FACIAL MIMIC ALTERATIONS IN TRIGEMINAL NEURALGIA: A PHYSIOTHERAPY ASSESSMENT

Autori

Valtorta Filippo [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy]

Basaia Silvia [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy]

Albano Luigi [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy; and Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy]

Sibilla Elisa [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy]

Sarasso Elisabetta [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy; and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy]

Emedoli Daniele [Department of Rehabilitation and Functional Recovery, IRCCS Ospedale San Raffaele, Milan, Italy]

Pompeo Edoardo [Vita-Salute San Raffaele University, Milan, Italy; and Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy]

Mortini Pietro [Vita-Salute San Raffaele University, Milan, Italy; and Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy]

Filippi Massimo [Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit, and Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy]

Agosta Federica [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy]

Background and aims

Trigeminal Neuralgia (TN) is a chronic neuropathic pain disorder characterized by paroxysmal episodes of facial pain in the distribution of the fifth cranial nerve. First-line treatment is pharmacological, while Gamma Knife radiosurgery (GKRS) becomes an option if medications fail. This study aimed to investigate facial mimicry alterations and the potential for recovery through a virtual reality (VR) rehabilitation.

Methods

Thirteen TN patients and 29 controls age- and sex-matched underwent facial mimicry assessment. TN patients were evaluated at baseline (pre-GKRS) and 3-months post-GKRS, while controls were assessed only at baseline. Seven TN patients also underwent VR-based facial mimic rehabilitation between the two timepoints. Fourteen photographs were taken during specific facial actions, and images were processed using two specific software to extract 40 facial metrics by applying 70 virtual face markers. Metrics were compared across timepoints and between rest and action positions. Comparisons were conducted between TN patients and controls, between the pain side and the no-pain side with controls, and between TN patients at baseline and follow-up.

Results

At baseline, significant differences in facial expressions were observed between all TN patients and controls during eyebrow furrowing, lip protrusion, and smiling. No significant differences were found between the TN pain side and the no-pain side in TN patients; however, both sides differed significantly from controls in eyebrow furrowing and smiling. Finally, longitudinal analysis revealed a significant improvement in eyebrow elevation at follow-up in TN patients, although no differences were observed between the VR and non-VR groups.

Conclusion

Results suggested TN patient exhibited reduced movement in different facial muscles compared to controls, and that limitations affect significantly both pain and no-pain side. Longitudinal results highlighted that both pain and no pain sides show improvements, with more notable changes in the no pain side for VR group, but a bigger sample size in needed to explore and confirm these results. These findings suggest altered facial mimicry due to TN, with potential for recovery. The role of physiotherapy in restoring facial movement over time remains an intriguing area for future research.

REFERENCES

[1] Emedoli D, Alemanno F, Houdayer E, Brugliera L, Iannaccone S, Tettamanti A. Mobile application tool for remote rehabilitation after discharge from coronavirus disease-19 rehabilitation unit. Healthc Technol Lett. 2022 Aug 8;9(4-5):70-76. doi: 10.1049/htl2.12033. PMID: 36225346; PMCID: PMC9535743.

[2] Dusseldorp JR, van Veen MM, Mohan S, Hadlock TA. Outcome Tracking in Facial Palsy. Otolaryngol Clin North Am. 2018 Dec;51(6):1033-1050. doi: 10.1016/j.otc.2018.07.003. Epub 2018 Aug 29. PMID: 30172554.

Fundings. Italian Ministry of Health (GR-2021-12374601).