Objective measurement of facial neuromuscular retraining therapy
combined with botulin toxin injection for facial paralysis
Abstract
Objective: We hypothesized that neuromuscular retraining therapy
combined with botulinum toxin injections (NMRT-B) could enhance the
effectiveness of treatment for facial problems caused by facial
paralysis. Also, we developed a new method to evaluate facial functions
in a detailed, accurate, and objective manner. Methods: It has been
recommended that patients with one-sided facial paralysis that does not
resolve for more than 6 months undergo scheduled treatment with NMRT-B.
The patients were scheduled to begin NMRT after 1–2 weeks of botulinum
toxin A injection on the affected side and/or on the unaffected side.
The second botulinum toxin A injection was conducted at 6 months after
the first injection, and NMRT was continued for more than 6 months. And
we used a computer-based numeric scoring system alone to confirm facial
functions. Results: Most patients with chronic facial paralysis who
underwent NMRT-B treatment exhibited better results after 1 year. NMRT-B
provided satisfactory control of synkinesis as well as primary movement.
Using our method for evaluation of facial asymmetry, the average primary
facial function movement score was calculated as 57.3 (0.573), average
secondary facial function movement score was 14.2 (0.142), and average
final facial function movement score was 43.1 (0.431) before treatment
Conclusions: We demonstrated that NMRT-B was effective for patients with
synkinesis and facial asymmetry and that the results differed depending
on the degree of facial paralysis. We also established a method to
evaluate facial paralysis in an objective manner that excludes
subjective judgment.