Skip to main content
SpringerLink
Log in

Rehabilitation bei Fazialisparese und Schwindel bei Patienten mit Vestibularisschwannom

Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma

  • Leitthema
  • Published:
HNO Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Fazialisparese und Schwindel als Symptom eines Vestibularisschwannoms (VS) oder als Folge der Therapie beeinträchtigen die Lebensqualität der Patienten erheblich.

Fragestellung

Die Arbeit analysierte die aktuelle Literatur zum Thema und gibt darauf basierend Handlungsempfehlungen.

Material und Methode

Es handelt sich um eine PubMed-basierte Literaturrecherche der letzten 10 Jahre.

Ergebnisse

Zur Behandlung der akuten postoperativen Fazialisparese nach VS-Operation gibt es keine evidenzbasierte medikamentöse Therapie. Für die chirurgische Therapie gibt es etablierte Verfahren zur Nervenrekonstruktion, zum Muskeltransfer und zu statischen Maßnahmen. Eine physiotherapeutische Bewegungstherapie, am besten mit Biofeedback, verbessert möglicherweise die Fazialisfunktion bei Patienten mit Defektheilung. Botulinumtoxin ist Therapie der Wahl zur Behandlung von Synkinesien. Gegen akuten und chronischen Schwindel bei Patienten mit VS werden dieselben Antivertiginosa wie bei anderen Schwindelpatienten eingesetzt. Bei noch erhaltener Vestibularisfunktion ist die präoperative intratympanale Gentamycinausschaltung und ein Kompensationstraining eine vielversprechende Therapiestrategie, um postoperativen Schwindel zu verringern. Eine gute Vestibularisrehabilitation umfasst ein intensives und regelmäßiges Bewegungstraining, am besten mit Echtzeitfeedback und Therapiekontrolle.

Schlussfolgerungen

Es gibt eine Vielzahl durch Studien belegte konservative, chirurgische oder kombiniert konservativ-chirurgische Behandlungsoptionen zur individuellen Fazialisrehabilitation bei VS-Patienten. Bei akutem Schwindel ist eine Pharmakotherapie angezeigt. Sowohl bei akutem als auch bei belastendem chronischem Schwindel lindert eine intensive Bewegungstherapie die Beschwerden.

Abstract

Background

Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients’ quality of life.

Objective

This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo.

Methods

The present review describes a PubMed-based search of the literature of the past 10 years.

Results

There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control.

Conclusion

There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Barbara M, Monini S, Buffoni A et al (2003) Early rehabilitation of facial nerve deficit after acoustic neuroma surgery. Acta Otolaryngol 123:932–935

    Article  PubMed  Google Scholar 

  2. Baricich A, Cabrio C, Paggio R et al (2012) Peripheral facial nerve palsy: how effective is rehabilitation? Otol Neurotol 33:1118–1126

    Article  PubMed  Google Scholar 

  3. Basta D, Ernst A (2011) Vibrotaktiles Neurofeedbacktraining mit dem Vertiguard®-RT-System. HNO 59:1005–1011

    Article  CAS  PubMed  Google Scholar 

  4. Basta D, Rossi-Izquierdo M, Soto-Varela A, Greters ME, Bittar RS, Steinhagen-Thiessen E, Eckardt R, Harada T, Goto F, Ogawa K, Ernst A (2011) Efficacy of a vibrotactile neurofeedback training in stance and gait conditions for the treatment of balance deficits: a double-blind, placebo-controlled multicenter study. Otol Neurotol 32:1492–1499

    Article  PubMed  Google Scholar 

  5. Bhama P, Bhrany AD (2013) Ocular protection in facial paralysis. Curr Opin Otolaryngol Head Neck Surg 21:353–357

    Article  PubMed  Google Scholar 

  6. Bianchi B, Ferri A, Leporati M et al (2014) Upper eyelid platinum chain placement for treating paralytic lagophthalmos. J Craniomaxillofac Surg 42:2045–2048

    Article  CAS  PubMed  Google Scholar 

  7. Boahene KD, Farrag TY, Ishii L et al (2011) Minimally invasive temporalis tendon transposition. Arch Facial Plast Surg 13:8–13

    PubMed  Google Scholar 

  8. Cakrt O, Chovanec M, Funda T et al (2010) Exercise with visual feedback improves postural stability after vestibular schwannoma surgery. Eur Arch Otorhinolaryngol 267:1355–1360

    Article  PubMed  Google Scholar 

  9. Cecini M, Pavese C, Comelli M et al (2013) Quantitative measurement of evolution of postparetic ocular synkinesis treated with botulinum toxin type A. Plast Reconstr Surg 132:1255–1264

    Article  CAS  PubMed  Google Scholar 

  10. Deleyiannis FW, Askari M, Schmidt KL et al (2005) Muscle activity in the partially paralyzed face after placement of a fascial sling: a preliminary report. Ann Plast Surg 55:449–455

    Article  CAS  PubMed  Google Scholar 

  11. Friedhofer H, Coltro PS, Vassiliadis AH et al (2013) Alternative surgical treatment of paralytic lagophthalmos using autogenic cartilage grafts and canthopexy. Ann Plast Surg 71:135–139

    Article  CAS  PubMed  Google Scholar 

  12. Geraghty AW, Kirby S, Essery R et al (2014) Internet-based vestibular rehabilitation for adults aged 50 years and over: a protocol for a randomised controlled trial. BMJ Open 4:e005871

    Article  PubMed  PubMed Central  Google Scholar 

  13. Guntinas-Lichius O, Streppel M, Stennert E (2006) Postoperative functional evaluation of different reanimation techniques for facial nerve repair. Am J Surg 191:61–67

    Article  PubMed  Google Scholar 

  14. Hammerschlag PE (1999) Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: evolution in management of facial paralysis. Laryngoscope 109:1–23

    Article  CAS  PubMed  Google Scholar 

  15. Henstrom DK (2014) Masseteric nerve use in facial reanimation. Curr Opin Otolaryngol Head Neck Surg 22:284–290

    Article  PubMed  Google Scholar 

  16. Hontanilla B, Marre D (2013) Eyelid reanimation with gold weight implant and tendon sling suspension: evaluation of excursion and velocity using the FACIAL CLIMA system. J Plast Reconstr Aesth Surg 66:518–524

    Article  Google Scholar 

  17. Hontanilla B, Marre D, Cabello A (2014) Masseteric nerve for reanimation of the smile in short-term facial paralysis. Br J Oral Maxillofac Surg 52:118–123

    Article  PubMed  Google Scholar 

  18. Hydman J, Bjorck G, Persson JK et al (2009) Diagnosis and prognosis of iatrogenic injury of the recurrent laryngeal nerve. Ann Otol Rhinol Laryngol 118:506–511

    Article  PubMed  Google Scholar 

  19. Ibrahim AM, Rabie AN, Kim PS et al (2013) Static treatment modalities in facial paralysis: a review. J Reconstruct Microsurg 29:223–232

    Article  Google Scholar 

  20. Jobe RP (1974) A technique for lid loading in the management of the lagophthalmos of facial palsy. Plast Reconstr Surg 53:29–32

    Article  CAS  PubMed  Google Scholar 

  21. Lacour M, Bernard-Demanze L (2014) Interaction between vestibular compensation mechanisms and vestibular rehabilitation therapy: 10 recommendations for optimal functional recovery. Front Neurol 5:285

    PubMed  Google Scholar 

  22. Laskawi R (1997) Combination of hypoglossal-facial nerve anastomosis and botulinum-toxin injections to optimize mimic rehabilitation after removal of acoustic neurinomas. Plast Reconstr Surg 99:1006–1011

    Article  CAS  PubMed  Google Scholar 

  23. Leckenby JI, Harrison DH, Grobbelaar AO (2014) Static support in the facial palsy patient: a case series of 51 patients using tensor fascia lata slings as the sole treatment for correcting the position of the mouth. J Plastic Reconstr Aesth Surg 67:350–357

    Article  Google Scholar 

  24. Lee BC, Kim J, Chen S et al (2012) Cell phone based balance trainer. J Neuroeng Rehabil 9:10

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lesavoy MA, Fan KL, Goldberg AG et al (2014) Facial reanimation by staged, split masseter muscle transfer. Ann Plast Surg 73:33–38

    Article  CAS  PubMed  Google Scholar 

  26. Lindsay RW, Robinson M, Hadlock TA (2010) Comprehensive facial rehabilitation improves function in people with facial paralysis: a 5‑year experience at the Massachusetts Eye and Ear Infirmary. Phys Ther 90:391–397

    Article  PubMed  Google Scholar 

  27. Loyo M, Jones D, Lee LN et al (2014) Treatment of the periocular complex in paralytic lagophthalmos. Ann Otol Rhinol Laryngol 124:273–279

    Article  PubMed  Google Scholar 

  28. Magnusson M, Kahlon B, Karlberg M et al (2007) Preoperative vestibular ablation with gentamicin and vestibular “prehab” enhance postoperative recovery after surgery for pontine angle tumours – first report. Acta Otolaryngol 127:1236–1240

    Article  CAS  PubMed  Google Scholar 

  29. Manni JJ, Beurskens CH, Van DV et al (2001) Reanimation of the paralyzed face by indirect hypoglossal-facial nerve anastomosis. Am J Surg 182:268–273

    Article  CAS  PubMed  Google Scholar 

  30. Mcdonnell MN, Hillier SL (2015) Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 1:CD005397

    PubMed  Google Scholar 

  31. Meldrum D, Herdman S, Moloney R et al (2012) Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial. BMC Ear Nose Throat Disord 12:3

    Article  PubMed  PubMed Central  Google Scholar 

  32. Meldrum D, Herdman S, Vance R et al (2015) Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil 96:1319–1328

    Article  PubMed  Google Scholar 

  33. Muller I, Kirby S, Yardley L (2015) Understanding patient experiences of self-managing chronic dizziness: a qualitative study of booklet-based vestibular rehabilitation, with or without remote support. BMJ Open 5:e007680

    Article  PubMed  PubMed Central  Google Scholar 

  34. Peterka RJ, Statler KD, Wrisley DM et al (2011) Postural compensation for unilateral vestibular loss. Front Neurol 2:57

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ramos DS, Bonnard D, Franco-Vidal V et al (2015) Stitchless fibrin glue-aided facial nerve grafting after cerebellopontine angle schwannoma removal: technique and results in 15 cases. Otol Neurotol 36:498–502

    Article  PubMed  Google Scholar 

  36. Roh JL, Park CI (2008) A prospective, randomized trial for use of prednisolone in patients with facial nerve paralysis after parotidectomy. Am J Surg 196:746–750

    Article  CAS  PubMed  Google Scholar 

  37. Rosen CA, Smith L, Young V et al (2014) Prospective investigation of nimodipine for acute vocal fold paralysis. Muscle Nerve 50:114–118

    Article  CAS  PubMed  Google Scholar 

  38. Rosson GD, Redett RJ (2008) Facial palsy: anatomy, etiology, grading, and surgical treatment. J Reconstruct Microsurg 24:379–389

    Article  Google Scholar 

  39. Salles AG, Costa EF, Ferreira MC et al (2015) Epidemiological overview of synkinesis in 353 patients with longstanding facial paralysis under treatment with botulinum toxin for 11 years. Plast Reconstruct Surg 136:1289–1298

    Article  CAS  Google Scholar 

  40. Saman Y, Bamiou DE, Gleeson M (2009) A contemporary review of balance dysfunction following vestibular schwannoma surgery. Laryngoscope 119:2085–2093

    Article  PubMed  Google Scholar 

  41. Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve – preservation and restitution of function. Neurosurgery 40:684–694 (discussion 694–685)

    Article  CAS  PubMed  Google Scholar 

  42. Scheller K, Scheller C (2014) Nimodipine for peripheral nerve recovery after maxillofacial and vestibular schwannoma surgery. Muscle Nerve 50:1026–1027

    Article  CAS  PubMed  Google Scholar 

  43. Schrom T, Buchal A, Ganswindt S et al (2009) Patient satisfaction after lid loading in facial palsy. Eur Arch Otorhinolaryngol 266:1727–1731

    Article  PubMed  Google Scholar 

  44. Sidle DM, Simon P (2013) State of the art in treatment of facial paralysis with temporalis tendon transfer. Curr Opin Otolaryngol Head Neck Surg 21:358–364

    Article  PubMed  Google Scholar 

  45. Springborg JB, Fugleholm K, Poulsgaard L et al (2012) Outcome after translabyrinthine surgery for vestibular schwannomas: report on 1244 patients. J Neurol Surgery Part B Skull Base 73:168–174

    Article  Google Scholar 

  46. Stennert E (1979) I. Hypoglossal facial anastomosis: its significance for modern facial surgery. II. Combined approach in extratemporal facial nerve reconstruction. Clin Plast Surg 6:471–486

    CAS  PubMed  Google Scholar 

  47. Strupp M, Dieterich M, Brandt T (2013) The treatment and natural course of peripheral and central vertigo. Dtsch Arztebl Int 110:505–515 (quiz 515–506)

    PubMed  PubMed Central  Google Scholar 

  48. Teixeira LJ, Valbuza JS, Prado GF (2011) Physical therapy for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev (12):CD006283. doi:10.1002/14651858.CD006283.pub3

    Google Scholar 

  49. Tjernstrom F, Fransson PA, Kahlon B et al (2009) Vestibular PREHAB and gentamicin before schwannoma surgery may improve long-term postural function. J Neurol Neurosurg Psychiatr 80:1254–1260

    Article  CAS  PubMed  Google Scholar 

  50. Tos T, Caye-Thomasen P, Stangerup SE et al (2003) Need for facial reanimation after operations for vestibular schwannoma: patients perspective. Scand J Plast Reconstr Surg Hand Surg 37:75–80

    Article  PubMed  Google Scholar 

  51. Tufarelli D, Meli A, Labini FS et al (2007) Balance impairment after acoustic neuroma surgery. Otol Neurotol 28:814–821

    Article  PubMed  Google Scholar 

  52. Vakharia KT, Henstrom D, Plotkin SR et al (2012) Facial reanimation of patients with neurofibromatosis type 2. Neurosurgery 70:237–243

    PubMed  Google Scholar 

  53. Varadharajan K, Beegun I, Daly N (2015) Use of steroids for facial nerve paralysis after parotidectomy: a systematic review. World J Clin Cases 3:180–185

    Article  PubMed  PubMed Central  Google Scholar 

  54. Vereeck L, Wuyts FL, Truijen S et al (2008) The effect of early customized vestibular rehabilitation on balance after acoustic neuroma resection. Clin Rehabil 22:698–713

    Article  PubMed  Google Scholar 

  55. Volk GF, Finkensieper M, Guntinas-Lichius O (2014) EMG biofeedback training at home for patient with chronic facial palsy and defective healing. Laryngorhinootologie 93:15–24

    PubMed  Google Scholar 

  56. Volk GF, Guntinas-Lichius O (2011) Diagnosis and therapy of vertigo. Laryngorhinootologie 90:301–324

    Article  PubMed  Google Scholar 

  57. Volk GF, Pantel M, Guntinas-Lichius O (2010) Modern concepts in facial nerve reconstruction. Head Face Med 6:25

    Article  PubMed  PubMed Central  Google Scholar 

  58. Volk GF, Pohlmann M, Sauer M et al (2013) Quantitative ultrasonography of facial muscles in patients with chronic facial palsy. Muscle Nerve 50:358–365

    Article  Google Scholar 

  59. Wackym PA, Hannley MT, Runge-Samuelson CL et al (2008) Gamma knife surgery of vestibular schwannomas: longitudinal changes in vestibular function and measurement of the dizziness handicap inventory. J Neurosurg 109(Suppl):137–143

    PubMed  Google Scholar 

  60. Weyns M, Koppen C, Tassignon MJ (2013) Scleral contact lenses as an alternative to tarsorrhaphy for the long-term management of combined exposure and neurotrophic keratopathy. Cornea 32:359–361

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland

    B. Müller, G. F. Volk &  O. Guntinas-Lichius

Authors
  1. B. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. F. Volk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Guntinas-Lichius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Guntinas-Lichius.

Ethics declarations

Interessenkonflikt

B. Müller, G. Volk und O. Guntinas-Lichius geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Müller, B., Volk, G.F. & Guntinas-Lichius, O. Rehabilitation bei Fazialisparese und Schwindel bei Patienten mit Vestibularisschwannom. HNO 65, 724–734 (2017). https://doi.org/10.1007/s00106-016-0125-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-016-0125-y

Schlüsselwörter

Keywords

Search

Navigation