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The main aim of the study was to determine whether the perception of synkinesis by patients with peripheral facial palsy (PFP) matched their clinician's severity assessment. Secondary objectives comprised: (1) to determine whether objective measurement of synkinesis matched the patient's perception; and (2) is to identify factors influencing patients' perceptions.This retrospective study took place from January to May 2020. Forty patients (8 per PFP grade, I-V/VI; 20 women, 20 men) filled out the Synkinesis Assessment Questionnaire (SAQ) and were assessed on the Sunnybrook Facial Grading System (SFGS). Photographs were analyzed on MEEI-Facegram software.Perceived synkinesis (total SAQ) matched objective grades (SFGS) (Z=2.89; P=0.004), especially for smiling (Z=3.84; P0.001) and lip protrusion (Z=3.79; P0.001). Synkinesis on lip protrusion was a more sensitive indicator of perceived synkinesis than synkinesis on smiling (Z=2.96; P=0.003). Duration (ρ=0.5137; P0.001) and grade of PFP (ChiPatient-reported outcome measures (PROMs) such as the SAQ are relevant for clinical evaluation.

Resume Les auteurs exposent les recommandations de la Societe francaise d’oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge de la paralysie faciale peripherique a la phase aigue. Un groupe de travail multidisciplinaire a ete charge d’effectuer une revue de la litterature scientifique sur cette thematique. A partir de ces textes et de l’experience de chacun, des recommandations ont ete redigees, puis relues par un groupe de lecture independant. Les recommandations proposees ont ete classees en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique decroissant. Un examen clinique ORL et neurologique complet est recommande devant tout patient se presentant pour une paralysie faciale peripherique pour confirmer le diagnostic de paralysie faciale idiopathique. Il est recommande de realiser une IRM avec injection etudiant tout le trajet du nerf facial si possible dans le premier mois. Il est recommande de realiser un ENMG pour evaluer le pronostic de recuperation. Il est recommande devant toute paralysie faciale idiopathique de debuter un traitement corticoide le plus precocement possible (idealement dans les 72 heures) a la dose de 1 mg/kg/J pendant 7 a 10 jours. Les therapies antivirales sont a associer avec un traitement corticoide en cas de paralysie severe ou precoce et en cas de PFP zosterienne. Il n’est pas recommande d’utiliser un antiviral seul. A ce jour, le benefice d’une decompression chirurgicale du nerf facial n’est pas demontre.

Facial palsy can be assessed using objective and subjective tools. The main purpose of this work was to use these tools to determine at 12 months the percentage of patients with sequelae and to specify the type of sequelae.Twenty-three patients with facial palsy were followed in this prospective and longitudinal study. They have been evaluated every 3 months during a year with the House and Brackmann grading scale and the Sunnybrook Facial Grading System. At 12 months, group A was composed of patients with complete recovery and group B, patients with sequelae.At 3 months, in patients of group B, the House-Brackmann grading scale (P=0.0134), the Sunnybrook Facial Grading System global score (P=0.0283) and dynamic score (P=0.0148) were lower than group A. Moreover, the movement "brow lift" (P=0.0181) seems to be relevant to predict follow-up. Synkinesis on "brow lift" (P=0.0270) and the treatment delay (P=0.0384) increased for group B. Sex, age, paralyzed side and recurrence of facial palsy had no influence.Objective and subjective tools determine thresholds and predictive scores of recovery with sequelae at 1 year. Nevertheless, it is relevant to assess clinically specific facial movements, such as "brow lift", to specify a recovery potential and to predict sequelae a year after the onset of facial palsy. As the treatment delay influences recovery, drug treatment should be recommended as early as possible.

AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.

The paper is mainly concerned with the analytical approach of the behaviour of a two-dimensional miniaturized MEMS transducer, namely a rectangular or square clamped plate loaded by a fluid-gap (squeeze film), surrounded by a small cavity (reservoir), and excited by an incident acoustic field (assume to be uniform on the plate). Until now, the problem has not been analytically solved owing to the geometry of the device in conjunction with the nature of the diaphragm (elastic plate) and its boundary conditions (zero deflection and zero normal slope along all edges); namely analytical eigenfunctions do not exist for the clamped plate. On the other hand, the analytical approach classically used to express the acoustic field in the fluid-gap relies on a modal expansion which does not match correctly with both the displacement field of the diaphragm and the boundary conditions at the entrance of the reservoir. Then, two particular questions arise: how to derive analytically the modal behaviour of the loaded clamped plate, and what analytical approach for the acoustic field in the fluid gap is convenient to describe its coupling with the displacement field of the plate? The aim of the paper is both to provide basically an exact analytical approach and to handle a numerical implementation (FEM) against which the analytical results are tested.

A patient who needs a surgery for facial rehabilitation must have a complete assessment. The etiology of the facial palsy must be clear. It is necessary to have a MRI of the facial nerve for the statement of the initial pathology or to search a lesion on the nerve. The facial palsy must be definite which is depending of the delay of the palsy and the etiology. An electromyography must be done. The choice of the procedure depends on the delay of the palsy, the site on the nerve, the associated diseases and the opinion of the patient after a good explanation.

Resume En France, la demence de type Alzheimer touche 850 000 personnes actuellement. Il est donc primordial d’apporter de nouvelles approches therapeutiques afin d’aider cette population en constante evolution. Parmi elles, la therapie ecosystemique applique une approche cognitivocomportementale aupres du patient, tout en apportant un soutien ecologique sur les moyens de communication a son entourage. Afin d’estimer l’interet de cette therapie, nous avons utilise le Rivermead Behavioral Memory Test (RBMT III), outil evaluant la memoire ecologique, pour comparer une population A composee de cinq patients MMS inferieur a 14 ayant suivi une therapie ecosystemique, a une population B de cinq patients egalement de memes stades, n’ayant pas ete pris en charge. Notre etude a revele que la population A avait obtenu des scores superieurs a ceux de la population B dans la majorite des epreuves. Enfin, la population A, ayant de meilleurs scores aux epreuves differees que la population B, semble garder les informations plus longtemps en memoire. Cette etude nous a donc montre que l’approche ecosystemique ameliore les capacites mnesiques. Cela nous permet de poser l’hypothese selon laquelle une therapie ecologique de la communication influerait sur les capacites cognitives a plus long terme.

Two bilingual patients had World Health Organization Grade II Gliomas removed from a language area, one in the left mesiofronto-cingular region and one in the left postero-temporal region. They performed a picture naming task in their two languages before their surgery and afterwards. Both patients showed slowness in naming in their first language but different patterns of naming performance across their first and second language. Their patterns depended upon the site of their lesion and their language experience. These data, from brain-damaged, bilingual adult patients, contribute to the neuropsychological literature on brain organization and plasticity, and highlight the importance of assessing naming speed to obtain a better understanding of impairment and recovery mechanisms.

Resume Cet article presente une etude portant sur l’influence des facteurs « âge » et « theme de la conversation » sur les competences communicatives de 33 sujets âges sains repartis en trois tranches d’âge : 55–69 ans, 70–84 ans et 85 ans et plus. Il propose egalement une normalisation de la grille d’evaluation des capacites de communication des patients atteints de demence de type Alzheimer (Gecco) de Rousseau. Pour finir, une comparaison des profils communicationnels d’une population Alzheimer et d’une population saine est envisagee.

La meilleure connaissance de l’histoire spontanee des gliomes de grade II de l’Organisation mondiale de la sante (OMS), a savoir la croissance reguliere, l’infiltration le long des faisceaux de substance blanche et surtout le risque de transformation anaplasique – menacant ainsi les pronostics fonctionnel et vital – associee a une minimisation des risques de traitements, a transforme l’attitude abstentionniste « classique » en une attitude resolument therapeutique. Le but est dorenavant de tendre vers l’elaboration de veritables strategies therapeutiques adaptees a chaque patient, a savoir de determiner l’ordre et le moment de chacun des traitements (1 voire 2 exerese chirurgicale, 1 voire 2 ligne de chimiotherapie, radiotherapie) en fonction de l’evolution tumorale (mesuree sur les images en resonance magnetiques regulieres de controle), de l’etat clinique et neuropsychologique ainsi que de l’organisation anatomofonctionnelle cerebrale individuelle (etudiee grâce aux methodes de cartographie), afin d’eviter la transformation maligne le plus longtemps possible tout en preservant la qualite de vie, cette tumeur survenant le plus souvent chez des patients jeunes avec une vie familiale et une activite socioprofessionnelle normales.

A patient who needs a surgery for facial rehabilitation must have a complete assessment. The etiology of the facial palsy must be clear. It is necessary to have a MRI of the facial nerve for the statement of the initial pathology or to search a lesion on the nerve. The facial palsy must be definite which is depending of the delay of the palsy and the etiology. An electromyography must be done. The choice of the procedure depends on the delay of the palsy, the site on the nerve, the associated diseases and the opinion of the patient after a good explanation.