Retrospective Study on Factors Influencing Facial Nerve Damage of Acute Peripheral Facial Palsy Patients: by Electromyography

Article information

J Korean Acupunct Moxib Soc. 2013;30(5):155-167
Publication date (electronic) : 2013 December 20
doi : https://doi.org/10.13045/acupunct.2013054
Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Kyung Hee University
*Corresponding author : Department of Acupuncture & Moxibustion Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea Tel : +82-2-440-8643 E-mail : Dspark0316@hanmail.net
Received 2013 November 10; Revised 2013 November 22; Accepted 2013 November 22.

Abstract

Objectives:

This research was conducted to investigate the factors that affect the level of facial nerve damage.

Methods:

From October 2009 to September 2013, the total number of 581 patients of Bell’s palsy and Ramsay-Hunt syndrome visited Facial Palsy Center in Kyung Hee University Hospital at Gangdong for Traditional Korean and Western combined medical treatment. Of these, 453 patients of peripheral facial nerve palsy were selected for the research. After reviewing the medical records that have details of age, gender, diagnosis(Bell’s palsy and Ramsay-Hunt syndrome), onset, underlying diseases(DM, HTN), and HbAlc value, the analysis on the influence factors on the level of facial nerve damage was drew out.

Results:

The axonal loss rate of oris branch and nasal branch were significantly higher than the axonal loss rate of frontal branch and oculi branch. In addition, the frequency of becoming a major damaged branch was also high in the oris branch nasal branch. The factors by month, weather, smoking, and alcohol did not influence EMG axonal loss rate. Male rather than female and patient with Rasmay-Hut syndrome rather than Bell’s palsy had a higher axonal loss rate in all branches. Of those, front of branch of male was remarkably higher than female. Patient with DM as P/H had high axonal loss rate in all branches. Patient with HTN as P/H had high axonal loss rate in all branches except for oris branches. Patients with DM and HTN group had significantly higher value from the average of axonal loss rate than patients who are only with HTN and without DM/HTN. DM alone group had significantly higher value than patients who are without DM/HTN. However, HTN alone was not significantly high. By analysing HbAlc of the patients who were hospitalised regardless DM, axonal loss rate was high in the order of DM group, preDM group, normal group. Nevertheless, only DM group showed higher axonal rate statistically than normal group. Considering DM and HbA1c value, the patients can be divided into 4 different groups of hkDM, lkDM, hfDM and nDM. By analysing those groups, the average damaged value of the groups with diagnosis followed by treatment(lkDM, hkDM) were higher than the average rate of hfDM and statistically higher than the rate of the nDM.

Conclusions:

The influential factors of increasing the level of EMG damage are male(only for the frontal branch), age above sixties, HTN, DM, and HbAlc value above 6.5. Besides, the negligible factors are month, season, diagnosis, alcohol, and smoking. Further research including clinical prognosis should be conducted.

Keywords: Facial palsy; EMG; DM; HbA1c; HTN; Age
Fig. 1.

Flow chart

DM Hx : diabetes mellitus history. HTN Hx : Hypertension history.

Fig. 2.

The monthly occurred frequency & mean, maximum axonal loss rate

The Comparison of Interbranch Axonal Loss Rate

The Monthly, Seasonal Occurred Frequency & Axonal Loss Rate

The Comparison of EMG Axonal Loss Rate Depending on Sex, Diagnosis

The Comparison of EMG Axonal Loss Rate Depending on Smoking and Alcohol

The Comparison of EMG Axonal Loss Rate Depending on Ages, Above or Under Sixties

The Comparison of EMG Axonal Loss Rate Depending on DM and HTN

The Comparison of EMG Axonal Loss Rate Depending on Correlative Analysis of DM and HTN

The Comparison of EMG Axonal Loss Rate Depending on HbA1c Value

The Comparison of EMG Axonal Loss Rate Depending on Correlative Analysis of DM and HbA1c Value

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Article information Continued

Fig. 1.

Flow chart

DM Hx : diabetes mellitus history. HTN Hx : Hypertension history.

Fig. 2.

The monthly occurred frequency & mean, maximum axonal loss rate

Table 1.

The Comparison of Interbranch Axonal Loss Rate

Br A Br B M-dif (Br A∼br B) Standard error p-value 95 % CI
LB UB
FT OC −1.1082 1.50786 .833 −4.9855 2.7692
FT NA −6.1567 1.50786 .000** −10.0341 −2.2794
FT OS −7.3522 1.50786 .000** −11.2296 −3.4749
OC NA −5.0486 1.50786 .005** −8.9259 −1.1712
OC OS −6.2441 1.50786 .000** −10.1214 −2.3667
NA OS −1.1955 1.50786 .858 −2.6818 5.0728

Br : branch. FT : frontal Br. OC : oculi Br. NS : nasal Br. OS : oris Br. MN : mean. MX : max.

M-dif : mean-difference. CI : confidence interval. LB : lower bound. UB : upper bound.

**:

p-value<0.01 by independent samples t-test

Table 2.

The Monthly, Seasonal Occurred Frequency & Axonal Loss Rate

Month N MN MX Season N MN MX
3 36 63.37±19.219 75.01±16.780 Spring 107 63.24±19.713 75.38±16.818
4 38 65.55±16.455 77.05±12.512
5 33 60.45±23.574 73.87±21.026
6 43 60.18±19.431 73.25±18.277 Summer 114 61.59±19.799 73.76±17.778
7 36 61.20±21.191 71.40±19.053
8 35 63.72±19.154 76.82±15.756
9 44 58.87±18.110 73.18±16.934 Fall 123 62.20±18.279 75.57±16.63
10 43 63.97±16.125 77.11±14.217
11 36 64.17±20.686 76.64±18.910
12 33 54.16±22.807 67.59±19.478 Winter 109 62.21±20.368 74.45±17.378
1 47 65.77±18.598 76.42±17.161
2 29 65.60±18.127 79.05±12.784

MN : mean axonal loss rate. MX : maximum axonal loss rate.

Table 3.

The Comparison of EMG Axonal Loss Rate Depending on Sex, Diagnosis

Br M-dif (M-W) p-value 95 % CI Mean dif (R-B) p-value 95 % CI
LB UB LB UB
FT 6.27221 .003* 2.14959 10.39483 4.51590 .194 −2.39217 11.42397
OC 2.92970 .177 −1.32812 7.18752 1.53990 .718 −6.84879 9.92859
NS 2.27002 .272 −1.78447 6.32451 .50397 .901 −7.47762 8.48557
OS 2.09061 .350 −2.29717 6.47838 3.45591 .433 −5.19819 12.11002
MN 3.39063 .065 −.21689 6.99816 2.50392 .490 −4.61198 9.61982
MX 2.12551 .189 −1.05139 5.30242 4.5668. .152 −1.68250 10.81617

M : men(N 201). W : women(N 252). R : Ramsay-Hunt’s syndrome(N 31). B : Bell’s palsy(N 422).

FT : axonal loss rate of frontal branch. OC : axonal loss rate of oculi branch.

NS : axonal loss rate of nasal branch. OS : axonal loss rate of oris branch.

MN : mean of axonal loss rate. MX : maximum of axonal loss rate Br. : Branch.

M-dif : mean-difference. CI : confidence interval. LB : lower bound. UB : upper bound.

*:

p-value<0.05 by independent-samples t-test.

Table 4.

The Comparison of EMG Axonal Loss Rate Depending on Smoking and Alcohol

Br M-dif. (S-nS) p-value 95 % CI Mean dif. (D-nD) p-value 95 % CI
LB UB LB UB
FT .78861 .769 −4.48503 6.06224 2.79510 .235 −1.82512 7.41532
OC −2.04322 .458 −7.44474 3.35831 −2.11632 .381 −6.85439 2.62176
NS .39421 .880 −4.74887 5.53729 .65615 .775 −3.85602 5.16832
OS −.67910 .811 −6.24269 4.88488 .44346 .858 −4.43809 5.32501
MN −.38488 .869 −4.97209 4.20234 .44460 .828 −3.58007 4.46926
MX −.58616 .865 −4.61808 3.44576 .33355 .853 −3.20418 3.87128

S : smoker(N 86). nS : non smoker(N 367). D : drinker(N 125). nD : non drinker(N 328).

FT : axonal loss rate of frontal branch. OC : axonal loss rate of oculi branch.

NS : axonal loss rate of nasal branch. OS : axonal loss rate of oris branch.

MN : mean of axonal loss rate. MX : maximum of axonal loss rate. Br : branch.

M-dif : mean-difference. CI : confidence interval. LB : lower bound. UB : upper bound.

Table 5.

The Comparison of EMG Axonal Loss Rate Depending on Ages, Above or Under Sixties

Br O Y M-dif. (O-Y) p-value 95 % CI
LB UB
FT 63.23±19.113 57.27±23.109 5.95856 0.009** 1.53059 10.38653
OC 66.11±20.247 57.85±23.366 8.25190 0.001** 3.62367 12.88013
NA 68.61±20.631 63.66±22.064 4.94388 0.042* 0.16966 9.71810
OS 71.01±20.417 64.50±24.302 6.51901 0.007* 1.81067 11.22735
MN 67.24±16.874 60.82±19.956 6.41834 0.003** 2.53425 10.30242
MX 78.71±15.016 73.63±17.535 5.07552 0.001** 1.63159 8.51944

O : old age≥60 years(N 104). Y : young age<60 years(N 349).

FT : axonal loss rate of frontal branch. OC : axonal loss rate of oculi branch.

NA : axonal loss rate of nasal branch. OS : axonal loss rate of oris branch.

MN : mean of axonal loss rate. MX : maximum of axonal loss rate. Br : branch.

M-dif : mean-difference. CI : confidence interval. LB : lower bound. UB : upper bound.

*:

p-value<0.05 by independent-samples t-test.

**:

p-value<0.01 by independent-samples t-test.

Table 6.

The Comparison of EMG Axonal Loss Rate Depending on DM and HTN

Br M-dif(D-nD) p-value 95 % CI M-di.(H-nH) p-value 95 % CI
LB UB LB UB
FT 10.02650** .003 3.49124 16.56176 5.27438* .045 .11348 10.43528
OC 8.84829* .010 2.13367 15.56291 5.30579* .049 .01614 10.59543
NS 9.53558** .003 3.15942 15.91175 6.61791* .010 1.59990 11.63592
OS 8.24269* .020 1.32110 15.16428 3.67094 .187 −1.78727 9.12916
MN 9.16327** .002 3.48498 14.84155 5.21725* .023 .73429 9.70022
MX 6.42445* .012 3.61547 11.43587 4.62756* .014 .95660 8.29852

D : DM Hx(N 50). nD : not DM Hx(N 403). H : HTN Hx(N 90). nH : not HTN Hx(N 363).

FT : axonal loss rate of frontal branch. OC : axonal loss rate of oculi branch.

NS : axonal loss rate of nasal branch. OS : axonal loss rate of oris branch.

MN : mean of axonal loss rate. MX : maximum of axonal loss rate Br. : branch.

M-dif. : mean-difference. CI : confidence interval. LB : lower bound. UB : upper bound.

*:

p-value<0.05 by independent-samples t-test.

**:

p-value<0.01 by independent-samples t-test.

Table 7.

The Comparison of EMG Axonal Loss Rate Depending on Correlative Analysis of DM and HTN

None HTN DM HTN +DM
N 332 71 31 19
MN 60.60±19.603a 64.48±18.049b 68.31±18.380a* 73.94±18.404a**b*
MX 73.51±17.448a 76.80±15.564b 77.84±16.819c 84.87±12.968a**b*

Br : branch. MN : mean of axonal loss rate. MX : maximum of axonal loss rate. HTN : Hypertension. DM : diabetes mellitus.

*:

p-value<0.05 by Mann-Whitney U test.

**:

p-value<0.01 by Mann-Whitney U test.

Table 8.

The Comparison of EMG Axonal Loss Rate Depending on HbA1c Value

Br nDM preDM DM
N 259 136 58
MN 60.87±20.092a 62.40±17.305b 68.44±20.485a*b*
MX 73.81±17.586a 74.85±15.909b 79.09±17.273a*

nDM : HbA1c<5.7. preDM : 5.7≤HbA1c<6.5. DM : HbA1c≥6.5.

Br : branch. MN : mean of axonal loss rate. MX : maximum of axonal loss rate.

*:

p-value<0.05 by independent-samples t-test.

Table 9.

The Comparison of EMG Axonal Loss Rate Depending on Correlative Analysis of DM and HbA1c Value

nDM hfDM lkDM hkDM
N 383 20 13 37
MN 61.12±19.184a 64.35±23.050b 71.14±17.055a* 70.20±19.080a*

nDM : not DM. hfDM : high-fresh DM. lkDM : low-known DM. hkDM : high-known DM.

MN : mean of axonal loss rate .

*:

p-value<0.05 by Mann-Whitney U test.