A Clinical Study to Observe Nasolabial Angle on Facial Palsy Sequelae by Disproportional Muscles of Expression

서 론

( )

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1). ,

,

2).

, , ,

,

, Bell's palsy, Melkersson's syndrome,

3).

John ⁴⁾

86%

, ³⁾ 95%

45%

, Peitersen 윤인환, 김남권

Original Article

A Clinical Study to Observe Nasolabial Angle on Facial Palsy Sequelae by Disproportional Muscles of Expression

In-Hwan Youn, Nam-Kwen Kim

Department of Ophthalmology Otolaryngology and Dermatology of Oriental Medicine Wonkwang University

Objectives: Electroacupuncture has the effect of recovering paralytic nerves and muscles. To treat disproportional muscles of expression with electroacupuncture, it is essential that we know the correct point of paralytic muscle.

Methods: We investigated 20 cases of patients with facial palsy sequelae. We measured nasolabial angles, checked grade of muscle palsy, and tested ENoG.

Results: This study showed significant correlation between nasolabial angles with these muscle groups (zygomatic group , zygomatic group , orbicularis oris muscle).

Conclusions: Disproportional facesare fixed by muscles of expression observed in facial palsy sequelae. We can treat muscular paralysis of these muscle groups with electroacupuncture for more complete recovery.

Key Words : facial palsy, facial palsy sequelae, muscle of expression, nasolabial angle, electroacupuncture

2008 5 21 2008 7 10

: , 1126-1

(Tel : +82-31-390-2671, Fax : +82-31-390-2319, E-mail : [email protected])

2008

71%

83%

.

, ,

, , ,

,

6).

,

7).

8).

, 1816 Louis Berlioz

9),

10).

. House-Brackmann Grade(H-B Grade) Kim's grade

,

nasolabial angle(NA) ,

ENoG

.

연구방법

1. 연구대상

2007 10 1 OO

, 2

20 .

2. 연구방법

( ) ( )

2

.

( ), ( ) ( ) ,

( ) , ( ) 4 ( )

20 .

( ) ( ) 11

11). Lucille Daniels

muscle testing Kim ¹²⁾

12 (

) 1 , ( ) 3 , ( )

( ) 8

.

(frontalis) (corrugator)

, ( )

(procerus), (orbic- ularis oculi)

( )

( )

13).

NA

, NA

ENoG H-B Grade, Kim's

grade .

1) Nasolabial angle(NA) (1) NA

orbicularis oris

. orbicularis oris

. orbicularis oris ,

.

zygomatic major muscle, zygomatic minor muscle, levator labii superioris, levator labii superioris alaeque nasi, levator anguli oris

. orbicularis oris

13). orbicularis oris

NA . (2)

Samsung KENOX Digimax V4 . 100cm,

.

(3)

‘ ’

. (4) NA

Adobe Photoshop 7.0

.

, nasolabial fold nasal ala

nasolabial fold ,

nasolabial fold (Fig. 1.).

2) Grade Check

H-B Grade¹⁴⁾ , Kim ¹³⁾

. 2

grade ,

.

(1) Gross scale : H-B Grade House JW, Brackmann DE 1985 grading system

(Table 1).

NA

Fig. 1.

(2) Regional scale : Kim's Grade Lucille Daniels muscle testing Kim

10 Normal( ),

Grade 1(50% ), Grade 2(50%

), Grade 3(50% ), Grade 4( ) (Table 2,3).

3) ENoG

20 ENoG

Grade Description Characteristics

Ⅰ Normal Gross : Slight weakness noticeable on close inspection may have very slight synkinesis At rest : Normal symmetry and tone

Ⅱ Mild

dysfunction

Motion : Forehead - Moderate to good function Eye - Complete closure with minimum effort Mouth - slight asymmetry

Gross : Obvious but not disfiguring difference between two sides, noticeable but severe synkinesis, contracture, and/or hemifacial spasm

At rest : Normal symmetry and tone

Ⅲ Moderate

dysfunction

Motion : Forehead - slight or moderate movement Eye - Complete closure with effort Mouth - slightly weak with maximum effort Gross : Obvious weakness and/or disfiguring asymmetry At rest : Normal symmetry and tone

Ⅳ Moderately

severe dysfunction

Motion : Forehead - None Eye - Incomplete closure

Mouth - Asymmetry with maximum effort Gross : Only barely perceptible

At rest : Asymmetry

Ⅴ severe

dysfunction

Motion : Forehead - None Eye - Incomplete closure Mouth - Slight movement

Ⅵ Total paralysis No movement Table 1.

Facial muscle Stage of facial muscle paralysis

Frontalis 0 1 2 3 4

Orbicularis oculi 0 1 2 3 4 Corrugator supercilii 0 1 2 3 4

Procerus 0 1 2 3 4

Zygomatic Group Ⅰ (Zygomatic major and Levator anguli oris) 0 1 2 3 4 Zygomatic Group Ⅱ (Zygomatic minor and Levator labii superior) 0 1 2 3 4 Orbicularis oris 0 1 2 3 4

Risorius 0 1 2 3 4

Depressor anguli oris 0 1 2 3 4

Platysma 0 1 2 3 4

Table 2.

7 . (1) ENoG

Nasolabial angle

,

(Fig. 2.).

Nasal Alae

. Levator labii superioris alaeque nasi m. .

Nasolabial Fold nasolabial fold

. nasal ala

nasolabial fold ,

nasolabial fold .

zygomatic Major and Levator anguli oris m., zygomatic Minor and Levator labii supe- rioris m. .

Mouth

. Obicularis oris .

3. 통계학적 분석

. , H-B Grade,

ENoG NA Pearson

. Kim's Grade NA

T ,

NA

. SPSS 14.0

.

연구결과

1. 남녀별, 연령별 분포

20 7 (35%),

Muscle movement Score

Normal Complete movement 0

Grade 1 Movement > 50% 1

Grade 2 Movement = 50% 2

Grade 3 Movement < 50% 3

Grade 4 None movement 4

Table 3.

2 1

3

Fig. 2.

13 (65%) , 20 1 (5%), 30 4 (20%), 40 8 (40%), 50

3 (15%), 60 4 (20%)

(Table 4).

2. 유병기간별 분포

2 ,

20 2

3 6 (30%), 3 6

3 (15%), 6 12

5 (25%), 12 24

3 (15%), 24 3

(15%) (Table 5).

3. Nasolabial angle(NA) 측정 결과 orbicularis oris

13), NA

.

NA 20

7 (35%), Frequency(persons) Percentage(%)

Sex Man 7 35

Woman 13 65

Age

20～29 1 5

30～39 4 20

40～49 8 40

50～59 3 15

60～ 4 20

Table 4.

Treatment period(months) Frequency(persons) Percentage(%)

2～3 6 30

3～6 3 15

6～12 5 25

12～24 3 15

24～ 3 15

Table 5.

Frequency (persons) Percentage (%)

Expressionless face

normal side < abnormal side 7 35

normal side > abnormal side 11 55

normal side = abnormal side 2 10

Expression face

normal side < abnormal side 7 35

normal side > abnormal side 10 50

normal side = abnormal side 3 15

Table 6.

11 (55%), 2 (10%)

. ‘ ’ NA

20 7 (35%),

10 (50%), 3 (15%) (Table 6).

4. Grade check 결과 H-B Grade

,

8).

Kim's Grade Lucille Daniels muscle testing

10

.

12).

H-B Grade 20 1

(5%), 13 (65%), 6 (30%),

~ 0 (0%) (Table 7).

Kim's Grade 40 1 22

, 17% . NA

28.75%

13.33% .

Kim's Grade NA

Zygomatic Group , Zygomatic Group , Orbi- cularis oris muscle (Table 8).

Grade Frequency (persons) Percentage (%)

House-Brackmann grade

Ⅰ

(Normal) 1 5

Ⅱ

(Mild dysfunction) 13 65

Ⅲ

(Moderate dysfunction) 6 30

Ⅳ

(Moderately severe dysfunction) 0 0

Ⅴ

(severe dysfunction) 0 0

Ⅵ

(Total paralysis) 0 0

Table 7.

Kim's Grade Score Percentage(%)

Total muscles 6.80 17

Concerned muscles with NA* 3.6 28.75

Not concerned muscles with NA 3.2 13.33

Concerned muscles with NA* : Zygomatic major musle and Levator anguli oris, Zygomatic minor muscle and Levator labii superior, Orbicularis oris muscle

Table 8.

5. ENoG 측정 결과

20 ENoG 7

, NA

nasal alae, nasolabial fold, orbicularis oris

.

ENoG evoked summating pote-

ntial amplitude

%

,

15).

ENoG nasal alae

41.29%, nasolabial fold 60.14

%, orbicularis oris 53.29%

(Table 9).

6. 유병기간과 NA의 비교

NA

Point Mean of recovery(%)

ENoG

Nasal alae 41.29

Nasolabial fold 60.14

Orbicularis oris 53.29

Table 9.

NA(Nasolabial Angle) Grade M^ⅰ) SD^ⅱ) T^ⅲ) p^ⅳ)

Expressionless face

Normal side Ⅱ

Ⅲ 29.15

30.67

4.54

5.39 -.637 .532

Abnormal side Ⅱ

Ⅲ 30.46

31.33

3.84

6.02 -.385 .705

Gap of both sides Ⅱ

Ⅲ 1.31

0.67

5.63

6.77 .217 .831

Expression face

Normal side Ⅱ

Ⅲ 34.54

33.67

6.57

5.82 .278 .784

Abnormal side Ⅱ

Ⅲ 34..85

34.50

7.31

7.71 .094 .926

Gap of both sides Ⅱ

Ⅲ 0.38

0.83

7.59

8.40 -.116 .909

ⅰ) M = Mean

ⅱ) SD = Standard Deviation

ⅲ) T = Test Statistics

ⅳ) p = p-value Table 11.

NA(Nasolabial Angle)

Expressionless face Expression face

Normal side Abnormal side Gap of both sides Normal side Abnormal side Gap of both sides Disease

Period 0.221 0.210 -0.018 -0.017 0.004 0.016

Table 10.

NA

(Table 10).

7. H-B Grade와 NA의 비교

H-B Grade NA

(Table 11).

8. Kim's Grade와 NA의 비교

Kim's Grade NA

NA .

Zygomatic Group NA

,

(p=0.001<0.01) , Zygomatic Group

0 NA

(Table 12).

Zygomatic Group Orbicularis oris muscle Zygomatic Group

NA ( - )

, (p=0.011<0.05).

NA .

(Table 13).

B^ⅰ) SE^ⅱ) ^ⅲ) T^ⅳ) p^ⅴ)

Constant -4.667 2.282 -2.045 0.056

Gap of muscles score^* 2.333 0.820 0.557 2.847 0.011

^ⅵ) F^ⅶ)

p

0.310 8.104 0.011

* Gap of Muscles Score = Zygomatic Group Ⅰ score - Zygomatic Group Ⅱ score + Orbicularis oris muscle score)

ⅰ) B = Unstandardized Coefficients

ⅱ) SE = Standard Error

ⅲ)  = Standardized Coefficients

ⅳ) T = Test Statistics

ⅴ) p = p-value

ⅵ) ^ = The Coefficient of Determination

ⅶ) F = F-test Test Statistics Table 13.

Zygomatic Group Ⅰ M^ⅰ) SD^ⅱ) T^ⅲ) p^ⅳ)

NA of Expressionless face

0 1

4.08 -3.50

2.61

6.12 3.840 0.001

NA of Expression face

0 1

4.67 -5.75

4.03

7.03 4.229 0.001

ⅰ) M = Mean

ⅱ) SD = Standard Deviation

ⅲ) T = Test Statistics

ⅳ) p = p-value Table 12.

9. ENoG와 NA의 비교

ENoG NA

(Table 14).

고 찰

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18).

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low frequency 91%

21). ^{22) 23)}

, ²⁴⁾

.

. H-B grade Kim's grade ,

nasolabial angle(NA) NA(Nasolabial Angle)

Expressionless face Expression face

Normal side Abnormal side Gap of both

sides Normal side Abnormal side Gap of both sides E

N o G

Nasal alae 0.449 -0.438 -0.631 -0.126 -0.363 -0.288

Nasolabial fold -0.369 -0.116 0.115 -0.430 -0.019 0.243

Orbicularis oris 0.079 0.088 0.029 -0.377 -0.259 -0.034

Table 14.

, ENoG .

2007 10 1 OO

2 ,

20 .

NA

7 (35%), 11 (55%),

2 (10%) , ‘ ’

NA

20 7 (35%), 10 (50%),

3 (15%) .

NA

NA , H-B

Grade NA , ENoG

NA

. Kim's Grade NA

. Zygomatic Group NA ,

(p=0.001<0.01) , Zygomatic Group

0 NA

(Table 12). Zygomatic Group Orbic- ularis oris muscle Zygomatic Group

NA (

- )

(p=0.011<0.05),

(Table 13). Zygomatic Group , Zygomatic Group Orb-

icularis oris muscle

NA .

,

NA Zygomatic

Group , Zygomatic Group , Orbicularis oris

muscle .

H-B grade

. Yanag- ihara grading system ,

,

25).

24).

. NA

,

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결 론

2007 10 1

2 , 20 NA, H-B Grade, Kim's Grade, ENoG

.

1. NA

. 2. H-B Grade NA

.

3. ENoG NA

.

4. Zygomatic Group (Zygomatic major musle and Levator anguli oris), Zyg- omatic Group (Zygomatic minor muscle and Levator labii superior), Orbicularis oris

muscle NA

.

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