syndrome. The dose requirement was similar to that in hemifacial spasm treatment. The reason for the differences probably relates to existing muscular denervation associated with hemifacial spasm and aberrant facial nerve regeneration.
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One hundred five patients received 391 graded injections of Clostridium botulinum type A toxin (Oculinum) to treat uncontrollable facial muscle spasm. Patients had essential blepharospasm (n = 61), hemifacial spasm (n = 24), or aberrant regeneration of the seventh cranial nerve (n = 20). Muscle spasms were reduced within two days of the first injection of toxin and, in most cases, the drug effect lasted three to four months. Control of facial muscle spasm was achieved in all patients. Complications related to treatment included transient blepharoptosis (n = 7), diplopia (n = 2), and altered facial expression (n = 11). Systemic side effects were not observed. Select chemodenervation of facial muscles with graded injections of botulinum toxin is a useful adjunct to control blepharospasm, hemifacial spasm, and facial spasm due to aberrant regeneration of the facial nerve.
Hemifacial spasm
Blepharospasm
Facial muscles
Clostridium botulinum
muscle spasm
Botulism
Muscle relaxant
Orbicularis oculi muscle
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Forty-one patients with unilateral or bilateral facial spasm were studied by electrophysiologic examination. All patients received local treatment with botulinum toxin. In the patients and controls, the measurements of the blink reflex revealed changes that (1) may indicate a central origin of the spasm in some cases, and (2) make it likely that the trigeminal nerve influences the facial nucleus and is thus involved in the regulation of the spasm.
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Objective To investigate the relationship among blink reflex, facial nerve electroneurography and functional lesion at the early stage of Bell's palsy. Methods Blink reflex and electroneurography of facial nerve were performed in 25 patients with early Bell's palsy.They were divided into mild to moderate damage and severe damage according to the result. They were evaluated by House-Blackmann(H-B) scale and were identified: grade I, normal; grade II-III, mild-moderate facial paralysis; grade IV-VI, severe facial paralysis. Results The positive rate of blink reflex was 100%, with the proportion of mild- moderate damage was 28% and severe damage was 72%. H-B scale evaluation showed the percentage of mild-moderate facial paralysis was 44%, severe facial paralysis was 56%, which was consistent with blink reflex(P0.05). The positive rate of electroneurography was 52%, with the proportion of mild- moderate damage was 44% and severe damage was 8%, which was inconsistent with H-B scale evaluation(P0.05). Conclusion Blink reflex is preferable to electroneurography in evaluating facial paralysis degree at the early stage of Bell's palsy.
Electroneuronography
Facial paralysis
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Botulinum toxin blocks acetylcholine release at the neuromuscular junction causing paralysis that is reversed within 4 months. The toxin was well known for its lethal effect when ingested with food (botulism); however, it was found to be highly effective in various disorders, both cosmetic and noncosmetic. The therapeutic uses in ophthalmology include treatment of strabismus, spastic focal facial dystonias, induction of temporary ptosis in cases of lagophthalmos (chemotarsorrhaphy), temporary correction of dysthyroid upper eyelid retraction, suppression of lacrimal gland secretion to temporarily control gustatory lacrimation, some cases of obstructive epiphora and primary hyperlacrimation, and temporary correction of lower lid entropion. In this prospective study, we evaluate the results of using botulinum toxin A (botox) injection in some periorbital pathologies namely, focal facial dystonias, lower lid entropion, lagophthalmos, and epiphora. Fifty patients were treated with botox (20 patients with focal facial dystonias, nine with lagophthalmos, eight with lower lid entropion, and 13 with epiphora), different techniques were used according to the pre-existing pathology, and the following data were recorded: age and sex, total dose for each injection, onset and duration of effect, degree of improvement, and the occurrence of any adverse effects. The study results supported the high efficacy of botulinum toxin for treatment of blepharospasm, hemifacial spasm, lagophthalmos, lower lid entropion, and epiphora, with marked to moderate improvement in 99, 87.5, 55.5, 75, and 92.3% of patients, respectively. Few side effects occurred but they resolved spontaneously without residues. We concluded that botulinum toxin A is a safe and effective treatment with a temporary outcome that may be desirable in certain situations.
Lagophthalmos
Blepharospasm
Entropion
Hemifacial spasm
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To investigate possible abnormalities of the blink reflex pathways, we analyzed the latencies and amplitudes of the blink reflex responses in the orbicularis oculi (Ooculi) muscle, following supraorbital nerve stimulation, in 19 patients with blepharospasm, 16 patients with torticollis spasmodica and 22 control subjects. Furthermore, in order to examine the suprasegmental control of the responses, the reflex responses were also evoked in the orbicularis oris (Ooris) muscle after stimulation of the ipsilateral supraorbital nerve. The responses were recorded only when subjects had no contractions of the eyelid muscles, either involuntarily, voluntarily or spontaneously; this could be controlled by a sound signal. The metrics of the reflex responses in the Ooculi and Ooris muscles in patient groups were comparable to those in controls. Our data indicate that the afferent and efferent pathways of the reflex arc and the suprasegmental control of the reflex are intact in patients with blepharospasm and torticollis spasmodica, at least during spasm-free intervals. Alterations of responses may occur during spasms due to either segmental or suprasegmental changes.
Blepharospasm
Supraorbital nerve
Orbicularis oculi muscle
Hemifacial spasm
Facial muscles
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