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.
The aim of the present study was to assess quality of life before and after surgery for hemifacial spasm, in order to validate two specific quality of life scales translated in French. Surgical ...results and complications were reported.
Twenty-three patients with hemifacial spasm treated by microvascular decompression were retrospectively included. The HFS-8 and HFS-30 quality of life scales were translated from English into French using a forward-backward method and implemented on patients at least one year after surgery.
Median HFS-8 and HFS-30 values were respectively 16±12.5 (range: 8–20.5) and 38±38.5 (range: 23–61.5) before surgery and 0.5±4.5 (range: 0–4.5) and 5±17.5 (range: 1–18.5) after surgery, showing significant improvement in quality of life (P<0.001). The internal consistency of both scales was excellent (Cronbach's alpha>0.9), and they were significantly correlated (Pearson coefficient=0.95; 95% CI 0.91; 0.98; P<0.0001). Success rates were 83% and 91%, respectively, after primary and revision surgeries. Complications were transient with minor consequences in 80% of cases, but could impact quality of life when lasting.
These results support the validity of the French versions of HFS-8 and HFS-30. Microvascular decompression is a safe and effective treatment for hemifacial spasm, and these scales are reliable tools to assess postoperative quality of life.
La contagion émotionnelle faciale résulte d’un mimétisme spontané de l’expression faciale d’autrui et d’une rétroaction faciale. L’étude se propose d’analyser la production et la perception des ...expressions faciales émotionnelles chez les patients présentant une paralysie faciale périphérique.
La contagion émotionnelle des patients a été analysée en terme de congruence, d’arousal, d’ambiguïté et de temps de réaction. La latéralité de la paralysie faciale a également été étudiée. Par la suite, la perception des expressions faciales des patients paralysés faciaux a été comparée à celle d’une population contrôle.
Quarante-trois patients et 133 sujets témoins ont participé à l’étude. Un protocole informatisé constitué de tâches de reconnaissance des expressions faciales émotionnelles d’acteurs (stoic Database) et de 8 patients, modalité statique et dynamique, a été administré à 35 patients ; leur motricité bucco-linguo-faciale (MBLF), la sévérité de l’atteinte (House et Brackmann Grading Scale) et l’amplitude de leur sourire (Échelle normalisée du sourire) ont été évaluées. L’effet miroir a été testé et des questionnaires spécifiques sur leur qualité de vie ont été proposés aux patients. Les sujets témoins ont constitué un jury naïf afin d’étudier d’éventuelles différences inter-groupes.
Les expressions faciales des patients paralysés ont été moins bien identifiées que les expressions des acteurs par le jury naïf (patients : 39,62 %, acteurs : 89,08 %, p<0,001, F=27,21). Les expressions faciales des patients sont évaluées comme étant moins intenses (arousal des patients : 2,37 0,72, acteurs : 6,17 1,63, p< 001, F=35,24). Les sourires des patients sont significativement plus intenses quand la paralysie faciale est latéralisée à gauche (arousal gauche 3,56/10, arousal droite 3,43/10, p=0,032) Les patients présentent une perception des expressions faciales moins précise que les sujets témoins (score moyen des patients : 66,72/123 ; score moyen des contrôles : 70,35/123 ; p=0,013, F=6,306). La durée de la paralysie faciale influence la perception des visages en modalité dynamique (p=0,008, F=7,934).
La contagion émotionnelle des patients est entravée non seulement sur le versant production des expressions faciales mais également sur le versant perception.
It is well-established that botulinum toxin (BT) injections improve quality of life in patients with postparalytic hemifacial spasm. Nevertheless, injection-related pain and contracture-related pain ...have not yet been studied. The primary objective of our study was to evaluate injection-related pain in patients with facial palsy sequelae, and to compare the standard technique (syringe) with the Juvapen device. The secondary objective was to evaluate the improvement of contracture-related pain one month after BT injection.
We conducted an observational, prospective, monocentric study based on 60 patients with facial palsy sequelae who received BT injections in our university ENT (ear, nose throat) department. There were 30 patients in the Juvapen group (J) and 30 in the standard technique group (ST). All patients completed Numerical Rating Scale (NRS) questionnaires immediately after the injections and one month later.
The average NRS score was 1.33/10 with Juvapen and 2.24/10 with the standard technique (
= 0.0058; Z = 2.75). In patients with contracture-related pain, the average NRS score was 3.53 before BT injection, and 0.41 one month after BT injection (
= 0.0001).
Juvapen is a less-painful injection technique than the standard one. BT reduces contracture-related pain one month after injection.
Objective The aim of this study was to assess the prognostic value of lymph node involvement in patients with squamous cell carcinoma of the oral cavity.
Study Design Retrospective study of 137 ...patients with T4 squamous cell carcinoma of the oral cavity treated by surgery and radiotherapy (84 N0, 23 N1, 16 N2, 14 N3). Twenty‐three patients in the N0 group had a history of surgery or radiotherapy. One hundred fourteen patients underwent limited or radical neck dissection unilaterally or bilaterally.
Methods The histological charts were reviewed and correlated with preoperative lymph node clinical stage. The local failure rate and the overall survival curves were calculated with respect to clinical and histological stages. The causes of death were analyzed.
Results No evidence of lymph node metastasis was found in 47.4% of cases (54 of 114 patients). Among the node‐positive (N+) patients, 39 had rupture of the lymph node capsule (R+). In the N0 group, 27.8% of patients were N+. Regional control rates after surgery and radiotherapy were 95% at 1 year and 85.4% at 5 years. The local failure rates were 6% in N0, 8.7% in N1, 31.2% in N2, 51.7% in N3, 9% in node‐negative (N−), and 29% in N+R+ patients. The overall survival rates at 3 and 5 years were, respectively, 44.7% and 34.8% in the N0 group, 37.7% and 37.7% (same rate at 3 and 5 years) in the N1 group, and 31.2% and 15.8% in the N2 group. None of the patients in the N3 group survived beyond 2 years. The overall survival rates at 5 years were 42.8% and 17.5% in the N− and N+ groups, respectively.
Conclusions In patients with locally advanced tumors (T4), clinical nodal status and histological nodal invasion were key prognostic factors. The presence of occult metastases in the N0 group justifies routine neck dissection.
To calculate the prevalence of sinonasal and ear involvement in an Erdheim-Chester disease (ECD) population, to describe the different ear, nose and throat (ENT) manifestations and to study the ...association between ENT involvement, other organ involvement, and BRAF mutations. We led a retrospective monocentric study in the national referral center for ECD. One hundred and sixty-two patients with ECD and ENT data were included between January 1, 1980 and December 31, 2020. Ear and nose clinical and radiological findings were noted. We described and studied the prevalence of ENT involvement in ECD population. The association between sinonasal and ear involvement, other organ involvement, and BRAF mutations was calculated. The prevalence of ENT manifestations is around 45%. No clinical rhinologic or otologic signs were specific to ECD. Sinus imaging was abnormal in 70% of cases. A bilateral maxillary sinus frame osteosclerosis was highly specific of ECD. Associations were found between the sinus MRI imaging type and BRAF status, central nervous system involvement, cerebellum involvement and xanthelasma. Sinonasal or ear involvement is frequent in ECD and has specific imaging features for sinuses. Trial registration: #2011-A00447-34.
(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.
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