Koichiro Sakamaki

Biofeedback Rehabilitation for Prevention of Synkinesis after Facial Palsy

OBJECTIVE We developed a new training method of biofeedback rehabilitation for the prevention of synkinesis after facial palsy and evaluated the efficacy of the training. METHODS Twenty-seven patients with complete facial palsy were divided randomly into 2 groups. Twelve of the patients were treated with the training method, and the other 15 patients served as controls. Patients were instructed to keep their eyes open symmetrically during mouth movements using a mirror. Thirty minutes of daily training was continued for a period of 10 months. The degree of synkinesis was evaluated by computing the percent asymmetry of eye opening width. RESULTS The percent asymmetry of eye opening width was significantly greater in the training group than in the control group (P < 0.05). The results indicate that the degree of synkinesis is much less in the training group than in the control group. CONCLUSION Our new training method is very effective for preventing the development of synkinesis after facial palsy.

Determining the Pathway of the Blink Reflex through Transcutaneous Electrical Stimulation of the Facial Nerve over the Stylomastoid Foramen

The afferent pathway of the late response (R2 component) of the blink reflex in response to transcutaneous electrical stimulation of the facial nerve over the stylomastoid foramen remains uncertain. The two major hypotheses regarding the afferent pathway of R2 are that it may consist of either the trigemino-facial or the facio-facial reflex. This study was performed to determine the afferent pathway of R2. Ninety-one patients with acute unilateral peripheral facial palsy and 21 controls were studied. The degree of facial nerve damage was classified into three groups: mild, moderate, and severe according to their electroneurographic value. In each group, the appearance rate, latency, and area under the curve of contralateral R2 elicited by electrical stimulation of the injured facial nerve over the stylomastoid foramen were measured and compared with those of controls. The contralateral R2 parameters did not differ between the patient groups and the controls. The results indicate that the afferent pathway of R2 is mediated not only through the facial nerve. We conclude that the auriculotemporal nerve (V3) and the great auricular nerve (C2, C3) may also contribute to the afferent pathway of R2.

Biofeedback Rehabilitation in a Patient with Severe Bell's Palsy as Prophylactic Treatment for Synkinesis.

Synkinesis of the facial muscles are common sequelae of peripheral facial nerve palsy. However, treatment for synkinesis is limited. The case of an 18-year-old woman with right-sided Bells palsy is reported. An electroneurography (ENoG) test showed complete degeneration of the facial nerve on the right side. There was a good possibility that the patient would eventually be troubled by synkinesis. As prophylactic treatment for the prevention of synkinesis, biofeedback rehabilitation was undertaken using a mirror and electromyography. Subsequently, the patient showed no simultaneous activation of the orbicularis oculi during mouth movements, which is the most common clinical symptom of Synkinesis. It is proposed that biofeedback rehabilitation is an effective prophylactic treatment for synkinesis.

Clinical Studies on Roxithromycin Treatment of Chronic Sinusitis.

Roxithromycin (RXM) was administered to 191 patients with chronic paranasal sinusitis. The overall rate of excellent and good clinical response was 58.1% as judged by the attending otolaryngologists and 56.0% as judged by the committee.In bacteriological examinations performed on 39 patients before administration 52 organisms were isolated, and 25 (83.3%) of the 30 cultures examined showed sensitivities to RXM. Among patients infected with sensitive organisms the clinical efficacy rate (CER) was 81.0%.X-ray examinations were performed on 59 patients with an CER of 66.1%. The rates for excellent and good results were 75.9% for maxillary sinusitis and 78.3% for ethmoid sinusitis.Side effects, in the form of mild digestive symptoms, were noted in only 3 patients (1.6%), but no treatment was required even though RXM was administered for a long period of time, up to 178 days.These results indicate that RXM is effective in the treatment of chronic paranasal sinusitis.