Analysis for the Idiopathic Facial Palsy Inpatients According to Distribution of  Constitution,  Classification and Assessment Tools

Seung Hwon Lee; Eun Sol Lee; Dong Kyun Seo; Kyeong A Lee; Jung Hee Kim; Chang Ho Hong; Sun Hee Jang; Hyoun Min Youn; Kyung Jeon Jang; Choon Ho Song; Cheol Hong Kim

doi:10.13045/acupunct.2013022

J Acupunct Res > Volume 30(4); 2013 > Article

Lee, Lee, Seo, Lee, Kim, Hong, Jang, Youn, Jang, Song, and Kim: Analysis for the Idiopathic Facial Palsy Inpatients According to Distribution of Sasang Constitution, Hyungsang Classification and Assessment Tools

Original Article

The Acupuncture 2013; 30(4): 55-68.

Published online: September 20, 2013

DOI: https://doi.org/10.13045/acupunct.2013022

Analysis for the Idiopathic Facial Palsy Inpatients According to Distribution of Sasang Constitution, Hyungsang Classification and Assessment Tools

Seung Hwon Lee¹, Eun Sol Lee¹, Dong Kyun Seo¹, Kyeong A Lee¹, Jung Hee Kim¹, Chang Ho Hong¹, Sun Hee Jang¹, Hyoun Min Youn¹, Kyung Jeon Jang¹, Choon Ho Song¹, Cheol Hong Kim^1,^2,^*

¹Department of Acupuncture & Moxibution Meridian & Acupoint, College of Oriental Medicine, Dong-Eui University

²Research Institute of Oriental Medicine, Dong-Eui University

^*Corresponding author : Department of Acupuncture and Moxibution Medicine, Dong-eui Oriental University Hospital, 62, Yangjeong-ro, Busanjin-gu, Busan, 614-851, Republic of Korea, Tel : +82-51-850-8612 E-mail : kmdkch@deu.ac.kr

Received July 31, 2013 Revised August 28, 2013 Accepted August 28, 2013

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

Objectives :

The purpose of this study is to analyze the distribution, relationship, prognosis and improvement score of idiopathic facial palsy inpatients according to constitutional differentiation ; Sasang constition, Hyungsang classification, Sasang constition combined with Hyungsang classification.

Methods :

A study was done on 102 patients who were diagnosed and treated as idiopathic facial palsy from April 2012 to Nomember 2012 at the Department of Acupuncture and Moxibution Medicine, Dong-eui Oriental University Hospital. Medical records of inpatinets who underwent facial ENoG, NET test were analyzed. Changes of HBGS grade and Yanagihara’s score were also evaluated. We classified inpaients acording to Sasang constitution by consulting to Department of Sasang constitutinal medicine, and to Hyungsang classification(Dam-body, Bangkwang-body) by measuring under medical system of 3D facial shapes(RS-400FL). The constitutional differentiation and general characteristics were initially analyzed, and valuse on ENoG, NET were correlated with constitutinal differentiation. Results of HBGS and Yanagihara’s score were also correlated with constitutinal differentiation.

Results :

Each 39.2 percent of idiopathic facial palsy inpatients were the Taeeumin and Soyangin, 21.6 percent were the Soeumin.
75.5 percent of idiopathic facial palsy inpatients were the Bangkwang-body, 24.5 percent were the Dam-body.
34.3 percent of idiopathic facial palsy inpatinets were the Taeeum-Bangkwang, 21.6 percent were the Soyang-Bangkwang, 19.6 percent were the Soeum-Bangkwang, 17.6 percent were the Soyang-Dam, 4.9 percent were the Taeem-Dam, 2 percent were the Soeum-Dam.
By sex, the each ratio of Taeeumin, Soeumin, Bangkwang-body, Taeeum-Bangkwang, Soeum-Bangkwang, Soyang-Bangkwang was higher in female, that of Dam-body, Taeeum-Dam, Soyang-Dam was higher in male.
By relations between Sasang constitution and Hyungsang classification, the each ratio of Taeeumin and Soeumin was higher in Bangkwang-body.
By values on ENoG and NET, evaluations of HBGS’s grade and Yanagihara’s score, there were no significant difference.

Conclusions :

In idiopathic facial palsy inpatients, the proportion of Taeeum and Soyang among the Sasang constitution was higher, that of Dam among the Hyungsang classification was higher, that of Taeeum-Bangkwang among the Sasang combined with Hyungsang was the highest. It would seem that Bangkwang-body, female were closely related to Taeeumin, Soeumin. Also, Dam-body were closely related to male. But when comparing groups, there was no statistically significant difference in prognosis and improvement.

Key Words: Idiopathic facial palsy; Sasang Constitution; Hyungsang Classification; ENoG; NET; HBGS; Yanagihara’s score.

Table 1.

House-Brackmann Facial Palsy Grade System

Grade	Characteristics
I. Normal	Normal facial function in all areas
II. Mild dysfunction	Gross Slight weakness noticeable on close inspection May have slight synkinesis At rest, normal symmetry and tone Motion Forehead : moderate-to-good function Eye : complete closure with minimal effort Mouth : slight asymmetry
III. Moderate dysfunction	Gross Obvious but not disfiguring difference between the two sides Noticeable but not severe synkinesis, contracture, or hemifacial spasm At rest, normal symmetry and tone Motion Forehead : slight-to-moderate movement Eye : complete closure with effort Mouth : slightly weak with maximum effort
IV. Moderately severe dysfunction	Gross Obvious weakness and/or disfiguring asymmetry At rest, normal symmetry and tone Motion Forehead : none Eye : incomplete closure Mouth : asymmetric with maximum effort
V. Severe dysfunction	Gross Only barely perceptible motion At rest, asymmetry Motion Forehead : none Eye : incomplete closure Mouth : slight movement
VI. Total paralysis	No movement

1985. American Academy of Otolaryngology-Head and Neck Surgery(AAO-HNS).

Table 2.

Yanagihara’s Unweighted Grading System


At rest	1	2	3	4
Wrinkle forehead	1	2	3	4
Blink	1	2	3	4
Closure of eye lightly	1	2	3	4
Closure of eye tightly	1	2	3	4
Closure of eye involved side only	1	2	3	4
Wrinkle nose	1	2	3	4
Whistle	1	2	3	4
Grin	1	2	3	4
Depress lower lip	1	2	3	4

5-point system : 4-normal, 3-slight, 2-moderate, 1-severe, 0-total.

Table 3.

General Characteristics of Participants

		Number(percentage)
Sasang constitution	Taeeumin / Soyangin / Soeumin	40(39.2) / 40(39.2) / 22(21.6)
Hyungsang Classification	Bangkwang-body / Dam-body	77(75.5) /25(24.5)
Sasang Constitution Combined with Hyungsang Classification	Taeeumin-Bangkwang	35(34.3)
	Taeeumin-Dam	5(4.9)
	Soyangin-Bangkwang	22(21.6)
	Soyangin-Dam	18(17.6)
	Soeumin-Bangkwang	20(19.6)
	Soeumin-Dam	2(2.0)
Sex	Male / female	35(34.3) / 67(65.7)
Affected part	Left / right	61(59.8) / 41(40.2)
	Total	102(100)

Table 4.

Characteristics of Participants by Sasang Constitution

	Taeeumin, N(%)	Soyangin, N(%)	Soeumin, N(%)	p-value
Sex(M/F)	12(30.0)/28(70.0)	21(52.5) / 19(47.5)	2(9.1) / 20(90.9)	0.002^*
Affected part(L/R)	21(52.5)/19(47.5)	27(67.5) / 13(32.5)	13(59.1) / 9(40.9)	0.391
Age(mean±/SD)	48.70±14.24	53.03±16.10	47.45±13.40	0.538^**

^*: using Pearson’s Chi-square test, p0.05.

^**: using one-way ANOVA, p>0.05.

Table 5.

Characteristics of Participants by Hyungsang Classification

	Bangkwang-body, (%)	Dam-body, N(%)	p-value
Sex(M/F)	15(19.5) / 62(80.5)	20(80.0) / 5(20.0)	0.000^*
Affected part(L/R)	43(55.8) / 34(44.2)	18(72.0) / 7(28.0)	0.152
Age(mean±/SD)	49.29±14.70	52.72±15.45	0.918^**

^*: using Pearson’s Chi-square test, p0.05.

^**: using independent-samples t-test, p>0.05.

Table 6.

Characteristics of Participants by Sasang Constitution Combined with Hyungsang Classification

	Participants	Sex(M/F)	Affected part(L/R)	Age(mean±/SD)
Taeeumin-Bangkwang, N(%)	35(34.3)	7(20.0) / 28(80.0)	19(54.3) / 16(45.7)	49.57±14.90
Taeeumin-Dam, N(%)	5(4.9)	5(100.0) / 0(0.0)	2(40.0) / 3(60)	42.60±6.03
Soyangin-Bangkwang, N(%)	22(21.6)	7(31.8) / 15(68.2)	13(59.1) / 9(40.9)	51.18±15.45
Soyangin-Dam, N(%)	18(17.6)	14(77.8) / 4(22.2)	14(77.8) / 4(22.2)	55.28±17.03
Soeumin-Bangkwang, N(%)	20(19.6)	1(5.0) / 19(95.0)	11(55.0) / 9(45.0)	46.70±13.83
Soeumin-Dam, N(%)	2(2.0)	1(50.0) / 1(50.0)	2(100.0) / 1(0.0%)	55.00±2.83
p-value	0.001^*	0.000^*	0.390	0.438^**

^*: using Pearson’s Chi-square test, p<0.05.

^**: using one-way ANOVA, p>0.05.

Table 7.

Comparison of ENoG and NET in Sasang Constitution

	ENoG	NET(D) forehead	NET(D) eye	NET(D) nose	NET(D) lip
Taeeumin	45.31±18.45	1.05±1.65	0.95±1.31	1.14±1.93	1.36±1.76
Soyangin	48.48±24.70	1.32±1.69	1.31±1.50	1.51±1.87	1.15±0.89
Soeumin	51.75±20.72	1.40±1.40	1.27±1.09	1.52±1.29	1.46±1.27
p-value	0.548	0.690	0.467	0.637	0.793

Values are number or mean±SD.

NET(D) : difference of abnormal and normal NET.

Using Kruskal-Wallis test, p<0.05.

Table 8.

Comparison of ENoG and NET in Hyungsang Classification

	ENoG	NET(D) forehead	NET(D) eye	NET(D) nose	NET(D) lip
Bangkwang-body	48.19±20.67	1.28±1.73	1.14±1.42	1.40±1.93	1.30±1.45
Dam-body	47.00±24.35	1.08±1.21	1.21±1.13	1.27±1.33	1.28±1.10
Z	−0.342	−0.430	−0.180	−0.401	−0.063
p-value	0.732	0.667	0.857	0.688	0.950

Values are Number or mean±SD.

NET(D) : difference of abnormal and normal NET.

Using Mann-Whitney U test, p<0.05.

Table 9.

Comparison of ENoG and NET in Sasang Constitution Combined with Hyungsang Classification

	ENoG	NET(D) forehead	NET(D) eye	NET(D) nose	NET(D) lip
Taeeumin-Bangkwang	45.15±17.93	1.19±1.73	0.96±1.38	1.24±2.05	1.48±1.80
Taeeumin-Dam	46.40±24.03	0.14±0.42	0.88±0.75	0.50±0.62	0.54±1.30
Soyangin-Bangkwang	50.86±25.51	1.36±1.28	1.31±1.23	1.52±1.45	1.44±0.89
Soyangin-Dam	45.56±24.10	1.36±1.28	1.31±1.23	1.52±1.45	1.44±0.89
Soeumin-Bangkwang	50.67±19.28	1.44±1.46	1.27±1.09	1.58±1.34	1.43±1.23
Soeumin-Dam	61.50±40.31	0.90±0.71	1.20±1.41	1.00±0.71	1.70±2.26
p-value	0.877	0.252	0.879	0.477	0.235

Values are number or mean±SD.

NET(D) : difference of abnormal and normal NET.

Using Kruskal-Wallis test, p<0.05.

Table 10.

Comparison of HBGS Grade and Y-score in Sasang Constitution

	Taeeumin	Soyangin	Soeumin	p-value
H1	3.75±0.44	3.65±0.53	3.73±0.56	0.606
Y1	16.80±6.17	18.20±6.60	17.50±7.72	0.605
H21	−0.03±0.29	0.03±0.28	−0.48±0.22	0.540
H31	−0.39±0.60	−0.45±0.60	−0.62±0.50	0.250
H41	−1.25±0.60	−1.20±0.72	−1.29±0.72	0.745
Y21	1.89±3.45	2.03±3.65	3.14±3.20	0.293
Y31	6.83±4.17	7.73±5.39	7.73±5.39	0.358
Y41	13.39±4.59	13.08±5.67	14.86±5.78	0.575

Values are number or mean±SD. Using Kruskal-Wallis test, p<0.05.

H1 : HBGS grade of admission date.

Y1 : Y-score of admission date.

H21 : the changes of HBGS during assessment date of ENoG - admission date.

H31 : the changes of HBGS during 2 weeks after onset - admission date.

H41 : the changes of HBGS during 4 weeks after onset - admission date.

Y21: the changes of Y-score during assessment date of ENoG - admission date.

Y31: the changes of Y-score during 2 weeks after onset - admission date.

Y41: the changes of Y-score during 4 weeks after onset - admission date.

Table 11.

Comparison of HBGS Grade and Y-score in Hyungsang Classification

	Bangkwang-body	Dam-body	Z	p-value
H1	3.74±0.50	3.60±0.50	−1.185	0.236
Y1	17.39±6.76	17.84±6.45	−0.316	0.752
H21	−0.01±0.27	0.00±0.29	−0.221	0.825
H31	−0.49±0.60	−0.40±0.50	−0.565	0.572
H41	−1.28±0.70	−1.12±0.36	−0.923	0.356
Y21	2.08±3.26	2.60±4.11	−0.324	0.746
Y31	8.12±5.72	8.12±5.72	−0.277	0.782
Y41	13.60±5.10	13.52±5.97	−0.103	0.918

Values are number or meam±SD. Using Mann-Whitney U test, p<0.05

H1 : HBGS grade of admission date.

Y1 : Y-score of admission date.

H21 : the changes of HBGS during Assessment date of ENoG - admission date.

H31 : the changes of HBGS during 2 weeks after onset - admission date.

H41 : the changes of HBGS during 4 weeks after onset - admission date.

Y21: the changes of Y-score during Assessment date of ENoG - admission date.

Y31: the changes of Y-score during 2 weeks after onset - admission date.

Y41: the changes of Y-score during 4 weeks after onset - admission date.

Table 12.

Comparison of HBGS Grade and Y-score in Sasang Constitution Combined with Hyungsang Classification

	Taeeumin-Bangkwang	Taeeumin-Dam	Soyangin-Bangkwang	Soyangin-Dam	Soeumin-Bangkwang	Soeumin-Dam	p-value
H1	3.77±0.43	3.60±0.55	3.72±0.55	3.56±0.51	3.70±0.57	4.00±0.00	0.644
Y1	16.63±5.99	18.00±8.00	18.27±6.80	18.11±6.53	17.75±8.07	15.00±0.00	0.947
H21	−0.03±0.31	0.00±0.00	0.00±0.31	0.06±0.24	0.00±0.00	−0.50±0.71	0.157
H31	−0.39±0.62	−0.40±0.55	−0.50±0.67	−0.39±0.50	−0.63±0.50	−0.50±0.71	0.697
H41	−1.23±0.62	−1.40±0.55	−1.36±0.79	−1.00±0.59	−1.26±0.73	−1.50±0.71	0.607
Y21	2.06±3.41	0.80±3.96	2.61±3.99	2.61±3.99	2.74±2.92	7.00±4.24	0.190
Y31	6.90±3.79	6.40±6.66	7.32±5.32	8.22±5.59	8.42±4.34	11.50±6.36	0.709
Y41	13.39±4.34	13.40±6.54	13.00±5.47	13.17±6.07	14.63±5.90	17.00±5.66	0.908

Values are number or mean±SD. Using Kruskal-Wallis test, p<0.05.

H1 : HBGS grade of admission date.

Y1 : Y-Score of admission date.

H21 : the changes of HBGS during assessment date of ENoG - admission date.

H31 : the changes of HBGS during 2 weeks after onset - admission date.

H41 : the changes of HBGS during 4 weeks after onset - admission date.

Y21 : the changes of Y-score during assessment date of ENoG - admission date.

Y31 : the changes of Y-score during 2 weeks after onset - admission date.

Y41 : the changes of Y-score during 4 weeks after onset - admission date.

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