• 한방안이비인후피부과학회지
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• 제22권1호
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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.

• 대한두개안면성형외과학회지
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• 제20권4호
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• pp.265-269
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• 2019

Congenital hypoplasia of the depressor anguli oris muscle is a rare cause of asymmetrical crying facies in newborns. The clinical manifestations range from mild to severe asymmetry and may persist up to adulthood. In the current case, the patient did not exhibit other congenital anomalies or paralysis of other branches of the facial nerve. This adult patient presented with severe asymmetrical lower lip deformity during full mouth opening since birth. A chromosomal study for the detection of 22q gene deletion yielded negative results. The electromyography findings of the lower lip were insignificant. Depressor labii inferioris muscle resection was not effective, but bidirectional (horizontal and vertical) fascia lata grafting improved the aesthetic appearance of the asymmetrical lower lip. The patient showed improved lower lip symmetry during full mouth opening at 1 year after the surgery. Therefore, the details of this rare case are reported herein.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권3호
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• pp.288-297
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• 2005

Rehabilitation of the paralyzed face as a result of trauma or surgery remains a daunting task. Complete restoration of emotionally driven symmetric facial motion is still unobtainable, but current techniques have enhanced our ability to improve this emotionally traumatic deficit. Problems of mass movement and synkinesis still plague even the best reconstructions. The reconstructive techniques used still represent a compromise between obtainable symmetry and motion at the expense of donor site deficits, but current techniques continue to refine and limit this morbidity. In chronically paralyzed face, direct nerve anastomosis, nerve graft, or microvascular-muscle graft is not always possible. In this case, regional muscle transposition is tried to reanimate the eyelid and lower face. Regional muscle includes maseeter muscle, temporalis muscle and anterior belly of the digastric muscle. Temporalis muscle is preferred because it is long, flat, pliable and wide-motion of excursion. In order to reanimate the upper and lower eyelid, Upper eyelid Gold weight implantion and lower eyelid shortening and tightening is mainly used recently, because this method is very simple, easy and reliable.

• Archives of Plastic Surgery
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• 제45권2호
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• pp.135-139
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• 2018

Background Static reconstruction surgery that tightens the tension of the inferior tarsus, thereby raising the lax lower eyelid, is a common treatment for paralytic ectropion of the lower eyelid. We present one such operative procedure, in which an orbicularis oculi muscle flap was used. Methods The surgical technique involves partial resection of the tarsus and the skin, as well as a superior-based orbicularis oculi muscle flap that is sutured to the firm tissue present on the Whitnall tubercle. The muscle flap is approximately 7 mm in width and 15 mm in length, with a superior pedicle that is attached to the tarsus at the medial point of the resected tarsus. The procedure results in contact between the ocular surface and the lower eyelid. Results The procedure was performed in 11 patients with lower eyelid ectropion due to facial paralysis. Ten cases showed a favorable outcome following surgery, with stable results seen over an average follow-up period of 4.5 years. In one case, recurrence of ectropion was observed 2 months after surgery due to an insufficient correction, and the patient required repeat surgery. Conclusions The orbicularis oculi muscle flap was an effective means of suspension and was able to maintain long-term traction tension. This procedure can therefore be considered a favorable treatment option for lower eyelid ectropion due to facial paralysis.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권4호
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• pp.256-259
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• 2013

Botulinum toxin type A (BTX-A) inhibits muscle contraction, which leads to reversible muscle atrophy and paralysis. Therefore, BTX-A injection can be an effective treatment of facial asymmetry that originated from the uncoordinated muscle movement. A 52-year-old patient was referred from another hospital for the correction of post-traumatic sequelae. The patient had prominent scar in the mandibular symphysis area with asymmetric lower lip movement. The reason for this asymmetric lower lip movement was due to damage in the lower lip depressor muscle. After the injection of BTX-A on the lower lip depressors, asymmetric lip movement has been improved.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.348-352
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• 2013

Background Temporalis muscle transfer produces prompt surgical results with a one-stage operation in facial palsy patients. The orthodromic method is surgically simple, and the vector of muscle action is similar to the temporalis muscle action direction. This article describes transferring temporalis muscle insertion to reconstruct incomplete facial nerve palsy patients. Methods Between August 2009 and November 2011, 6 unilateral incomplete facial nerve palsy patients underwent surgery for orthodromic temporalis muscle transfer. A preauricular incision was performed to expose the mandibular coronoid process. Using a saw, the coronoid process was transected. Three strips of the fascia lata were anchored to the muscle of the nasolabial fold through subcutaneous tunneling. The tension of the strips was adjusted by observing the shape of the nasolabial fold. When optimal tension was achieved, the temporalis muscle was sutured to the strips. The surgical results were assessed by comparing pre- and postoperative photographs. Three independent observers evaluated the photographs. Results The symmetry of the mouth corner was improved in the resting state, and movement of the oral commissure was enhanced in facial animation after surgery. Conclusions The orthodromic transfer of temporalis muscle technique can produce prompt results by applying the natural temporalis muscle vector. This technique preserves residual facial nerve function in incomplete facial nerve palsy patients and produces satisfying cosmetic outcomes without malar muscle bulging, which often occurs in the turn-over technique.

• Journal of Acupuncture Research
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• 제19권2호
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• pp.238-249
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• 2002

Facial palsy is commonly encountered disease in the clinic but bilateral facial palsy is known as rare disease. Type of facial nerve paralysis include unilateral, recurrent ipsilateral, recurrent alternating and bilateral simultaneous palsies. Among the types, the reported incidence of bilateral simultaneous palsy is 0.3~2% of facial paralysis patients. We experienced I case of patient with bilateral simultaneous facial palsy that was concluded as bilateral bell's palsy. Objective : The purpose of this paper is to report the patient with bilateral facial palsy, who improved by oriental medical treatment. Another purpose is to review the current literature and to differential diagnosis of bilateral facial paralysis. Methods and Results : The patient was treated by acupuncture, herb medication and self-massage on facial muscle for 14 weeks. House-brackmann grading score was improved into I/I (Rt/Lt) from IV/IV. Conclusion : Through reviewing some literatures and reports, It is concluded that bilateral facial palsy was related to many other disorders and more ominous than unilateral facial palsy. therefore, its work-up should include a complete neurologic assesment and thorough evaluation. also, we consider that bilateral Bell's palsy can improve by oriental medical treatments.

• 대한기관식도과학회지
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• 제12권2호
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• pp.19-25
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• 2006

There have been numerous modalities to recover blink function of orbicularis oculi muscle in patients with facial paralysis. However, there is still no optimal method for reanimation of eyelid. In this study, we tried to recover blink function of paralyzed rabbit's eyelid with the ion polymer metal composite (IPMC) which is one of the electroactive polymers that is spotlighted as artificial muscle. We manufactured IPMC by plating the platinum over perfluorosulphonic acid polymer ($Nafion^{(R)}$). IPMC was coated by Norland optical adhesive for the purpose of insulation and keeping it from dry. IPMC modifications by roughening the surface of Nafion, repetitive plating (maximum 4 times) with platinum, and lengthening the width of IPMC were done. The facial paralysis was induced in the rabbit by sectioning of facial nerve at the main trunk. After minimum period of 4 weeks, IPMC was inserted in the paralyzed rabbit's eyelid. By modification, the force generated by IPMC was enhanced. Restoration of blink function in paralyzed rabbit was achieved on electrical stimulation of the IPMC by 5 voltage direct current. IPMC can be promising option for facial reanimation, but further studies are needed to enhance the efficiency of IPMC.

• 대한두개안면성형외과학회지
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• 제21권6호
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• pp.351-356
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• 2020

Background: We have devised a novel surgical method, termed as temporalis muscle tendonperiosteum (T-P) compound surgical method, by modifying pre-existing techniques. Our method is characterized by elevation of temporalis muscle tendon and the periosteum of the mandibular ramus as a single compound. Here, we describe the concept and clinical outcomes of our method. Methods: We conducted both a cadaveric study and a clinical study. First, we used four human cadavers (two males and two females) to confirm the anatomy of the temporalis muscle tendon and availability of sufficient length extension through the elevation of the T-P compound. Moreover, we obtained measurements of the mouth angle and the philtrum angle from a total of six patients (two males and four females) and compared them between preoperatively and postoperatively. Results: The mean length of the periosteal portion was measured as 2.43± 0.15 cm (range, 2.2-2.6 cm). There was an improvement in the mouth angle postoperatively as compared with preoperatively (7.2°± 3.0° vs. 14.5°± 4.7°, respectively). Moreover, there was also an improvement in the philtrum angle postoperatively as compared with preoperatively (7.2°± 3.4° vs. 17.2°± 6.5°, respectively). Conclusion: Our method is a simple, minimally-invasive modality that is effective in achieving good clinical outcomes. Its advantages include an ability to achieve a firm extension of the temporalis muscle tendon as well as a lack of requirement for a donor site that may cause complications.

• 한방안이비인후피부과학회지
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• 제22권3호
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• pp.167-177
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• 2009

Objective : Bell's palsy is common and has many clinic study. but bell's palsy sequela is not enough study until now. So this study was evaluated bell's palsy sequela, catamnesis, demonstrator and herb. Methods : From December 2007 to November 2008, patients who visited Dong-seo Oriental Medicine ENT. A clinic study was done on patient who were diagosed bell's palsy, onset 2months over when first visited OPD and treated 3weeks over in Dong-seo Oriental Medicine Cental. To evaluate grade of paralysis, House-Brackman Scale was used. We classified period of improving, sequelas symptom except of facial muscle paralysis, Oriental Medicine diagnosis and herb. Results & Conculsion : 1. The distribution of sex : male 38.88%, female 61.11%. The distribution of age was presented that forty to fifty was the most in 10case(55.55%) 2. The distribution of the region of facial palsy : Rt(55.55%), Lt(44.44%) 3. In distribution of period of first HB-Scale improving : 1~2month was most in 10case(55.55%) 4. In distribution of symptom except of facial muscle paralysis : Dryness of eye 33.33%, Tearling 22.22%, Facial hypoesthesia 22.22%, Mastoid pain 22.22% 5. The distribution of demonstrator : Gi Deficiency and Deficiency of Both Gi and Blood was most in 11case(50%) 6. The distribution of treatment : Palmul-tang and Bojungikki-tang was the most herb in 6case(33.33%) and only acupuncture treatment and rehabilitation treatment was 5case(27.77%).