Bell's palsy

[physiobob]

Physiobob,

Asap , searched for its meaning to find you mean as soon as possible .I agree with you regarding the educational role .

My Question regarding when (Timing ) was concerning the Electro-role as Ultrsound and espicially Electrical Stimulation When ??

Tung,

Seems you know Synkinesis ,So why did not you comment regarding it ?
Seems most of moderate to severe nerve facial injuries develop Synkinesis ,our role could ,unfortunately, share in developing Synkinesis .

Cheers
Emad

syn·ki·ne·sis (sĭn'kə-nē'sĭs, -kī-, sĭng'-) pronunciation, noun.

Definition: Involuntary movement of muscles or limbs accompanying a voluntary movement.

Facial synkinesis

Definition

Facial synkinesis is the involuntary movement of facial muscles that accompanies purposeful movement of some other set of muscles; for example, facial synkinesis may result in the mouth involuntarily closing or grimacing when the eyes are purposefully closed.

Description

Facial synkinesis occurs during recuperation from conditions or injuries that affect the facial nerve, for example during recovery from Bell's palsy. During recovery, as the facial nerve tries to regenerate, some new nerve twigs may accidentally regrow in close proximity to muscles that they wouldn't normally innervate (stimulate). Facial synkinesis may occur transiently, during recovery, or may become a permanent disability.

As with all facial injuries or palsies, facial synkinesis can cause considerable emotional distress. Lack of control over one's facial expressions is known to be a serious psychological stressor.

Interestingly electrotherapy e.g. muscle stimulation has been cited as both a treatment and a cause of synkinesis. The difficult thing to work out is what is compensatory movement and what is a true synkinesis. Any budding or sprouting of a nerve is going to take time to develop and so one cannot possibly suggest that a dyskinesia in the early post facial palsy client is due in fact to synkinesis that has resulted from nerve sprouting. More likely it is due to the client trying to hard to get the appropriate muscles to contract. This is evident all the time in stroke and we call it compensatory strategy or compensatory movements which are the result really of trying to hard.

it is therefore important to assess whether these movements are due to "effort" or are truely due to unwanted, aberrant movements that occur with volitional and spontaneous movements.

Causes and symptoms

Facial synkinesis can follow any injury or condition causing palsy or paralysis of the facial nerve. The most common associated disorder is Bell's palsy; about 40% of all individuals who are recovering from Bell's palsy will experience facial synkinesis during recovery.

Note: Other conditions that may prompt the development of facial synkinesis include stroke, head injury, birth trauma, head injury, trauma following tumor removal (such as acoustic neuroma), infection, Lyme disease, diabetes, and multiple sclerosis.

Facial synkinesis can cause a number of abnormalities in the facial muscles. For example, when a patient with facial synkinesis tries to close his or her eyes, the muscles around the mouth may twitch or grimace. Conversely, when the patient tries to smile, the eyes may involuntarily close. The phenomenon of purposeful mouth movements resulting in involuntary eye closing is often referred to as "jaw winking." Unfortunately, as with any facial deformity or disability, facial synkinesis carries with it a high risk of concomitant depression, anxiety, and disruption of interpersonal relationships and employment.

Diagnosis

Diagnosis is usually apparent on physical examination. When the patient is asked to move certain facial muscles (i.e., smile), other facial muscles will be activated (e.g., the eyes may close involuntarily). When the underlying condition is unclear, a variety of tests may be required, such as CT or MRI scanning or EMG (electromyographic) testing to evaluate the functioning of the facial nerves and muscles.

Treatment team

In the broader sense Facial synkinesis may be treated by neurologists, physiotherapists or otorhinolaryngologists.

Treatment

Treatment may include:

* surgery, to remove causative tumors or other sources of pressure on and damage to the facial nerve
* steroid medications, to decrease inflammation of the facial nerve
* facial exercises, with and without mirror stimulated feedback
* electrical stimulation (this remains controversial, and may, in fact, worsen facial synkinesis in some patients)
* intensive video-assisted, electromyographic feedback facial muscle retraining
* injections of the paralytic agent botox into the muscle groups that are contracting involuntarily, or "hypervoluntarily"

Prognosis

The prognosis of facial synkinesis is quite variable, depending largely on the prognosis of the underlying condition that caused its development.

Resources

BOOKS

Goetz, Christopher G., ed. Textbook of Clinical Neurology. Philadelphia: W. B. Saunders Company, 2003.

PERIODICALS

Armstrong, M. W., R. E. Mountain, and J. A. Murray. "Treatment of facial synkinesis and facial asymmetry with botulinum toxin type A following facial nerve palsy." Clin Otolaryngol 21, no. 1 (February 1996): 15–20.

Messé, S. R. "Oculomotor synkinesis following a midbrain stroke." Neurology 57, no. 6 (September 2001): 1106–1107.

Münevver, Çelik, Hulki Forta, and Çetin Vural. "The Development of Synkinesis after Facial Nerve Paralysis." European Neurology 43 (2000): 147–151.

Zalvan, C., B. Bentsianov, O. Gonzalez-Yanes, and A. Blitzer. "Noncosmetic uses of botulinum toxin." Dermatol Clin 22, no. 2 (April 2004): 187–195.

WEBSITES

Diels, H. Jacqueline. New concepts in Non-Surgical Facial Nerve Rehabilitation. Bell's Palsy Infosite. (June 2, 2004). http://www.bellspalsy.ws/printretrain.htm.