Effectiveness of facial exercise therapy for facial nerve dysfunction after superficial parotidectomy: a randomized controlled trial

Abstract

Objectives: To compare the effectiveness of a daily home-based facial exercise therapy with a supervised rehabilitation technique for the treatment of postoperative facial dysfunction in patients undergoing conventional superficial parotidectomy. Design: Prospective, randomized trial, controlled. Setting: Surgery and Rehabilitation Units, university hospital. Subjects: Consecutive patients (n=79, mean age 48 years) who underwent superficial parotidectomy with facial nerve dissection were randomly divided into two groups. Intervention: Control group (CG) were given a daily homework manual to perform ordinary postoperative facial mimic exercises autonomously in front of the mirror at home. Experimental group (EG) patients with moderate-severe paresis received supervised rehabilitation therapy that consisted in weekly sessions with facial exercises and massages and performed daily facial exercises at home. EG patients with slight paresis were instructed to undertake self-massage and mirror exercises. Main outcome measures: Postoperative dysfunction of facial nerve and branches was quantified measuring the prevalence, magnitude and duration of paresis by the House-Brackmann Facial Nerve Grading System up to 12th months. Results: Facial paresis incidence at 1st week was 77.2%, being the marginal-mandibular nerve the most affected (64.5%). No statistically significant differences were found at any time of the study when comparing the frequency, magnitude and duration of paresis between EG and CG and among patients who had presented moderate-severe paresis. In the absence of intraoperative nerve injury, complete recovery of facial mobility was observed within 12 months, regardless of treatment group. Conclusion: Rehabilitation therapy and mirror facial exercises performed autonomously at home were equally effective for postoperative functional recovery.

Complications after superficial parotidectomy for pleomorphic adenoma

“…The function of the facial nerve was graded with the House-Brackmann facial nerve grading system (HBFNGS). The HBFNGS is a widely validated instrument ( 13 , 14 ) that classifies the grade of clinical paresis from grade I (no paresis) to grade VI (total paresis). For this study, it was considered that an affectation of grade II or above in either of the nerve branches had a clinical paresis of the facial nerve.…”

Parotidectomy-related facial nerve lesions: proposal for a modified Sunnybrook Facial Grading System

“…Even the Facial Nerve Grading Scale 2.0 (the revised HB) 22 , which proposes a regional evaluation of the face, does not enable the evaluator to distinguish whether the dysfunction of the oral region is related to the buccal branch, or to the MMB, or both. An adapted HB approach has been used to assess the facial nerve branches post-parotidectomy 23 . However, some aspects of this method were not clear, such as the criteria to objectively differentiate between some discrete nuances of the HB grades (III and IV), and which muscles or facial expressions were selected to assess each branch (especially the buccal).…”

“…At the first outpatient physiotherapy appointment (median time after surgery: 28 days, interquartile range [IQR]: [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], the assessment of the five standard facial expressions ( forehead wrinkle, eye closure, smile, snarl and lip pucker) was performed as recommended by the S-FGS. Additionally, the DLI and DAO integrity was evaluated using the same criteria through the command "show the lower teeth".…”

Qualität der Therapie von Speicheldrüsenerkrankungen

“…Auch scheint eine perioperative Prophylaxe mit Dexamethason nicht geeignet zu sein, um die Rate von postoperativen Fazialisparesen nach Parotidektomie zu senken; so gezeigt in einer prospek-tiven randomisieren Studie von 49 Patienten [105]. In einer prospektiven Studie an 79 Patienten mit Fazialisparese nach lateraler Parotidektomie waren die Erholungsraten in einer Gruppe von Patienten mit typischer mimischer Übungsbehandlung zuhause genauso gut wie bei einer physiotherapeutisch überwachten Übungsbehandlung [106]. pyrroniumbromid und Botulinumtoxin finden sich auch in der HNO-Leitlinie zur Hypersalivation (siehe unten).…”