A fisioterapia associada à aplicação de toxina botulínica na hipercinesia do músculo platisma após paralisia de Bell
Data
2023-12-08
Autores
Penteado, Teresa Cristina Baptistuzzo 
Orientadores
Testa, José Ricardo Gurgel
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: Avaliar em pacientes com sequelas de Paralisia de Bell, se a fisioterapia associada a toxina botulínica diminui a hipercinesia do platisma após o término do efeito da droga. Métodos: Entre julho e outubro de 2021, no Ambulatório de Distúrbios do Nervo Facial do Departamento de Otorrinolaringologia da UNIFESP/EPM, 22 pacientes, de ambos os sexos, com idade média de 50 anos, com sequelas de Paralisia de Bell entre 2 e 3 anos, correspondendo aos graus III e IV de House-Brackmann, com presença de hipercinesia no músculo platisma, foram divididos em Grupo estudo e Grupo Controle. Todos os pacientes receberam aplicação de TB-A (Dysport) para o tratamento de sequelas. O grupo estudo recebeu adicionalmente fisioterapia no músculo platisma. O estudo durou 8 meses e os pacientes foram avaliados antes e depois do tratamento segundo HB e FGS, tendo sido adicionada a discriminação dos músculos envolvidos nas sincinesias a cada expressão do FGS. Resultados: Na avaliação FGS, no componente Sincinesia, houve melhora significativa do grupo estudo e piora do grupo controle. A simetria de repouso, do movimento voluntário e o score da escala permaneceram inalterados, assim como o HB. No grupo estudo houve melhora expressiva nas sincinesias ao sorrir e ao fechar o olho, melhora significativa ao franzir a testa, não houve efeito ao elevar o lábio superior e na protusão labial. Quanto a presença dos músculos sincinéticos, diminuiu a quantidade de pacientes com envolvimento do platisma ao sorrir, fechar o olho e franzir a testa enquanto o aumentou o número de pacientes do grupo controle com hipercontração do platisma ao franzir a testa e ao fechar o olho. Ao término do estudo, a dose necessária de TB-A a ser injetada no músculo platisma, para a mesma finalidade, diminuiu expressivamente. Conclusão: a fisioterapia associada a toxina botulínica diminuiu a hipercinesia do platisma após o término do efeito da droga.
Objectives: To assess whether physiotherapy associated with botulinum toxin reduces hyperkinesia of the platysma in patients with sequelae of Bell's Palsy after the drug has worn off. Methods: Between July and October 2021, at the Facial Nerve Disorders Clinic of the Department of Otorhinolaryngology at UNIFESP/EPM, 22 patients of both sexes, with an average age of 50 years, with sequelae of Bell's Palsy between 2 and 3 years, corresponding to HouseBrackmann grades III and IV, with the presence of hyperkinesis in the platysma muscle, were divided into a Study Group and a Control Group. All patients received TBA (Dysport) for the treatment of sequelae. The study group also received physiotherapy on the platysma muscle. The study lasted 8 months and the patients were assessed before and after treatment according to HB and FGS, with the discrimination of the muscles involved in the synkinesis added to each expression of the FGS. Results: In the FGS assessment, in the Synkinesis component, there was a significant improvement in the study group and a worsening in the control group. Resting symmetry, voluntary movement symmetry and the final score remained unchanged, as did HB. In the study group, there was a significant improvement in synkinesis when smiling and closing the eye, a significant improvement when frowning, there was no effect on raising the upper lip and lip protrusion. As for the presence of synkinetic muscles, the number of patients with involvement of the platysma when smiling, closing the eye and frowning decreased, while the number of patients in the control group with hypercontraction of the platysma when frowning and closing the eye increased. At the end of the study, the necessary dose of TBA to be injected into the platysma muscle, for the same purpose, decreased significantly. Conclusion: Physiotherapy associated with botulinum toxin reduced platysma hyperkinesia after the drug had worn off.
Objectives: To assess whether physiotherapy associated with botulinum toxin reduces hyperkinesia of the platysma in patients with sequelae of Bell's Palsy after the drug has worn off. Methods: Between July and October 2021, at the Facial Nerve Disorders Clinic of the Department of Otorhinolaryngology at UNIFESP/EPM, 22 patients of both sexes, with an average age of 50 years, with sequelae of Bell's Palsy between 2 and 3 years, corresponding to HouseBrackmann grades III and IV, with the presence of hyperkinesis in the platysma muscle, were divided into a Study Group and a Control Group. All patients received TBA (Dysport) for the treatment of sequelae. The study group also received physiotherapy on the platysma muscle. The study lasted 8 months and the patients were assessed before and after treatment according to HB and FGS, with the discrimination of the muscles involved in the synkinesis added to each expression of the FGS. Results: In the FGS assessment, in the Synkinesis component, there was a significant improvement in the study group and a worsening in the control group. Resting symmetry, voluntary movement symmetry and the final score remained unchanged, as did HB. In the study group, there was a significant improvement in synkinesis when smiling and closing the eye, a significant improvement when frowning, there was no effect on raising the upper lip and lip protrusion. As for the presence of synkinetic muscles, the number of patients with involvement of the platysma when smiling, closing the eye and frowning decreased, while the number of patients in the control group with hypercontraction of the platysma when frowning and closing the eye increased. At the end of the study, the necessary dose of TBA to be injected into the platysma muscle, for the same purpose, decreased significantly. Conclusion: Physiotherapy associated with botulinum toxin reduced platysma hyperkinesia after the drug had worn off.
Descrição
Citação
PENTEADO, Teresa Cristina Baptistuzzo. A fisioterapia associada à aplicação de toxina botulínica na hipercinesia do músculo platisma após paralisia de Bell. 2023. 96 f. Tese (Doutorado em Otorrinolaringologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2023.