• Journal of Korean Medicine Rehabilitation
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• v.33 no.2
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• pp.87-94
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• 2023

This study aims to demonstrate the effectiveness of facial chuna manual therapy in treating the sequelae of Bell's palsy. Four patients were treated with facial chuna manual therapy once a week for 4 weeks, consisting of facial muscle massage, acupoint pressure, contracture chuna, and synkinesis chuna. The changes in symptoms (contracture and sysnkinesis) were measured using the Sunnybrook Facial Grading Scale (SFGS), Synkinesis Assessment Questionnaire (SAQ), Facial Disability Index (FDI), Contracture/Synkinesis scale using a facial scanning system, Numeric Rating scale (NRS) for synkinesis or contracture, and Was It Worth It questionnaire. After treatments, SFGS, Contracture/Synkinesis scale, and NRS for synkinesis or contracture showed significant improvements. SFGS increased in three cases from 39~76 to 52~85 score. SAQ decreased in two cases from 53.33~57.78 to 40.00~55.56. FDI increased in three cases from 120~128 to 138~145. These results suggest that Korean medicine treatment, including facial chuna manual therapy can be effective in improving the sequelae of Bell's palsy.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.32 no.3
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• pp.202-211
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• 2019

Objectives : This study is to report 4 cases of the facial palsy sequelae synkinesis treated with Thread-Embedding Acupuncture(TEA) and Jung-An acupuncture(JAA). Methods : 4 patients received Korean medical treatment consists of TEA and JAA. Results : After treatment, relief of facial synkinesis and enhancement of facial symmetry were observed in all patients. Conclusions : This study suggests that TEA and JAA may be effective on facial palsy sequelae synkinesis. Therefore it seems that additional reporting about relevant studies is likely to be required.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.25 no.4
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• pp.1-11
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• 2012

Objective : The purpose of this study is to analyze research trends on facial synkinesis after bell's palsy in order to build stepping stone in the hope of further related study in Korean medicine society. Methods : We searched Pubmed with the title "facial synkinesis" only developed after bell's palsy for the last 10 years and analyzed their impact factors, interventions, types of study, published countries, journals and years. Results : We found 12 papers and interventions included in each studies turned out to be effective and showed meaningful outcomes, but, the number of papers is still inadequate though, constantly published annually. And we were unable to find any studies with oriental treatments. Conclusions : Further attention and studies are needed on this topic in Korean medicine society in order to search appropriate oriental clinical care for the bell's palsy patients suffering facial synkinesis.

• Annals of Clinical Neurophysiology
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• v.7 no.2
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• pp.88-92
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• 2005

Blink reflex could be a useful tool to differentiate facial synkinesis as one of complications of facial neuropathy, from volitional associated movements. We had performed applied blink reflex test for 23 patients with objective evidence of hemifacial weakness in which orbicularis oculi muscle(zygomatic branch) and mentalis muscle(mandibular branch) are electrophysiologically evaluated in response to supraorbital stimulation of trigeminal nerve. For an unaffected side of face there is no evidence of positive blink reflex from the mentalis muscle. We concluded that a positive blink reflex from mentalis muscle is almost always suggestive of chronic facial neuropathy even in clinical silence of facial synkinesis, or an aberrant reinnervation after peripheral facial neuropathy, and does not electrophysiologically correlate with the severity of facial palsy.

• Journal of Acupuncture Research
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• v.28 no.2
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• pp.75-87
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• 2011

Objectives : The purpose of this study is research on facial palsy sequelae and evaluating scale that have studied insufficiently until now. Methods : We researched on the symptoms, epidemiology and evaluating scale of facial palsy sequelae. For this, we searched the research papers on facial palsy sequelae and the clinical papers that find out the effect of treatment by evaluating facial palsy sequelae. Results : The symptoms of facial palsy sequelae are synkinesis, contracture, spasm, crocodile tears syndrome, tearing decrease, gustation impairment, hearing impairment, tinnitus, hyperacusis, etc. Among these, synkinesis, contracture, spasm and crocodile tears syndrome are the most frequently observed broadly. The poor prognosis factor of facial palsy can be the risk factor of facial palsy sequelae. For example, severe degeneration of facial nerve can be the risk factor of facial palsy sequelae. Most of clinical papers on facial palsy sequelae have used NRS(numeric rating scale) as evaluating scale. But NRS is very subjective scale. The scales of Stennert, Peitersen, Murata et al. can evaluate facial palsy sequelae grossly. Sunnybrook scale, Sydney scale, SAQ(synkinesis assessment questionnaire), the scale of Kim, the scale of Scott, HFS-7(hemi facial spasm), HFS-36 and Schirmer's test can evaluate the respective symptoms of facial palsy sequelae. Conclusions : The symptoms of facial palsy sequelae are synkinesis, contracture, spasm, crocodile tears syndrome, etc. Most of clinical papers on facial palsy sequelae have used NRS as evaluating scale. There were some scales that can evaluate facial palsy sequelae grossly and respectively. In future, we will need more progressed study of facial palsy sequelae and evaluating scale.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.633-641
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• 2022

Introduction In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes. Methods Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale. Results FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, -24.51 to -14.66, p < 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly (p < 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment (p < 0.01), more chemodenervation episodes (p < 0.01), increased doses of botulinum toxin (p < 0.001), and having higher EGGS score (p < 0.001). Conclusions This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.22 no.1
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• pp.157-171
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• 2009

Objective : The face is very important for human communication. So facial palsy patients experience not only physical disturbances but also serious emotional stress. Therefore the focus of treatment must be to not only aid the recovery of objective symptoms but also the improvement of subjective quality of life. However there has not been enough Oriental Medical study in this field until now. Thus this study was begun to suggest a useful index for the treatment of facial palsy. Methods : Grade of paralysis, sequelas, and quality of life were used for evaluation. To evaluate Grade of paralysis, House-Brackman Grade was used as the Gross scale and Kim's Grade was used as the Regional scale. Sequelas were evaluated by muscle contraction, synkinesis, NA, and grade of philtrum tilt. Quality of life was evaluated by SF-36v2, Facial Disability Index, and Vas. Results & Conclusion : 1. The change of grade of paralysis between the early and the present time reveals remarkable improvement statistically. 2. There was a remarkable improvement in all parts of quality of life except several areas of SF-36(RP, RE, MH, VT) 3. In only PF(Physical Function) of FDI, quality of life increased remarkably according to the improvement of grade of paralysis. 4. There is the positive relationship among Kim's grade, HB grade and Synkinesis 2. 5. Synkinesis among sequelas has the greatest effect on quality of life. And muscle contraction, change of NA, and grade of philtrum tilt also affect quality to some extent. 6. There was no remarkable relationship between the period of illness and change of quality of life. 7. Change of NA is shown after 3 months of illness and synkinesis becomes worse after 6 months of illness.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.13 no.2
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• pp.152-164
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• 2000

1. We experienced one case with facial palsy and paralytic strabismus, which improved under the treatment of Acupuncture, Infrared, Electroacupuncture and Massage. 2. The prognostic factor of facial palsy was affected by On Set and neurodegeneration (such as synkinesis, contraction, spasm and crocodile tear). 3. In facial palsy, Myoneural Excitability Test by Electroacupuncture, which will need the objective clinical standard, was available for the evaluation of therapeutic effect and prognosis.

• Journal of Haehwa Medicine
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• v.28 no.1
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• pp.1-12
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• 2019

Objectives : The aim of this study is to review clinical studies of facial palsy sequelae treatment Methods : We used search engines such as PUBMED, OASIS, RISS. We limited sequelae as the cases after three months from the onset. We excluded the studies including operational treatments. We considered papers pubulished only after year 2000. Results : The kinds of treatments were acupunture treatment, physical therapy, Botulinum toxin, and steroids and antiviral agent. Four studies about acupuncture treatment were searched. Two were case studies and the other two were case series studies. Six studies about physical therapy were searched and they were devided into three according to their specific methods - neuromuscular training and biofeedback, electrical stimulation, and facial exercises. We reviewed three studies about Botulinum toxin and 3 studies about combined therapy. Conclusions : Evidence level of the acupuncture studies was not high. Neuromuscular retraining and biofeedback therapies were shown to be effective especially to synkinesis. Mime therapy, one of the facial exercise has significant effect. Electrical stimulation is thought to activate the plasticity of central nerve system. Botulimum Toxin has effective temporary treatment. Steroid therapy increases recovery rate and reduces sequelae.

• Journal of Acupuncture Research
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• v.33 no.3
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• pp.89-99
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• 2016

Objectives : This study was performed to develop objective methods for evaluating facial palsy sequelae using a 3D Facial Scanning System. Methods : Fifty-eight patients with facial palsy sequelae were selected. Their medical records were reviewed to collect demographic data, facial palsy sequelae evaluation, Facial Disability Index questionnaire, and test results (3D Facial Scanning System). Five different facial expressions (at rest, eye closure, eyebrow elevation, smiling, and whistling) were photographed. Sunnybrook Scale was associated with distances between predetermined facial points. Results : The average Sunnybrook composite score was $58.88{\pm}17.31$. Secondary movements (mouth to eye synkinesis, contracture of eye, and contracture of mouth) showed significant difference according to the Sunnybrook Scale. In voluntary movements, eyebrow height at eyebrow elevation, length between mouth angle and central line while whistling, and eyelid width at maximum eye opening showed significant difference. Facial palsy Sequelae Index (FSI) was correlated with Sunnybrook sub-scales (resting symmetry, voluntary movement, and synkinesis). Conclusion : These results demonstrate that a 3D Facial Scanning System is useful for evaluating facial palsy sequelae. This method may facilitate objective evaluation for facial palsy sequelae and it could be applied in clinical trials.