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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2018; 22(04): 348-357
DOI: 10.1055/s-0037-1607335
Original Research
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

The Contribution of Surface Electromyographic Assessment for Defining the Stage of Peripheral Facial Paralysis: Flaccid or Sequelae Stage

Daniele Fontes Ferreira Bernardes
1   Department of Otorhinolaryngology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
,
Ricardo Ferreira Bento
2   Department of Otolaryngology, Universidade de São Paulo, São Paulo, SP, Brazil
,
Maria Valeria Schimidt Goffi Gomez
3   Department of Otorhinolaryngology, Hospital das Clínicas da FMUSP, São Paulo, SP, Brazil
4   Department of Audiology, AC Camargo Cancer Center, São Paulo, SP, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

10. März 2017

08. September 2017

Publikationsdatum:
26. Oktober 2017 (online)

   Lizenzen und Reprints

Abstract

Introduction Surface electromyographic activity may not be symmetric, even in subjects with no facial paralysis history.

Objective To evaluate the contribution of the index of electromyographic (IEMG) activity in the identification of the two extremes of the facial paralysis course.

Methods Thirty-four subjects with unilateral peripheral facial paralysis were selected. A control group was composed of volunteers without a history of facial paralysis. The electromyographic assessment of the facial muscle was performed by placing surface electrodes during movements of the forehead, eyes and lips using MIOTEC equipment, such as the MIOTOOL (Miotec, Porto Alegre, Brazil) software. The electromyographic activity was also recorded in other channels during the primary activity to identify the presence of synkinesis. The statistical analysis was performed using the Statistical Package for Social Sciences for Macintosh (SPSS Inc, Chicago, IL, USA). The IEMG activity was obtained from the division of the electromyographic activity root mean square (RMS) values on both sides.

Results There was a statistically significant difference among the groups in all the analyzed indexes. The ocular-oral synkinesis in all patients must be correctly identified (with 100% sensitivity and specificity) using an IEMG activity of 1.62 as a cutoff point. The oral-ocular synkinesis must be correctly identified (93.3% sensitivity and 95.9% specificity) using the IEMG activity of 1.79 as a cutoff point.

Conclusion The IEMG activity is below the normal scores in patients in the flaccid stage, whereas patients in the sequelae stage can either show normal values or values above or below the normal scores. The IEMG activity was shown to have high sensitivity and specificity in the identification of synkinesis.

Keywords

facial paralysis - electromyography - surface
 

  • References

  • 1 Bento RF. Doenças do Nervo Facial. In: Bento RF, Miniti A, Marone S. Tratado de Otologia. São Paulo: Edusp; 1998: 427-459
    Google Scholar
  • 2 Lazarini PR, Costa HJZR, Camargo ACK. Anatomo-fisiologia e fisiopatologia do Nervo Facial. In: Lazarini PR, Fouquet ML. Paralisia Facial Avaliação Tratamento Reabilitação. São Paulo: Lovise; 2006: 25-32
    Google Scholar
  • 3 Vanswearingen J. Facial rehabilitation: a neuromuscular reeducation, patient-centered approach. Facial Plast Surg 2008; 24 (02) 250-259
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 4 Rosson GD, Redett RJ. Facial palsy: anatomy, etiology, grading, and surgical treatment. J Reconstr Microsurg 2008; 24 (06) 379-389
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve 1990; 13 (09) 771-784
    CrossrefGoogle Scholar
  • 6 Irintchev A, Wernig A. Denervation and reinnervation of muscle: physiological effects. Eur Arch Otorhinolaryngol 1994; (Suppl): S28-S30
    Google Scholar
  • 7 Moran CJ, Neely JG. Patterns of facial nerve synkinesis. Laryngoscope 1996; 106 (12 Pt 1): 1491-1496
    CrossrefPubMedGoogle Scholar
  • 8 Bernardes DFF, Gomez MV, Pirana S, Bento RF. Functional profile in patients with facial paralysis treated in a myofunctional approach. Pro Fono 2004; 16 (02) 151-158
    PubMedGoogle Scholar
  • 9 Devriese PP. Treatment of sequelae after facial paralysis: a global approach. J Laryngol Otol 1998; 112 (05) 429-431
    CrossrefPubMedGoogle Scholar
  • 10 Diels HJ. Facial paralysis: is there a role for a therapist?. Facial Plast Surg 2000; 16 (04) 361-364
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Goffi-Gomez MVS, Vasconcelos LGE, Bernardes DFF. Reabilitação Miofuncional da Paralisia Facial Periférica. In: Piccolotto- Ferreira. (Org.). Tratado de Fonoaudiologia. 1 ed. São Paulo: Roca; 2004: 512-526
    Google Scholar
  • 12 VanSwearingen JM, Brach JS. Changes in facial movement and synkinesis with facial neuromuscular reeducation. Plast Reconstr Surg 2003; 111 (07) 2370-2375
    CrossrefPubMedGoogle Scholar
  • 13 May M, Schaitkin B. The Facial Nerve, May's Second Edition. New York: Thieme; 2000: 301-318
    Google Scholar
  • 14 Novak CB. Rehabilitation strategies for facial nerve injuries. Semin Plast Surg 2004; 18 (01) 47-52
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 15 Goffi-Gomez MVS. Reabilitação miofuncional nas seqüelas da paralisia facial periférica. In Lazarini PR, Fouquet ML. Paralisia Facial. São Paulo: Lovise; 2006: 149-59
    Google Scholar
  • 16 Scriba H, Stoeckli SJ, Veraguth D, Pollak A, Fisch U. Objective evaluation of normal facial function. Ann Otol Rhinol Laryngol 1999; 108 (7 Pt 1): 641-644
    CrossrefPubMedGoogle Scholar
  • 17 Coulson SE, Croxson GR, Gilleard WL. Three-dimensional quantification of the symmetry of normal facial movement. Otol Neurotol 2002; 23 (06) 999-1002
    CrossrefPubMedGoogle Scholar
  • 18 Linstrom CJ. Objective facial motion analysis in patients with facial nerve dysfunction. Laryngoscope 2002; 112 (7 Pt 1): 1129-1147
    CrossrefPubMedGoogle Scholar
  • 19 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
    CrossrefGoogle Scholar
  • 20 Ross BG, Fradet G, Nedzelski JM. Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg 1996; 114 (03) 380-386
    CrossrefPubMedGoogle Scholar
  • 21 Brach JS, VanSwearingen JM. Physical therapy for facial paralysis: a tailored treatment approach. Phys Ther 1999; 79 (04) 397-404
    CrossrefPubMedGoogle Scholar
  • 22 Henkelmann TC, May M. Physical Therapy and Neuromuscular Rehabilitation. IN: May M, Schaitkin B. The Facial Nerve, May's Second Edition. Thieme; 2000: 301-318
    Google Scholar
  • 23 Nakamura K, Toda N, Sakamaki K, Kashima K, Takeda N. Biofeedback Rehabilitation for Prevention of Synkinesis After Facial Nerve Palsy. Otolaryngol Head Neck Surg 2003; 128 (04) 539-543
    CrossrefPubMedGoogle Scholar
  • 24 Cronin GW, Steenerson RL. The effectiveness of neuromuscular facial retraining combined with electromyography in facial paralysis rehabilitation. Otolaryngol Head Neck Surg 2003; 128 (04) 534-538
    CrossrefPubMedGoogle Scholar
  • 25 Bernardes DFF, Franco MZ. . Surface electromyography in peripheral facial paralysis patients [monography]. Escola Estadual Prof. Eurico Figueiredo (Cepef). 2008
  • 26 van Lieshout PH, Peters HF, Starkweather CW, Hulstijn W. Physiological differences between stutterers and nonstutterers in perceptually fluent speech: EMG amplitude and duration. J Speech Hear Res 1993; 36 (01) 55-63
    CrossrefGoogle Scholar
  • 27 Genaro KF. Fissura lábio palatina: atividade eletromiográfica do lábio superior. São Paulo: Tese (Doutorado) – Universidade Federal de São Paulo – Escola Paulista de Medicina; 1995: 109
    Google Scholar
  • 28 Marchiori SC, Vitti M. Eletromiografia na fala; como e porquê. IN: Marchesan I. Tópicos em Fonoaudiologia. São Paulo: Lovise; 1996
    Google Scholar
  • 29 Perlman AL, Palmer PM, McCulloch TM, Vandaele DJ. Electromyographic activity from human laryngeal, pharyngeal, and submental muscles during swallowing. J Appl Physiol (1985) 1999; 86 (05) 1663-1669
    CrossrefGoogle Scholar
  • 30 Tomé MC, Marchiori SC. Análise eletromiográfica dos músculos orbiculares superior e inferior da boca em crianças respiradores nasais e bucais durante a emissão de sílabas. Pró-fono Revista de Atualização Científica 1999; 11 (01) 1-7
    Google Scholar
  • 31 Rahal ACR. Eletromiografia dos músculos masseteres e supra-hióideos em mulheres com oclusão normal e com má-oclusão classe I de Angle durante a fase oral da deglutição [dissertation]. Faculdade de Medicina da Universidade de São Paulo. 2002:36
    Google Scholar
  • 32 Rahal A, Goffi-Gomez MVS. Avaliação eletromiográfica do músculo masseter em pessoas com paralisia facial periférica de longa duração. Rev CEFAC 2007; 9 (02) 207-212
    Google Scholar
  • 33 Furquim de Andrade CR, Sassi FC, Juste FS, Ercolin B. Modelamento da fluência com o uso da eletromiografia de superfície: estudo piloto. Pro Fono 2008; 20 (02) 129-132
    CrossrefPubMedGoogle Scholar
  • 34 Rahal A, Pierotti S. Eletromiografia e Cefalometria na Fonoaudiologia. In: Tratado de Fonoaudiologia. São Paulo: Editora Roca; 2004: 237-253
    Google Scholar
  • 35 Mitre EI, Lazarini PR, Dolci JE. Objective method for facial motricity grading in healthy individuals and in patients with unilateral peripheral facial palsy. Am J Otolaryngol 2008; 29 (01) 51-57
    CrossrefPubMedGoogle Scholar
  • 36 Lazarini PR, Figueiredo MT. Testes Elétricos do Nervo Facial. In: Lazarini PR, Fouquet ML. Paralisia Facial Avaliação Tratamento Reabilitação. São Paulo: Lovise; 2006: 53-63
    Google Scholar
  • 37 Ohyama M, Obata E, Furuta S, Sakamoto K, Ohbori Y, Iwabuchi Y. Face EMG Topographic analysis of mimetic movements in patients with Bell's palsy. Acta Otolaryngol Suppl 1988; 446: 47-56
    Google Scholar
  • 38 Wood DA, Hughes GB, Secic M, Good TL. Objective measurement of normal facial movement with video microscaling. Am J Otol 1994; 15 (01) 61-65
    Google Scholar
  • 39 Pennock JD, Johnson PC, Manders EK, VanSwearingen JM. Relationship between muscle activity of the frontalis and the associated brow displacement. Plast Reconstr Surg 1999; 104 (06) 1789-1797 , discussion 1798–1799
    CrossrefGoogle Scholar
  • 40 On AY, Yaltirik HP, Kirazli Y. Agreement between clinical and electromyographic assessments during the course of peripheric facial paralysis. Clin Rehabil 2007; 21 (04) 344-350
    CrossrefPubMedGoogle Scholar