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Helium neon and diode laser therapy is an effective adjunctive therapy for facial paralysis

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Abstract

This study presents our six-year experience in laser therapy for rehabilitation of facial paralysis. Mixed laser irradiation using a 904 nm diode GaAs and 632.8 (HeNe) was utilized. Laser irradiation was performed on the range of facial nerve ramifications in eight different places, 5 min on each place, four times a week. No other medicine was used if the patient arrived 48 h after having the lesion. When the patient arrived after the first week, meticorten was utilized as a supplement, a dosage of 40 mg per day, for seven days. Based on our experience, the patients who are more inclined to attend treatment sessions are those who have been suffering from paralysis for more that a month and who have submitted to other kinds of treatments with negative results. They were even offered surgery. For these patients, we have required up to a maximum of 30 sessions and we have achieved 100% recovery, even with patients who have had the lesion for three or six months. Patients who attended therapy within two weeks after suffering the paralysis recovered 100% with no additional medicationonly laser therapy. With these patients we needed a maximum of 15 sessions. LLLT is presented as a safe, noninvasive, easy to apply and comparatively side-effect-free modality offering a complementary and effective tool in the treatment of facial paralysis.

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... Laser therapy represents a non-invasive, pain-free method of treatment for all patients with BP, including those who cannot receive corticosteroids because of diabetes or hypertension [8]. However, few studies have investigated the efficacy of low-dose laser treatment in patients with BP [9][10][11]. Therefore, the aim of the present study was to determine the impact of efficacy of low-level laser therapy (LLLT) in conjunction with conventional facial exercises on functional outcomes during the early recovery period in patients with facial paralysis. ...
... Laser treatment was administered at a wavelength of 830 nm, output power of 100 Mw, and frequency of 1 KHz using a gallium-aluminum-arsenide (GaAIAs, infrared laser) diode laser (Chattanooga, Mexico, USA). A mean energy density of 10 J/cm 2 was administered to eight points of the affected side for 2 min at each point; in all the cases, the laser was in direct contact with the superficial roots of the facial nerve on the affected side ( Fig. 2) [9]. The total energy delivered to the patient during one session was 80 J. Laser treatment was performed for three sessions per week, over a period of 6 weeks. ...
... Approximately 69% of patients with BP exhibit spontaneous improvement [24]; however, the remaining 31% experience continued symptoms, and various sequelae may occur [25]. Although few studies have discussed the efficacy of low-level laser therapy in the treatment of BP, Bernal [9] revealed that laser treatment is a painless adjunctive treatment method without side effects for patients with facial paralysis, especially those with diabetes and hypertension, for whom corticosteroid treatment is contraindicated. In addition, Ladalardo et al. [10] reported that patients with BP who received treatment with gallium arsenide (GaAs) laser diodes exhibited significant functional improvement. ...
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The aim of the present study was to investigate the efficacy of low-level laser therapy in conjunction with conventional facial exercise treatment on functional outcomes during the early recovery period in patients with facial paralysis. Forty-six patients (mean age: 41 ± 9.7 years; 40 women, 6 men) were randomized into two groups. Patients in the first group received low-level laser treatment as well as facial exercise treatment, while patients in the second group participated in facial exercise intervention alone. Laser treatment was administered at a wavelength of (830 nm, output power of 100 Mw, and frequency of 1 KHz) using a gallium-aluminum-arsenide (GaAIAs, infrared laser) diode laser. A mean energy density of 10 J/cm² was administered to eight points of the affected side of the face three times per week, for a total of 6 weeks. The rate of facial improvement was evaluated using the Facial Disability Index (FDI) before, 3 weeks after, and 6 weeks after treatment. Friedman analysis of variance was performed to compare the data from the parameters repeatedly measured in the inner group analysis. Bonferroni correction was performed to compare between groups as a post hoc test if the variance analysis test result was significant. To detect the group differences, the Bonferroni Student t-test was used. The Mann-Whitney U-test was used to compare numeric data between the groups. In the exercise group, although no significant difference in FDI scores was noted between the start of treatment and week 3 (P<0.05), significant improvement was observed at week 6 (p<0.001). In the laser group, significant improvement in FDI scores relative to baseline was observed at 3 and 6 weeks (p<0.001). Improvements in FDI scores were significantly greater at weeks 3 and 6 in the laser group than in the exercise group (p<0.05). Our findings indicate that combined treatment with LLLT and exercise therapy is associated with significant improvements in FDI when compared with exercise therapy alone.
... For LLLT, a gallium-arsenide diode (GaAs) laser (BTL-5000 laser) was used with infrared probes of 830 nm wavelength and 100 mW output power, average energy density of 10 J/cm 2 , frequency of 1 KHz, and a duty cycle of 80 %. In all cases, the laser was in direct contact with the superficial roots of the facial nerve on the affected side (Fig. 2) and was applied for 2 min and 5 s per point for 8 points [24] with a total energy of 80 J. LLLT was applied for a total of 18 treatment sessions over a period of 6 consecutive weeks (three sessions/week). Facial massage and facial expression exercises in front of a mirror were performed after each session for all patients. ...
... Bernal [24] previously found that LLLT is an excellent complementary medium for the recovery of facial paralysis and provides a painless therapeutic alternative without side effects that can be used on any type of patient, including those who cannot use corticosteroids, such as diabetics and hypertensive patients [24]. In addition, Ladalardo et al. [10] studied the effect of GaAs diode laser in patients with Bell's palsy and used HBS to assess the outcome. ...
... Bernal [24] previously found that LLLT is an excellent complementary medium for the recovery of facial paralysis and provides a painless therapeutic alternative without side effects that can be used on any type of patient, including those who cannot use corticosteroids, such as diabetics and hypertensive patients [24]. In addition, Ladalardo et al. [10] studied the effect of GaAs diode laser in patients with Bell's palsy and used HBS to assess the outcome. ...
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The aim of the present study was to investigate and compare the effects of high intensity laser therapy (HILT) and low level laser therapy (LLLT) on the treatment of patients with Bell's palsy. Forty-eight patients participated in and completed this study. The mean age was 43 ± 9.8 years. They were randomly assigned into three groups: HILT group, LLLT group, and exercise group. All patients were treated with facial massage and exercises, but the HILT and LLLT groups received the respective laser therapy. The grade of facial recovery was assessed by the facial disability scale (FDI) and the House-Brackmann scale (HBS). Evaluation was carried out 3 and 6 weeks after treatment for all patients. Laser treatments included eight points on the affected side of the face three times a week for 6 successive weeks. FDI and HBS were used to assess the grade of recovery. The scores of both FDI and HBS were taken before as well as 3 and 6 weeks after treatment. The Friedman test and Wilcoxon signed ranks test were used to compare the FDI and HBS scores within each group. The result showed that both HILT and LLLT significantly improved the recovery of patients with Bell's palsy. Moreover, HILT was the most effective treatment modality compared to LLLT and massage with exercises. Thus, both HILT and LLLT are effective physical therapy modalities for the recovery of patients with Bell's palsy, with HILT showing a slightly greater improvement than LLLT.
... Although there is a high rate of spontaneous recovery in Bell's palsy, we believe it should be encouraged by effective physical therapy modalities. There is some evidence that adverse consequences of Bell's palsy could be preventable if the patients had received complementary treatment to conventional therapy with laser within 15 days of the diagnosis (14). Therefore, the laser provides an excellent passive addition to the therapy since it improves the recovery from facial palsy while eliminating the possibility of side effects caused by corticosteroids. ...
... Laser therapy has a favorable prognosis in the regeneration of peripheral nerves in both neurosensory and neuromotor deficits. Moreover, the High Intensity Laser Therapy (HILT) combined with massage and exercises has been proven as a more effective therapeutic modality when compared to the low level laser therapy LLLT combined with massage and exercises, and when compared to massage, exercises, and sham laser (14)(15)(16). However, the studies on the efficiency of HILT are scarce and further research is needed to confirm these findings. ...
Article
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Bell’s palsy, or idiopathic peripheral facial nerve palsy is a neurologic condition characterized by unilateral weakness of facial muscles. The evidence-based guidelines mostly consider the acute treatment of Bell’s palsy. However, chronic cases of Bell’s palsy are not supported by strong evidence regarding treatment options, except for a weak recommendation to utilize physical therapy. This case report has presented an application of a combination of physical therapy modalities (Mirror Book Therapy, High Inten-sity Laser Therapy, and Acupuncture) within 10 weeks, to treat a patient with long-term sequelae. This combination of therapies has resulted in a significant improvement in the level of recovery measured by facial grading scales. However, further research is necessary to provide stronger evidence regarding the benefits of this treatment option.
... LLLI is widely used in clinical medicine as therapeutic tool. It has been shown to be an effective therapeutic modality for a variety of conditions including wound healing [2,6], pain relief [17,29], the treatment of long-standing paraesthesias [5,25], nerve injury [5], rheumatoid arthritis [24], carpal tunnel syndrome [30], and others more. ...
... LLLI is widely used in clinical medicine as therapeutic tool. It has been shown to be an effective therapeutic modality for a variety of conditions including wound healing [2,6], pain relief [17,29], the treatment of long-standing paraesthesias [5,25], nerve injury [5], rheumatoid arthritis [24], carpal tunnel syndrome [30], and others more. ...
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Summary Background: Patients who had been treated with low level laser (LLL) for their digital ulcers reported an impressive improvement of their symptoms of episodic digital ischaemia .Therefore this pilot study was performed to evaluate the efficacy of LLL as a new nondrug non-invasive treatment for patients with primary and secondary Raynaud’s phenomenon (RP). Patients and methods: Forty patients (29 female, 11 male, mean age 51 years) with active primary (28%) and secondary (72%) Raynaud’s phenomenon received 10 sessions of LLL distant irradiation during winter months. Assessment of subjective and objective parameters was performed at baseline, one week after the last session and three months later. Variations of subjective parameters as number of daily acute episodes and severity of discomfort were assessed by a coloured visual analogue scale. A standardised cold challenge test using computed thermography of continuous temperature recordings by means of infrared telethermography was used to assess the digital blood flow. Results: A significant improvement was noticed clinically and thermographically after 6 weeks and 3 months, respectively (p < 0.0001). Conclusions: These data suggest that LLL treatment has a good short and medium term effectiveness in patients with Raynaud’s phenomenon.
... Previous studies proved the positive effect of both LLLT [27] and high-intensity laser therapy (HILT) [28] in the management of IBP. However, there was no studyfor the available literature-that investigated the effect of MLS in cases of IBP till now. ...
Article
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The objective of this study is to investigate the effect of scanning and point application of multiwave locked system (MLS) laser therapy on the recovery of patients with idiopathic Bell’s palsy (IBP). A randomized double-blind placebo-controlled trial was carried out on 60 patients with subacute BP. Patients were randomly assigned into three groups of 20 patients each. Facial massage and facial exercises were applied to all patients. Group one received MLS laser as a manual scanning technique (10 J/cm², area 50cm², total energy 500 J). Group two received MLS laser using point application technique (10 J/point, 8 points, total 80 J). Group three received placebo laser. House–Brackmann scale (HBS) and facial disability index (FDI) were used to evaluate the facial recovery. Assessment was performed at baseline and after 3 and 6 weeks of treatment. Comparison within and between groups was performed statistically with significance level p < 0.05. Results showed significant improvement in the FDI and HBS after treatment in all groups. Both scanning and point application significantly improved the score of FDI and HBS more than placebo group. Scanning technique combined with facial massage and exercises had a more significant effect than the point application group or the placebo group in improving FDI and HBS scores after 3 and 6 weeks of treatment. The MLS laser is an effective physiotherapy method used for the treatment of patients with IBP. MLS laser in scanning or point application techniques was more effective than exercise alone with greater effect of scanning technique than point application technique.
... A randomized double-blind placebo-controlled trial by Alayat et al. compared the efficacy of high and Low-level Laser Therapy in BP and found both interventions to be effective in improving recovery of facial function and symmetry [16]. In their study, Bernal et al. reported 100% recovery in patients who started to receive LLLT within two weeks of the onset of facial paralysis [24]. LLLT is said to produce a physiological effect in the target tissue termed photobiomodulation. ...
Article
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Purpose: Electrotherapy is a common intervention for the rehabilitation of Bell’s palsy. Low-level laser therapy (LLLT) and electrical stimulation (ES) are two therapeutic interventions for Bell’s palsy that have been proven to be superior to conventional treatments. To date, no clinical trial has compared the effectiveness of these two interventions. This pilot study aims to compare the effectiveness of LLLT and ES in the management of acute Bell’s palsy. Methods: This randomized clinical trial included 25 participants with acute Bell’s palsy who were randomized into two groups wherein 12 participants received LLLT and 13 participants received ES. All participants received 12 treatment sessions over 2 weeks. Sunnybrook Facial Grading System (SFGS) was used to assess facial symmetry and Facial Disability Index (FDI) for facial function. Outcomes were assessed at baseline and after 2 weeks. Results: There was a significant improvement in SFGS and FDI scores within both groups (P<0.005). There was no significant difference in SFGS and FDI scores between groups (P = 0.164; P=0.423). Conclusion: There is no difference in effectiveness between LLLT and ES in improving facial symmetry and function in acute Bell’s palsy.
... For photobiomodulation therapy, a gallium-arsenide diode (GaAs) laser (830 nm) which had the following specifications: 830 nm wavelength and 100 mW output power and 0.1 cm diameter, average energy density of 4 J/cm2, frequency of 1 KHz, and a duty cycle of 80% 27 . In all cases, the laser was in direct contact with the superficial roots of the facial nerve on the affected side and was applied for 15s per point for 8 points. ...
Article
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Patients with peripheral facial paralysis (PFP) have some degree of recovery. The aim of this study was to evaluate prognostic factors and physical therapy modalities associated with functional recovery in patients with PFP. This is a cohort study with 33 patients. We collected the following variables of patients who underwent treatment at the rehabilitation center: age, sex, risk factors, affected side, degree of facial paralysis (House-Brackmann scale), start of rehabilitation, and therapy modality (kinesiotherapy only; kinesiotherapy with excitomotor electrotherapy; and kinesiotherapy with excitomotor electrotherapy and photobiomodulation therapy). The outcomes were: degree of facial movement (House-Brackmann) and face scale applied 90 days after treatment. Degree of PFP was associated with functional recovery (RR=0.51, 95% CI: 0.51-0.98; p=0.036). The facial movement was associated with the time to start rehabilitation (r=−0.37; p=0.033). Lower facial comfort was observed among women, worse ocular comfort was associated with diabetes mellitus, worse tear control with prior PFP, and worse social function with the degree of PFP. Our results indicate that the all modalities present in this study showed the same result in PFP. Recovery of PFP was associated with degree of nerve dysfunction, the length of time to onset of rehabilitation, female sex, hypertension, diabetes mellitus, and previous PFP, all of which were associated with worse outcomes on the face scale.
... Bernal [80] tratou pacientes portadores de paralisia facial com laser HeNe e AsGa. Os pacientes que receberam laser até os 2 primeiros dias após a lesão obtiveram resultados de recuperação total em 100% dos casos em 15 sessões. ...
Article
O objetivo desta revisão é complementar os dados revisados na parte 1 onde foram discutidos princípios e generalidades, disponibilizar ao leitor referencial teórico para conhecer a interação do laser de baixa intensidade com os diferentes tipos de tecidos e analisar as distintas respostas. Este material constitui um acervo atualizado onde se especificam os diversos parâmetros aplicados e a técnica utilizados em cada trabalho, o qual vai servir para que os profissionais interessadas nesta área direcionem melhor suas pesquisas e determinem com maior precisão as doses para o tratamento de seus pacientes ao contar com diferentes alternativas.Palavras-chave: laser de baixa intensidade, bioefeitos, fotoreatividade tecidual.
... 5,6 Low-level laser therapy (LLLT) has been shown to be effective at nerve regeneration and improving nerve function 7,8 including the facial nerve. 9,10 Bell palsy is typically self-limiting. It is reported that there is a high rate of spontaneous recovery especially for people who can still partly move their facial muscles in 1 to 2 months 11 During this time, the patient has to consider www.journalchiromed.com ...
Article
Objective The purpose of this case report is to describe chiropractic management including the use of cold laser and chiropractic manipulation in the treatment of a patient with Bell palsy. Clinical features A 40-year-old male patient had a 10-day history of facial paralysis on his left side, including the inability to close his left eye, which also had tearing and a burning sensation. The patient had trouble lifting his left lip and complained of drooling while brushing his teeth. There was no previous history of similar symptoms or a recent infection. Prior treatment had included oral steroids. Intervention and outcome The patient was treated with low-level laser therapy and chiropractic manipulation 2 times in 4 days. The laser was applied along the course of the facial nerve for 30 seconds at each point and for 1 minute at the stylomastoid foramen. The laser used was a GaAs class 4 laser with a wavelength of 910 nm. The patient perceived a 70% to 80% improvement of facial movement after the first treatment. After the second treatment, the patient reported full control of his facial movements. Conclusion A patient with acute facial paralysis appeared to have complete resolution of his symptoms following the application of low-level laser therapy and chiropractic manipulation.
... Other studies also demonstrated that low-intensity electrical current stimulation increases the number of new blood vessels during the repair of experimentally induced wounds in Wistar rats [30][31][32]. Furthermore, low-level laser therapy has been shown to enhance angiogenesis and local microcirculation [43,44] and to exert beneficial effects on osteogenesis [45][46][47][48][49]. ...
Article
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This study evaluated the effects of microcurrent stimulation (10 μA/5 min) and 904 nm GaAs laser irradiation (3 J cm−2 for 69 s/day) on excisional lesions created in the calvaria bone of Wistar rats. The results showed significant responses in the reduction of inflammatory cells and an increase in the number of new blood vessels, number of fibroblasts and deposition of birefringent collagen fibers when these data were compared with those of samples of the untreated lesions. Both applications, microcurrent and laser at 904 nm, favored tissue repair in the region of bone excisions during the study period and these techniques can be used as coadjuvantes in the repair of bone tissue.
... Quantitative analysis also showed a larger number of blood vessels in the DL group when compared to the HL group on day 14. Several studies have demonstrated that LLLT increases local microcirculation [59] and angiogenesis [60]. Furthermore, application of low-level electrical currents increased the number of newly formed vessels during experimental wound healing in Wistar rats [29,30]. ...
Article
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This study evaluated the effects of microcurrent application and 670 nm InGaP laser irradiation on wound healing in healthy and alloxan diabetic rats. The animals were divided into eight groups: healthy control (HC); diabetic control (DC); healthy treated with microcurrent (HMC); diabetic treated with microcurrent (DMC); healthy irradiated with laser (HL); diabetic irradiated with laser (DL); healthy receiving laser and microcurrent application (HLMC) and diabetic receiving laser and microcurrent application (DLMC). Wound samples were collected on days 2, 6, 10 and 14 of treatment for structural analysis, morphometry, and Western blotting to quantify the expression of TGF-β1 and VEGF. Comparison of animals receiving laser and microcurrent therapy showed a reduction in the number of inflammatory cells in diabetic animals, as well as an increase of fibroblasts in healthy animals and of newly formed vessels in healthy and diabetic animals. Expression of TGF-β1 was increased on day 6 in all groups, especially diabetic animals. A reduction in the expression of this protein was observed on day 10 in all groups. VEGF expression was higher on day 6 in treated and control diabetic animals when compared to healthy animals. Analysis of VEGF expression in the laser- and microcurrent-treated groups on day 10 showed a decrease in diabetic animals and an increase in healthy animals. In conclusion, laser therapy and microcurrent stimulation exert beneficial effects on wound healing in both healthy and diabetic animals.
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Introduction and Aim: Bell’s palsy is an instantaneous lower motor neurons injury of 7th cranial nerve associated with infection and swelling. It produces unexpected unilateral weakness of facial muscles, progresses rapidly and attains peak symptoms within a week. The most common age of incidence is between 20 to 40 years. Although facial paralysis in Bell’s palsy is self-limited, only 80% of the patients make a full recovery. There are studies stating that both galvanic electrical stimulation and laser therapy speed up the recovery of facial paralysis, but the extent of complete recovery is unknown. Hence, this study is an attempt to understand and compare how laser therapy and galvanic electrical stimulation affect facial appearance and facial muscle functions in Bell's palsy. Materials and Methods: This study included thirty subjects with acute onset of Bell’s palsy aged between 20-40 years. They were randomly grouped into A and B. Galvanic electrical stimulation and low-level laser therapy were given to group A and group B respectively for 6 weeks (3 sessions/week) along with facial exercises. Facial disability index scale was used to measure facial muscle function and Sunny brook scale was used to measure facial symmetry in pre- and post-treatment periods. Results: When comparing the pre- and post-mean values of groups A and B on the Sunny Brook facial grading and the facial disability index (physical, social), group B (with low level laser therapy) showed a highly significant difference in mean values at p 0.001. Conclusion: Low-level laser therapy can be used as an adjective in treating the patients with Bell’s palsy.
Article
Introduction: Bell's palsy is acute facial paralysis with unclear etiology that results in weakness of facial muscles or paralysis on one side of the face. Methods: This prospective, randomized, single-blind, controlled study was conducted on 45 patients with Bell's palsy who were randomly divided into three equal groups. Two groups received either low-level laser therapy (LLLT) or electrical stimulation (E.S.) both in conjunction to medications, massage, and facial exercise treatment. The third group (control) was treated with medication, massage, and facial exercise. Results: The primary outcome was the improvement of nerve conduction velocity of facial nerve while the secondary outcome was the change of Sunnybrook facial grading system (SBGS). The outcome measures were evaluated pre- and posttreatment. There was statistically significant difference between the three groups in favor of the LLLT group regarding the nerve action potential amplitude and latency, in addition to signs of nerve regeneration and improved SBGS. Conclusion: This short-term investigation revealed that LLLT proved to be more efficient than E.S. in facial nerve regeneration for patients with Bell's palsy.
Article
Introduction: The most common causes of the abrupt onset of unilateral facial weakness are stroke and Bell’s palsy. The drug regimen together with electrical stimulation was more effective in treating Bell’s palsy than conventional drug treatment alone. We aimed to evaluate more effective and safe therapies for the treatment of Bell’s palsy. Methods: This clinical interventional study was conducted on 30 diabetic patients with Bell’s palsy who referred to a pain clinic for 1 year and were treated by low-level laser (LLL). The system of House-Brackmann was used for assessing the severity of nerve damage and patients were evaluated by electromyography and nerve conduction study (NCS) before and after treatment with low-level laser. These patients had not consumed any other medication for facial nerve palsy. Results: In the present study, 30 cases with poorly controlled diabetes mellitus (18 females and 12 males) were studied. After 12 sessions of low-level laser therapy (LLLT), we could observe complete recovery in 18 patients and partial recovery in 6 patients after 3 months. Conclusion: The recovery rate showed that LLLT is a safe, reliable and proper alternative approach for the treatment of facial nerve palsy, especially in the presence of underlying conditions such as diabetes mellitus.
Article
Objective: To provide a review of the literature about the photobiomodulation therapy (PBMT) dental treatment protocols in oral medicine based on validated clinical studies that have been published so far. Background data: The lack of effective therapies for the treatment of various types of oral diseases or the presence of invasive therapeutic methods along with the use of a wide range of medications has had a significant impact on the quality of life of these patients. PBMT as a noninvasive and nondrug method can play an influential role in the treatment of oral diseases. Methods: In this study, published clinical studies up to April 2019 were reviewed from library sources, Google Scholar, PubMed and Medline, Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI). Results: In general, the findings of this study showed that PBMT has had a positive effect on the treatment of oral lichen planus, recurrent aphthous stomatitis, hyposalivation, pemphigus vulgaris, recurrent herpes simplex, burning mouth syndrome, bisphosphonate-related osteonecrosis of the jaw, trigeminal neuralgia, facial nerve paralysis, geographic tongue, and chronic sinusitis. Conclusions: PBMT can be effective (as an alternative treatment or in combination with other therapies) in improving symptoms or in the complete treatment of oral diseases. However, further clinical studies are still necessary to achieve more robust results.
Article
Seven cases of peripheral facial palsy, who were patients of our hospital’s dermatological clinic, were treated with diode low reactive-level laser therapy (LLLT) while another seven cases, who were patients of our hospital’s otolaryngological clinic, were treated with a combination therapy consisting of LLLT and corticosteroid therapy, over the past one and half years. The clinical efficacy of the two regimens has been analyzed so that the comparison could be made utilizing a separate corticosteroid therapy group as the control. Those patients who had received LLLT showed a very similar overall recovery from the palsy when compared to those treated with corticosteroid, however those patients who had received the combination therapy showed the best recovery in the shortest period. No clinically significant adverse effect resulting from the LLLT was noted. Our results suggest that LLLT would be a suitable alternative treatment for those facial palsy patients for whom corticosteroid is not manageable, and furthermore that LLLT would be an ideal adjunctive treatment for those facial palsy patients for whom corticosteroid therapy is manageable.
Article
There are many unresolved views on the efficacy of a wide range of therapeutic approaches in the treatment of Bell's palsy. The purpose of this paper was to review systematically randomised controlled trials, controlled trials and case studies relating to the efficacy of electrotherapy modalities in the management of acute and chronic Bell's palsy. The electrotherapy modalities reviewed included electrical stimulation, electromyography biofeedback, ultrasound, laser and short-wave diathermy.All the included studies were reviewed according to a self-devised checklist. Methodological considerations including the paucity of literature, and overall poor quality of trials impact the conclusions of this review. A clinical reasoning model and reflective practice, which consider the physiological effects of electrotherapeutic modalities according to the stages of healing of nerve injury, is offered. Guidance for electrotherapy intervention is suggested as well as possible areas for future research.
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We recently performed a pilot study which suggested that clinical and thermographic improvements occurred in patients with primary and secondary Raynaud's phenomenon (RP) following treatment with low level laser irradiation (LLLI). In view of these findings, we have proceeded with a double blind, placebo-controlled study. Forty seven patients suffering from primary or secondary RP were randomly assigned in a double-blind manner to receive either 10 sessions of distant LLLI (16 f, 8 m, median age 45 years) or placebo irradiation (21 f, 2 m, median age 46 years) during winter months. The attack frequency of RP was measured by a diary count; its severity was assessed by means of visual analogue scale. Response to cold challenge test before and after LLL or placebo treatment was assessed by infrared thermography. Overall a significant reduction of the frequency as well as the severity of RP in patients with either LLLI (frequency p < 0.0001, severity p < 0.0001) or placebo treatment (frequency p < 0.0001, severity p = 0.02) was found, but patients in the LLLI group exhibited a statistically more significant improvement of the frequency at 6 weeks p = 0.007 and 3 months p = 0.02 and the severity p = 0.02, p = 0.04 of RP. Thermographic response to cold challenge improved only in patients treated with LLL but not in those treated with placebo. LLLI significantly lowers the frequency and severity of Raynaud's attacks in patients with primary and secondary RP. Since this therapeutic modality is a safe, and non-invasive treatment, it might be considered as an alternative to existing therapeutic regimes.
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Quantitative studies have been performed to determine the action of low-intensity visible monochromatic light on various cells (E. coli, yeasts, HeLa); also irradiation conditions (wavelength, dose) conducive to vital activity stimulation have been examined. Respiratory chain components are discussed as primary photo-acceptors. The possible ways for photosignal transduction and amplification are discussed. It is proposed that enhanced wound-healing due to irradiation with low-intensity visible laser light (He-Cd, He-Ne and diode lasers) is due to increased proliferation of cells.
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Macrophages are a source of many important mediators of wound repair. It was the purpose of this study to see if light could stimulate the release of these mediators. In this study an established macrophage-like cell line (U-937) was used. The cells were exposed in culture to the following wavelengths of light: 660 nm, 820 nm, 870 nm, and 880 nm. The 820-nm source was coherent and polarised, and the others were non-coherent. Twelve hours after exposure the macrophage supernatant was removed and placed on 3T3 fibroblast cultures. Fibroblast proliferation was assessed over a 5-day period. The results showed that 660-nm, 820-nm, and 870-nm wavelengths encouraged the macrophages to release factors that stimulated fibroblast proliferation above the control levels, whereas the 880-nm wavelength either inhibited the release of these factors or encouraged the release of some inhibitory factors of fibroblast proliferation. These results suggest that light at certain wavelengths may be a useful therapeutic agent by providing a means of either stimulating or inhibiting fibroblast proliferation where necessary. At certain wavelengths coherence is not essential.
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This paper briefly reviews the authors' experimental and clinical use of lasers over a 20-year period, during which laser effects on 15 biological systems were studied. Low-energy laser radiation was found to have a stimulating effect on cells, and high-energy radiation had an inhibiting effect. The application of lasers to stimulate wound healing in cases of nonhealing ulcers is recommended.
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The change in excitability of unstained nerve cells from neonatal rat cerebellum was measured as a function of the energy flux and wavelength of incident laser light. The energy flux was in the range of 0 to 100 microJ/sq. microns. 6 wavelengths between 490 and 685 nm were used. Laser pulses above a threshold energy flux significantly reduced the cells' excitability as measured by extracellular stimulation. The sensitivity of the cells, defined as the inverse of the threshold energy density, increased by an order of magnitude toward the shorter wavelengths. These results are consistent with primary absorption of the light by mitochondrial enzymes, resulting in local heating followed by mitochondrial calcium release into the cytoplasm.