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Synkinesis in Bell's palsy in a randomised controlled trial
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Öron-, näs- och halssjukdomar.
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2017 (Engelska)Ingår i: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 42, nr 3, s. 673-680Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
2017. Vol. 42, nr 3, s. 673-680
Nationell ämneskategori
Oto-rino-laryngologi
Identifikatorer
URN: urn:nbn:se:uu:diva-315889DOI: 10.1111/coa.12799ISI: 000399941300024PubMedID: 27882653OAI: oai:DiVA.org:uu-315889DiVA, id: diva2:1076238
Tillgänglig från: 2017-02-22 Skapad: 2017-02-22 Senast uppdaterad: 2019-10-03Bibliografiskt granskad
Ingår i avhandling
1. Sequelae after Facial Palsy: Clinical, Anatomical and Electrophysiological Studies
Öppna denna publikation i ny flik eller fönster >>Sequelae after Facial Palsy: Clinical, Anatomical and Electrophysiological Studies
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Sequelae after peripheral facial palsy, which among others include synkinesis, non-functional smile and/or lower lip asymmetry, may be devastating for the patient. Bell’s palsy is the most common form of peripheral facial palsy. 

Aim: The aim was to study a) frequency and potential predictive factors of synkinesis in Bell’s palsy b) new surgical treatment options after facial nerve injury c) coactivation between muscles innervated by the facial nerve and the most common donor nerves in smile reanimation d) anatomical features of the lower lip depressors. 

Methods: I: Frequency, severity and early predictors of synkinesis development were studied in 829 Bell’s palsy patients. II and IV: Anatomical technical feasibility of intra-facial nerve transfers was analyzed. V: Anatomical features of lower lip depressor muscles were studied and a literature review for lower lip depressor myectomies was performed. III: Coactivation of muscles innervated by cranial nerves during voluntary facial movements was measured with electromyography. 

Results: I: In Bell’s palsy, synkinesis frequency was 21.3% at 12-months and Sunnybrook composite score at one month was found to be a good predictor for synkinesis. II and IV: A tension-free oculo-zygomatic and platysma-marginal mandibular nerve transfer was anatomically feasible. Full recovery of the lower lip after platsysma-marginal mandibular nerve transfer was found in a clinical case. III: The masseter muscle had a narrower coactivation pattern compared to the tongue. Bite induced a strong coactivation in the zygomaticus major muscle. V: The width of the depressor labii inferioris was 20 ± 4 mm and the distance from the midline to the lateral muscle border was 32 ± 4 mm. For the depressor anguli oris muscle, the corresponding measurements were 14 ± 3 mm and 54 ± 4 mm. The mean recurrence rate after lower lip myectomy reported in the literature is 21%.  

Conclusion: I: Synkinesis in Bell’s palsy was 21%. Sunnybrook composite score at one month is a good predictor for synkinesis. II: Oculo-zygomatic nerve transfer may be a suitable technique to reduce eye synkinesis and achieve a stronger smile. III: The narrow coactivation pattern in the masseter muscle may be advantageous for spontaneous smile development. IV: The platysma motor nerve transfer is a feasible procedure and can lead to full recovery in lower lip paralysis. V: Knowledge of the width of the depressor muscles is of importance to ensure complete resection in lower lip myectomy.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2019. s. 44
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1601
Nyckelord
Facial palsy, Marginal mandibular paralysis, Smile reconstruction, Synkinesis
Nationell ämneskategori
Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:uu:diva-394136 (URN)978-91-513-0766-4 (ISBN)
Disputation
2019-11-30, Skoog salen, Ingång 78-79, Akademiska sjukhuset, Uppsala, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-11-11 Skapad: 2019-10-03 Senast uppdaterad: 2019-11-27

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Bylund, NinaJensson, DavidRodriguez-Lorenzo, AndresJonsson, Lars

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Bylund, NinaJensson, DavidEnghag, SaraHadziosmanovic, NerminRodriguez-Lorenzo, AndresJonsson, Lars
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Öron-, näs- och halssjukdomarPlastikkirurgiUppsala kliniska forskningscentrum (UCR)
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