uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Bylund, Nina
Publications (4 of 4) Show all publications
Jensson, D., Enghag, S., Bylund, N., Jonsson, L., Wikström, J., Grindlund, M. E., . . . Rodriguez-Lorenzo, A. (2018). Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.. Plastic and reconstructive surgery (1963), 141(4), 582e-585e
Open this publication in new window or tab >>Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.
Show others...
2018 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 141, no 4, p. 582e-585eArticle in journal (Refereed) Published
Abstract [en]

In reanimation surgery, effortless smile can be achieved by a nonfacial donor nerve. The underlying mechanisms for this smile development, and which is the best nonfacial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural coactivation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic activity in muscles innervated by the masseter, hypoglossal, and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous electromyographic activity in facial muscles was also studied. Smile coactivated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer electromyographically measured coactivations compared with the tongue (two of seven versus five of seven). The trapezius muscle demonstrated no coactivation during mimic movements. Movements of the masseter, tongue, and trapezius muscles induced electromyographically recorded coactivation in the facial muscles. Bite resulted in the strongest coactivation of the zygomaticus major muscle. The authors demonstrated coactivation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong coactivation of the zygomaticus major muscle was noted. The narrower coactivation pattern in the masseter muscle may be advantageous for central relearning and the development of a spontaneous smile. The strong coactivation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-347468 (URN)10.1097/PRS.0000000000004235 (DOI)000428668900014 ()29595736 (PubMedID)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2019-10-03Bibliographically approved
Bylund, N., Jensson, D., Enghag, S., Berg, T., Marsk, E., Hultcrantz, M., . . . Jonsson, L. (2017). Synkinesis in Bell's palsy in a randomised controlled trial. Clinical Otolaryngology, 42(3), 673-680
Open this publication in new window or tab >>Synkinesis in Bell's palsy in a randomised controlled trial
Show others...
2017 (English)In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 42, no 3, p. 673-680Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study the development of synkinesis in Bell's palsy. Frequency, severity, gender aspects and predictors were analysed.

DESIGN: Data from the randomised controlled Scandinavian Bell's palsy trial including 829 patients.

MAIN OUTCOME MEASURES: Frequency and severity of synkinesis at 12 months were the main outcome measures. Mean Sunnybrook synkinesis scores, voluntary movement scores and composite scores between 6 and 12 months were compared.

RESULTS: In 743 patients with a 12-month follow-up, synkinesis frequency was 21.3%. There was no gender difference. Synkinesis was moderate to severe in 6.6% of patients. Those with synkinesis at 6 months had a synkinesis score of 4.1 (±2.8 sd), which increased to 4.7 (±3.2) (P = 0.047) at 12 months (n = 93). Sunnybrook composite score at 1 month was the best predictor for synkinesis development with receiver operating characteristics and area under the curve (AUC) 0.87. Risk for synkinesis increased with a lower Sunnybrook composite score. Furthermore, at 1 month, symmetry of voluntary movement had higher predictive value for synkinesis than resting symmetry with AUC 0.87 and 0.77, respectively. Gentle eye closure and open-mouth smile were the only independent significant predictive items (AUC 0.86).

CONCLUSIONS: Moderate-to-severe synkinesis was present in 6.6% of patients. The mean synkinesis score increased between 6 and 12 months, and outcome should therefore be evaluated after at least 12 months. Sunnybrook composite score and symmetry of voluntary movement at 1 month were good predictors for synkinesis.

National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-315889 (URN)10.1111/coa.12799 (DOI)000399941300024 ()27882653 (PubMedID)
Available from: 2017-02-22 Created: 2017-02-22 Last updated: 2019-10-03Bibliographically approved
Marsk, E., Bylund, N., Jonsson, L., Hammarstedt, L., Engström, M., Hadziosmanovic, N., . . . Hultcrantz, M. (2012). Prediction of nonrecovery in Bell's palsy using sunnybrook grading. The Laryngoscope, 122(4), 901-906
Open this publication in new window or tab >>Prediction of nonrecovery in Bell's palsy using sunnybrook grading
Show others...
2012 (English)In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 122, no 4, p. 901-906Article in journal (Refereed) Published
Abstract [en]

Objectives/Hypothesis: To develop a clinical prognostic model to identify Bell's palsy patients with risk for nonrecovery at 12 months.

Study Design: Data from a prospective, randomized, double-blind, placebo-controlled, multicenter study.

Methods: There were 829 patients with Bell's palsy randomized in a factorial fashion to treatment with prednisolone or no prednisolone. Facial function was assessed with the Sunnybrook grading scale. Univariate and multivariate logistic regression analyses at different time points were used to identify factors predicting nonrecovery, defined as Sunnybrook < 70 at 12 months. Variables studied were age, gender, time to inclusion, prednisolone treatment, side of palsy, pain at inclusion, and Sunnybrook scores. Factors of predictable significance were used to construct prognostic models at baseline, days 11 to 17, and at 1 month. Receiver operating characteristics curves were created to test the predictive capacity of the models.

Results: At baseline, treatment with prednisolone or no prednisolone (P = .0005), age (P = .04) and the Sunnybrook score (P = .0002) were significant factors for predicting nonrecovery. The receiver operating characteristics area under the curve at baseline for these three variables was 0.74 (sensitivity 0.83, specificity 0.57). At days 11 to 17 and at 1 month, the Sunnybrook score was the only significant predictive variable. The respective areas under the curves for the Sunnybrook score at these time points were 0.83 (sensitivity 0.81, specificity 0.75) and 0.94 (sensitivity 0.91, specificity 0.85).

Conclusions: Sunnybrook grading at 1 month most accurately predicts nonrecovery at 12 months in Bell's palsy.

Keywords
Facial palsy, facial paralysis, facial nerve, prognosis, multivariate analysis, receiver operating characteristics, area under the curve, Level of Evidence: 1b
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-173334 (URN)10.1002/lary.23210 (DOI)000301714800039 ()
Available from: 2012-04-24 Created: 2012-04-23 Last updated: 2017-12-07Bibliographically approved
Berg, T., Bylund, N., Marsk, E., Jonsson, L., Kanerva, M., Hultcrantz, M. & Engström, M. (2012). The Effect of Prednisolone on Sequelae in Bell's Palsy. Archives of Otolaryngology - Head & Neck Surgery, 138(5), 443-447
Open this publication in new window or tab >>The Effect of Prednisolone on Sequelae in Bell's Palsy
Show others...
2012 (English)In: Archives of Otolaryngology - Head & Neck Surgery, ISSN 0886-4470, E-ISSN 1538-361X, Vol. 138, no 5, p. 443-447Article in journal (Refereed) Published
Abstract [en]

Objective: To study whether prednisolone reduces sequelae in Bell's palsy. Design: Prospective, randomized, double-blind, placebo-controlled, multicenter trial with 12 months of follow-up. Setting: Seventeen referral centers. Patients: In all, 829 patients aged 18 to 75 years. Interventions: Randomization within 72 hours in a factorial fashion to placebo plus placebo (n=206); prednisolone, 60 mg/d for 5 days, with the dosage then tapered for 5 days, plus placebo (n=210); valacyclovir hydrochloride, 1000 mg 3 times daily for 7 days, plus placebo (n=207); or prednisolone plus valacyclovir (n=206). Main Outcome Measures: Facial function at 12 months assessed with the Sunnybrook and House-Brackmann grading systems. Results: In 184 of the 829 patients, the Sunnybrook score was less than 90 at 12 months; 71 had been treated with prednisolone and 113 had not (P<.001). In 98 patients, the Sunnybrook score was less than 70; 33 had received prednisolone and 65 had not (P<.001). The difference between patients who received prednisolone and who did not in House-Brackmann gradings higher than I and higher than II was also significant (P<.001 and P=.01, respectively). No significant difference was found between patients who received prednisolone and those who did not in Sunnybrook scores less than 50 (P=.10) or House-Brackmann grades higher than III (P=.80). Synkinesis was assessed with the Sunnybrook score in 743 patients. Ninety-six patients had a synkinesis score more than 2, of whom 33 had received prednisolone and 63 had not (P=.001). Sixty patients had a synkinesis score more than 4, of whom 22 had received prednisolone and 38 had not (P=.005). Conclusion: Prednisolone significantly reduces mild and moderate sequelae in Bell's palsy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-177629 (URN)000305415100001 ()
Available from: 2012-07-17 Created: 2012-07-17 Last updated: 2017-12-07Bibliographically approved
Organisations

Search in DiVA

Show all publications