Degree of severity after myofunctional therapy and electrostimulation in a patient with severe peripheral facial paralysis. Case study

Abstract

Ramsay-Hunt syndrome (RSH) consists of peripheral facial paralysis (PFP) caused by the herpes zoster virus. It represents 7% of PFP (Arana-Alonso et al, 2010) and has a worse prognosis than idiopathic forms. 20-30% of cases have complete recovery, compared to more than 70% of Bell's palsies. Objective: To describe changes in the degree of severity after the application of manual myofunctional therapy and electrostimulation in a patient with PFP after SRH who attends the Speech Therapy Service of the Hospital Nacional de Clínicas, in Córdoba Capital, in the year 2024.

Case study. 69-year-old female patient with severe PFP after SRH. Informed consent is available. Variables studied: Degree of PFP Severity, measured by speech therapy evaluation protocol for peripheral facial paralysis (PEFPFP) (Assum et al, 2019), Manual Myofunctional Therapy (MMT), applied through facial manual stimulation and Neuromuscular Electrostimulation (NMEE)., applied through Facial Electrical Stimulation. PEFPFP was measured on 3 occasions, at the beginning of treatment, after 14 sessions of MMT and 15 sessions of MMT combined with EE.

According to the PEFPFP, the initial severity score was 82 points, corresponding to a severe degree. After the application of MMT it was 57 points, corresponding to a moderate degree. After the application of combined MMT and NMES it was 22 points, corresponding to a mild grade. The combination of interventions was decided considering the patient's evolution, since a plateau was observed in the facial symmetry subdomain. In relation to the above, it was possible to corroborate that this subdomain improved only 4 points after MMT (from 22 to 18) while it improved 15 points after the combination with NMES (from 18 to 3).

Both MMT and the combination with NMES produced favorable changes, reducing the degree of severity in similar periods of time, however the combination of both interventions demonstrated greater effects on facial symmetry.