Physical Therapy for Iatrogenic Facial Paralysis: A Systematic Review.

doi:10.1001/jamaoto.2020.3049

Paper

Physical Therapy for Iatrogenic Facial Paralysis: A Systematic Review.

Published Sep 24, 2020 · Nneoma S. Wamkpah, Latoya M. Jeanpierre, J. Lieu

JAMA otolaryngology-- head & neck surgery

UNKNOWN SJR score

15

Citations

1

Influential Citations

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Abstract

Importance Facial paralysis (FP) after surgery has substantial functional, emotional, and financial consequences. Most iatrogenic FP is managed by watchful waiting, with the expectation of facial function recovery. A potential treatment is physical therapy (PT). Objective To investigate whether noninvasive PT compared with no PT or other intervention improves facial nerve outcomes in adults with iatrogenic FP. Evidence Review Patients with noniatrogenic FP, facial reanimation surgery, and invasive adjunctive treatments (acupuncture or botulinum toxin injection) were excluded. A systematic review was conducted for records discussing iatrogenic FP and PT; a search for these records was performed using Ovid MEDLINE (1946-2019), Embase (1947-2019), Scopus (1823-2019), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform (2004-2019), and ClinicalTrials.gov (1997-2019). The references of all the included articles were also assessed for eligible studies. All human participant, English-language study designs with at least 2 cases were included. Quality assessment was performed using the Methodological Index for Non-randomized Studies (MINORS) and the revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. All search strategies were completed on May 16, 2019, and again on October 1, 2019. Findings Fifteen studies (7 of which were retrospective cohort studies) and 313 patients with iatrogenic FP were included in the systematic review. Most iatrogenic FP (166 patients [53%]) was associated with parotidectomy; traditional PT (ie, facial massage) was the most common intervention (196 patients [63%]). The use of various facial grading systems and inconsistent reporting of outcomes prevented direct comparison of PT types. Conclusions and Relevance Because of heterogeneity in reported outcomes of facial nerve recovery, definitive conclusions were unable to be made regarding the association between PT and outcomes of iatrogenic FP. Physical therapy probably has benefit and is associated with no harm in patients with iatrogenic FP.

Study Snapshot

Key takeawayPhysical therapy probably has benefit and is associated with no harm in patients with iatrogenic facial paralysis, but definitive conclusions on its effectiveness remain unclear due to heterogeneous reporting.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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References

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Integrated use of motor imagery and mirror therapy improves facial physical function and quality of life in patients with peripheral facial nerve palsy.

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The modified Sunnybrook Facial Grading System effectively assesses marginal mandibular branch function after parotidectomy, improving facial rehabilitation outcomes.

Citations

Characterizing the Impact of Facial Rehabilitation on Acute Facial Paralysis

Facial rehabilitation therapy can significantly improve functionality in patients with acute facial paralysis, regardless of time to treatment.

Effects of vagus nerve stimulation on cognitive function in patients with epilepsy: a systematic review and meta-analysis

Vagus nerve stimulation does not significantly improve cognitive function in patients with epilepsy, but significantly improves seizure frequency, mood, and quality of life.

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Post-parotidectomy facial nerve rehabilitation for both benign and malignant neoplasms shows significant improvement, with no significant difference in treatment duration or session number.

Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis

Selective stimulation of the zygomaticus muscle can be achieved using a broad phase duration range (25-1,000 ms) and an average amplitude 6 mA, with the most comfortable and effective results observed between 50 and 250 ms.

Mesenchymal Stem Cell-Derived Exosomes Promote Recovery of The Facial Nerve Injury through Regulating Macrophage M1 and M2 Polarization by Targeting the P38 MAPK/NF-Κb Pathway

MSC-derived exosomes show potential in promoting facial nerve injury recovery and reducing inflammation by targeting the p38 MAPK/NF-b pathway.

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Smile reanimation with masseteric-to-facial nerve transfer and cross-face nerve grafting effectively balances facial displacements, leading to more symmetric facial movements in patients with segmental midface paresis.