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Original article
Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae
Efecto de la toxina botulínica tipo A en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica
U. Díaz-Aristizabal
Corresponding author
udiaz@xarxatecla.cat

Corresponding author.
, M. Valdés-Vilches, T.R. Fernández-Ferreras, E. Calero-Muñoz, E. Bienzobas-Allué, L. Aguilera-Ballester, J. Carnicer-Cáceres
Servicio de Rehabilitación y Medicina Física, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
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or chewing&#59; elevation of the oral commissure upon raising of the eyebrows or closing the eyes&#59; and the appearance of platysma bands when pursing the lips&#46; The pathogenesis of these sequelae is not understood&#44; although it has been suggested that aberrant regeneration of facial nerve fibres and synaptic reorganisation in the facial nerve nucleus may explain synkinesis&#44; spasms&#44; hypertonia&#44; and SMC&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These abnormal movements decrease the motility of paretic muscles&#59; thus&#44; in addition to a sensation of stiffness&#44; tension&#44; or pain&#44; patients also display facial asymmetry&#44; both at rest and in movement&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The face is one of the most important parts of the body in the social context&#44; identifying us as individuals and playing a fundamental role in self-image and in social interaction&#46; Therefore&#44; facial involvement due to PFP may provoke a psychological disorder that negatively impacts patients&#8217; self-esteem and socialisation&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Botulinum toxin type A &#40;BTX-A&#41; causes reversible muscle paralysis by inhibiting acetylcholine release at the neuromuscular junction&#44; without causing a long-term lesion to the muscle or nerve&#46; For several decades&#44; it has been used to treat a wide variety of diseases&#44; such as strabismus&#44; blepharospasm&#44; spasmodic dysphonia&#44; headache disorders&#44; achalasia&#44; hyperhidrosis&#44; and some sphincter disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A large body of research has demonstrated the efficacy of BTX-A infiltrations for reducing abnormal facial movements &#40;spasms&#44; hypertonia&#44; SMC&#44; and synkinesis&#41;&#46; Furthermore&#44; the treatment improves facial symmetry at rest and in movement&#44; and facial expressiveness&#44; and is minimally invasive without significant adverse effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;11</span></a> Nonetheless&#44; despite the existence of multiple studies on the treatment of PFP sequelae with BTX-A&#44; few researchers have assessed its effects on quality of life&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the light of the above&#44; the present study aims to evaluate the effect of BTX-A infiltrations as a treatment for PFP sequelae in our setting&#46; In addition to analysing its effects on facial nerve function and on synkinesis&#44; we also address the effect of the treatment on patient quality of life&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a prospective study of a cohort of 20 patients treated with BTX-A to minimise sequelae remaining after incomplete resolution of PFP&#59; sequelae most frequently consisted in muscle paresis&#44; hypertonia&#44; SMC&#44; spasms&#44; and synkinesis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The sample included 15 women &#40;75&#37;&#41; and 5 men &#40;25&#37;&#41;&#59; PFP affected the left side in 13 patients &#40;65&#37;&#41; and the right in 7 &#40;35&#37;&#41;&#46; Regarding aetiology&#44; PFP was caused by surgery in 5 patients &#40;25&#37;&#59; acoustic neuroma in one&#44; meningioma in one&#44; otologic surgery in 2&#44; and parotid tumour in one&#41;&#44; Bell&#8217;s palsy in 11 &#40;55&#37;&#41;&#44; herpes zoster infection in 3 &#40;15&#37;&#41;&#44; and hypertensive crisis in one &#40;5&#37;&#41;&#46; Patients had a mean &#40;standard deviation&#41; age of 58&#46;1 &#40;12&#46;07&#41; years &#40;range&#44; 39&#8211;78&#41;&#46; Mean disease progression time was 26&#46;5 months &#40;range&#44; 6&#8211;164&#59; Q<span class="elsevierStyleInf">1</span>&#8211;Q<span class="elsevierStyleInf">3</span>&#44; 8&#46;25&#8211;70&#46;5&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Participants were recruited from among patients attending outpatient consultations at the rehabilitation and physical medicine department of Xarxa Sanit&#224;ria i Social Santa Tecla in Tarragona &#40;Spain&#41; to receive BTX-A infiltrations&#44; between April 2017 and May 2019&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The inclusion criteria were as follows&#58; age 18 years and above&#44; progression time of at least 6 months&#44; incomplete resolution of PFP&#44; and willingness to participate in the study by completing the questionnaires&#46; All patients had previously completed a tailored programme of neuromuscular re-education&#44; with an initial phase of outpatient therapy followed by a home exercise programme&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The scales and questionnaires used were&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Sunnybrook Facial Grading System &#40;SFGS&#41;&#46; The SFGS measures the degree of impairment caused by PFP&#46; Scores range from 0 to 100&#44; with 100 points indicating normal function&#59; the scale assesses movement&#44; symmetry at rest&#44; and synkinesis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Facial Clinimetric Evaluation &#40;FaCE&#41;&#46; The FaCE questionnaire evaluates quality of life in patients with PFP&#46; The scale includes several domains &#40;facial movement&#44; facial comfort&#44; oral function&#44; eye comfort&#44; lacrimal control&#44; and social function&#41; and is scored from 0 to 100&#44; with a score of 100 considered normal&#46; In this study&#44; we analysed total FaCE score and the social function subscale&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Synkinesis Assessment Questionnaire &#40;SAQ&#41;&#46; This questionnaire evaluates synkinesis in different muscle groups in patients with PFP sequelae&#46; Scores range from 20 to 100&#44; with higher scores reflecting greater severity&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients underwent clinical evaluation and completed questionnaires prior to BTX-A infiltration &#40;on the same day&#41; and at 4 weeks&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The site and dosage of infiltrations were determined on a case-by-case basis&#44; according to the pattern of sequelae in each patient&#58; facial asymmetry&#44; hypertonia&#44; SMC&#44; synkinesis&#44; or overloading of facial muscles&#46; All infiltrations were administered by the same clinician&#59; 18 patients received onabotulinum toxin A &#40;Botox&#174;&#41; and 2 received incobotulinum toxin A &#40;Xeomin&#174;&#41;&#46; BTX-A was diluted at 100 IU in 2<span class="elsevierStyleHsp" style=""></span>mL physiological saline or 50 IU in 1<span class="elsevierStyleHsp" style=""></span>mL saline&#44; and administered using a 1<span class="elsevierStyleHsp" style=""></span>mL syringe with a 30<span class="elsevierStyleHsp" style=""></span>G needle&#46; A dose of 1&#8211;5 IU was administered at each injection point&#44; depending on the target muscle&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the SPSS statistics software&#44; version 17&#46;0&#46; Data were analysed with the paired sample <span class="elsevierStyleItalic">t</span> test&#59; the threshold for significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">This study was approved by the local clinical research ethics committee &#40;reference no&#46; C&#46;I&#46; 071&#47;2017&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">The total BTX-A dose administered ranged from 7&#46;5 to 100 IU&#46; Doses were 7&#46;5 IU in one patient &#40;5&#37;&#41;&#44; 45 IU in 2 &#40;10&#37;&#41;&#44; 50 IU in 11 &#40;55&#37;&#41;&#44; 85 IU in one &#40;5&#37;&#41;&#44; 90 IU in 4 &#40;20&#37;&#41;&#44; and 100 IU in one &#40;5&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The target muscles on the unaffected side were the frontalis&#44; zygomaticus major&#44; corrugator&#44; mentalis&#44; and depressor labii inferioris&#44; whereas on the affected side infiltrations targeted the frontalis&#44; corrugator&#44; orbicularis oculi&#44; mentalis&#44; depressor labii inferioris&#44; levator labii superioris&#44; platysma&#44; buccinator&#44; masseter&#44; temporalis&#44; and sternocleidomastoideus muscles&#46; Although the latter 3 muscles are not innervated by the facial nerve&#44; they were hypertonic in some patients&#44; hence the decision to administer BTX-A&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Mean &#40;standard deviation&#41; SFGS score was 64&#46;8 &#40;15&#46;75&#41; prior to infiltration&#44; increasing to 69&#46;7 &#40;16&#46;10&#41; after treatment&#46; We also observed increases in total FaCE score &#40;from 52&#46;42 &#91;22&#46;29&#93; to 64&#46;5 &#91;17&#46;76&#93;&#41; and FaCE social function score &#40;from 61&#46;15 &#91;29&#46;07&#93; to 78&#46;44 &#91;23&#46;25&#93;&#41;&#46; Mean SAQ score decreased from 46&#46;22 &#40;12&#46;44&#41; before treatment to 37&#46;55 &#40;10&#46;95&#41; after BTX-A infiltration&#46; All of these changes were statistically significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding adverse reactions&#44; 3 patients presented a mild increase in weakness of the orbicularis oculi muscle&#44; and a further 2 patients presented slightly increased weakness of the levator labii superioris with drooping of the upper lip&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The face is probably the most important part of the body in the social sphere&#46; As noted by Le Breton&#44; &#8220;even the humblest of individuals wears his face as the greatest sign of his difference&#46; It is the most human place in man&#8221;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#58; the face is the fundamental element of the body that identifies us as unique individuals&#44; the defining feature that differentiates one person from another&#46; Therefore&#44; PFP can be interpreted as an insult to individual identity&#44; with many patients expressing it in those terms &#40;&#8220;I&#8217;m not myself any more&#44;&#8221; &#8220;that&#8217;s not me in the picture&#8221;&#41;&#46; It also goes against prevailing beauty standards&#44; based on balance&#44; harmony&#44; and geometric proportions&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However&#44; the most severely affected area after PFP is social interaction&#44; with the face representing the fundamental part of the body in personal presentation&#44; in everyday conversation and non-verbal communication through facial expressions or the lack thereof&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;17</span></a> Thus&#44; patients with PFP may present social disability&#44; a stigma that will affect all face-to-face interactions&#44; obliging them to employ a series of social strategies including concealment&#44; masking&#44; exhibition&#44; or social withdrawal&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;17</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">It is for this reason that we consider it insufficient to limit the evaluation of PFP to facial nerve function&#44; without considering the psychological effects of the disease or its impact on quality of life&#46; Assessing psychological distress in these patients can be challenging&#44; and questionnaires may present limitations&#46; Therefore&#44; subjective tools such as in-depth interviews may provide more information&#46; We recommend the use of additional instruments to complement the evaluation of facial nerve function&#44; exploring the impact of disease on these patients&#8217; quality of life&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">It has been extensively demonstrated that BTX-A infiltration is a safe&#44; efficacious&#44; minimally invasive treatment for PFP sequelae&#44; improving both abnormal facial movements and facial symmetry at rest and in movement&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;11</span></a> The infiltration begins to take effect after 3 to 7 days&#44; with the benefit lasting approximately 4 months&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Weakening the muscles of the non-paralysed side not only improves symmetry&#44; but also enables strengthening and improved functioning of the affected side&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> Attenuation of synkinesis&#44; SMC&#44; and hypertonia can also increase facial motility on the affected side&#44; as abnormal movements do not interfere in the function of paretic muscles<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#59; however&#44; motility may also be reduced by the effect of BTX-A&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">According to our results&#44; BTX-A infiltration causes a significant improvement in facial nerve function &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; as measured with the SFGS&#44; confirming the reports of other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8&#44;10&#44;11</span></a> However&#44; the improvement observed was not as pronounced as those reported by other researchers&#46; Nonetheless&#44; some authors&#44; such as Couch et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> have observed a reduction in SFGS scores due to reduced motility secondary to BTX-A&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our results also show a significant reduction in synkinesis &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#44; as assessed with the SAQ&#44; once more confirming the findings of other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> As with SFGS score&#44; the change in SAQ scores was not as large as those reported in other articles&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Though extensive research has been conducted on the effect of BTX-A infiltrations on PFP sequelae&#44; few studies have evaluated the efficacy of the treatment in improving quality of life&#46; A review by Fuzi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> that explored this subject only identified 6 eligible studies&#44; concluding that BTX-A infiltration is an effective&#44; minimally invasive treatment that improves the quality of life of patients with PFP sequelae&#46; In one of the studies reviewed&#44; Kleiss et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> observed a statistically significant increase in the social function and facial comfort subscores after treatment with BTX-A&#59; Mehta and Hadlock<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> observed significant improvements in all FaCE subscale scores&#46; Though it is not reviewed by Fuzi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> the study by Couch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> also identified a statistically significant increase in social function and facial comfort scores after BTX-A infiltration&#46; Our study analysed the total and social function subscale scores&#44; omitting the remaining subscales&#44; and confirmed that BTX-A infiltration significantly increases quality of life in patients with PFP sequelae&#44; with greater improvements than those reported by other authors&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Other studies use the Facial Disability Index &#40;FDI&#41; to evaluate quality of life after treatment with BTX-A&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Salles et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> reported a statistically significant increase in FDI physical and social function subscale scores at 6 months after infiltration&#44; while Do Nascimento et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> detected a significant increase in FDI social function subscale score after infiltration of onabotulinum toxin A&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The study by De Carvalho et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> used the Body Image Quality of Life Inventory&#44; observing a statistically significant improvement in body image at 6 months after BTX-A infiltration&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Other authors have developed ad hoc questionnaires that address physical&#44; psychological&#44; and social factors to evaluate the effect of BTX-A infiltrations on quality of life&#44; social interactions&#44; and self-perception&#44; and report statistically significant improvements in all these areas&#46; However&#44; their results should be interpreted with caution as the questionnaires used are not validated&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11&#44;25</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Both the FDI and the FaCE were developed and validated for evaluating the impact of PFP sequelae on quality of life&#59; however&#44; there is no unanimous agreement on which tool should be used&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> Several of the studies discussed used the FaCE&#44;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;20&#44;21</span></a> whereas others used the FDI<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;23</span></a> and some used ad hoc tools&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11&#44;25</span></a> The main issue with ad hoc tools is reproducibility&#59; similarly&#44; no validated Spanish-language version is available for the FaCE and SAQ scales&#46; A validated Spanish-language version of these scales would constitute a significant advance in the study of quality of life in patients with PFP in our setting&#46; We recommend that one of these instruments be used in clinical practice in addition to measures of facial nerve function&#44; and particularly the FaCE scale for assessing quality of life&#46; Despite the lack of a validated Spanish-language version&#44; the scale shows a strong correlation with scales measuring facial nerve function &#40;SFGS&#41;&#44; disability &#40;FDI&#41;&#44; and psychological distress &#40;Hospital Anxiety and Depression Scale&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">With respect to infiltration technique&#44; it is important to note that BTX-A infiltration is a highly personal and individualised treatment&#44; and each patient presents a specific set of sequelae within a pattern of aberrant reinnervation including muscle paresis&#44; hypertonia&#44; SMC&#44; spasms&#44; and synkinesis&#44; with considerable variability between individual patients&#46; Furthermore&#44; not all patients attribute the same importance to the same aspects of these sequelae&#59; thus&#44; patients&#8217; subjective perception should inform decisions about the pattern of BTX-A infiltration&#46; The experience of the professional administering the treatment is also of fundamental importance&#46; Dosage must be determined carefully due to the risk that&#44; in attempting to reduce hypertonia&#44; SMC&#44; and synkinesis&#44; we may exacerbate the weakness of the paretic muscles&#46; Special attention must be paid to specific muscles&#44; such as the zygomaticus major and levator labii superioris&#44; which often simultaneously present both hypertonia and paresis&#44; and should be treated with very low doses of BTX-A &#40;up to 1&#46;5 IU&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> In our study&#44; 2 patients presented slightly increased weakness of the levator labii superioris&#44; with drooping of the upper lip&#44; following infiltration of 1&#46;25 IU of BTX-A&#59; this symptom resolved within 3 weeks&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Many patients with PFP sequelae also present hypertonia of muscles not innervated by the damaged facial nerve&#44; such as the masseter&#44; temporalis&#44; and sternocleidomastoideus&#46; We administered BTX-A infiltrations to these muscles in affected patients&#44; observing a considerable improvement in pain and in the sensation of stiffness&#46; The physiological mechanism causing the increased tone in these muscles is unknown&#44; and our literature search yielded no articles on the subject&#46; We suggest that PFP with permanent sequelae may cause a biomechanical alteration in facial activities such as chewing&#44; gesticulation&#44; or speech&#44; resulting in overloading of other muscles not innervated by the facial nerve&#44; and potentially leading to tension or pain&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The adverse reactions observed in 5 participants &#40;mild exacerbation of orbicularis oculi weakness in 3 and mild exacerbation of the levator labii superioris weakness with drooping of the upper lip in 2&#41; are consistent with those reported in the literature&#44; which include difficulty speaking&#44; eating&#44; and drinking&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9&#44;19&#44;23</span></a> As reported in the literature&#44; adverse effects are mild and transient&#44; and are outweighed by the benefit for patients&#8217; quality of life&#46; The adverse reactions observed in our study were mild and resolved within 3 to 4 weeks&#46; No patient presented such complications as ptosis&#44; dry eyes&#44; keratitis&#44; lagophthalmos&#44; or systemic symptoms&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Our study presents certain limitations&#44; and the results should be interpreted with caution&#46; Firstly&#44; we should mention the relatively small sample size and lack of a control group&#46; Secondly&#44; no validated Spanish-language version of the FaCE and SAQ questionnaires is available&#46; Finally&#44; quality of life was evaluated using a questionnaire&#44; which provides very limited information on such a complex domain as quality of life&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0180" class="elsevierStylePara elsevierViewall">BTX-A infiltrations improve facial nerve function and reduce synkinesis in patients with PFP sequelae&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">This treatment is minimally invasive&#44; causes no relevant adverse effects&#44; and improves quality of life in these patients&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study aimed to assess the effects of botulinum toxin A &#40;BTX-A&#41; infiltration on face muscle function&#44; synkinesis&#44; and quality of life in patients with sequelae of peripheral facial palsy &#40;PFP&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We present the results of a prospective study including a sample of 20 patients with sequelae of PFP &#40;15 women&#44; 5 men&#41; who underwent BTX-A &#40;Botox&#169; or Xeomin&#169;&#41; infiltration&#46; All patients had previously received personalised treatment with neuromuscular retraining&#46; A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment&#46; The effect of BTX-A on face muscle function&#44; quality of life&#44; and synkinesis was evaluated using the Sunnybrook Facial Grading System &#40;SFGS&#41;&#44; the Facial Clinimetric Evaluation &#40;FaCE&#41; questionnaire&#44; and the Synkinesis Assessment Questionnaire &#40;SAQ&#41;&#44; respectively&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Mean SFGS scores increased from 64&#46;8 to 69&#46;9 after BTX-A infiltration &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46; Increases were also observed in mean total FaCE scores &#40;from 52&#46;42 to 64&#46;5&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and the mean score on the FaCE social function subscale &#40;from 61&#46;15 to 78&#46;44&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Mean SAQ scores decreased from 46&#46;22 to 37&#46;55 after BTX-A infiltration &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">BTX-A infiltration increases face muscle function&#44; improves quality of life&#44; and reduces synkinesis in patients with sequelae of PFP&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Valorar el efecto del tratamiento con infiltraciones de Toxina Botul&#237;nica tipo A &#40;TXB-A&#41; en la funcionalidad facial&#44; las sincinesias y la calidad de vida en pacientes con secuelas de Par&#225;lisis Facial Perif&#233;rica &#40;PFP&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Presentamos un estudio prospectivo con una muestra de 20 pacientes con secuelas de PFP &#40;15 mujeres&#44; 5 varones&#41;&#44; a los que se infiltr&#243; TXB-A &#40;Botox&#169; o Xeomin&#169;&#41;&#46; Todos los pacientes realizaron previamente un tratamiento personalizado basado en la reeducaci&#243;n neuromuscular&#46; Se realiz&#243; una evaluaci&#243;n cl&#237;nica previa a las infiltraciones y otra al cabo de 4 semanas&#46; El efecto de las infiltraciones sobre la funcionalidad facial fue valorado mediante la escala Sunnybrook Facial Grading System &#40;SFGS&#41;&#46; El efecto sobre la calidad de vida se evalu&#243; a trav&#233;s del cuestionario Facial Clinimetric Evaluation Scale &#40;FaCE&#41;&#44; y el efecto sobre la reducci&#243;n de sincinesias se estudi&#243; utilizando el cuestionario Synkinesis Assessment Questionnaire &#40;SAQ&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La media de los valores del SFGS se increment&#243; tras el tratamiento con TXB-A&#44; de 64&#44;8 a 69&#44;9 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#44;004&#41;&#46; Tambi&#233;n se increment&#243; la media de los valores del FaCE Total&#44; de 52&#44;42 a 64&#44;5 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#44;001&#41;&#44; y la media de la subescala Social del FaCE&#44; de 61&#44;15 a 78&#44;44 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#44;001&#41;&#46; La media de los valores del SAQ disminuy&#243; con las infiltraciones de TXB-A&#44; de 46&#44;22 a 37&#44;55 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Las infiltraciones de TXB-A incrementan la funcionalidad facial&#44; mejoran la calidad de vida y reducen las sincinesias en pacientes con secuelas de PFP&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; FaCE&#58; Facial Clinimetric Evaluation&#59; OR&#58; odds ratio&#59; SAQ&#58; Synkinesis Assessment Questionnaire&#59; SD&#58; standard deviation&#59; SFGS&#58; Sunnybrook Facial Grading System&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Difference between means&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">SFGS pre-infiltration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64&#46;80 &#40;15&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;73&#8722;8&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SFGS post-infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#46;70 &#40;16&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FaCE total pre-infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">52&#46;42 &#40;22&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;63&#8722;17&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FaCE total post-infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64&#46;50 &#40;17&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FaCE social pre-infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#46;15 &#40;29&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; &#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;21&#8722;24&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FaCE social post-infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;44 &#40;23&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SAQ pre-infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;22 &#40;12&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;86&#8722;13&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SAQ post-infiltration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;55 &#40;10&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pre- and post-infiltration scores on the Sunnybrook Facial Grading System&#44; total and social function subscale of the Facial Clinimetric Evaluation&#44; and Synkinesis Assessment Questionnaire&#46;</p>"
        ]
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psychological distress in people with disfigurement from facial palsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Fu"
                            1 => "C&#46; Bundy"
                            2 => "S&#46;A&#46; Sadig"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eye&#46;"
                        "fecha" => "2011"
                        "volumen" => "25"
                        "paginaInicial" => "1322"
                        "paginaFinal" => "1326"
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonmotor disabilities in patients with facial palsy measured by patient-reported outcome measure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;F&#46; Volk"
                            1 => "T&#46; Granitzka"
                            2 => "H&#46; Kreysa"
                            3 => "C&#46;M&#46; Klingner"
                            4 => "O&#46; Guntinas-Lichius"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lary.25695"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope&#46;"
                        "fecha" => "2016"
                        "volumen" => "126"
                        "paginaInicial" => "1516"
                        "paginaFinal" => "1523"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26421410"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The development of synkinesis after facial nerve paralysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Celik"
                            1 => "H&#46; Forta"
                            2 => "C&#46; Vural"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000008154"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Neurol&#46;"
                        "fecha" => "2000"
                        "volumen" => "43"
                        "paginaInicial" => "147"
                        "paginaFinal" => "151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10765054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlaci&#243;n entre deficiciencia&#44; afectaci&#243;n psicol&#243;gica&#44; discapacidad y calidad de vida en la par&#225;lisis facial perif&#233;rica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "U&#46; D&#237;az-Aristizabal"
                            1 => "M&#46; Vald&#233;s-Vilches"
                            2 => "T&#46;R&#46; Fern&#225;ndez-Ferreras"
                            3 => "E&#46; Calero-Mu&#241;oz"
                            4 => "E&#46; Bienzobas-Allu&#233;"
                            5 => "T&#46; Morac&#233;n-Naranjo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nrl.2017.03.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurologia&#46;"
                        "fecha" => "2019"
                        "volumen" => "34"
                        "paginaInicial" => "423"
                        "paginaFinal" => "428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28549753"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of botulinum toxin in head and face medicine&#58; an interdisciplinary field"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Laskawi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1746-160X-4-5"
                      "Revista" => array:5 [
                        "tituloSerie" => "Head Face Med&#46;"
                        "fecha" => "2008"
                        "volumen" => "4"
                        "paginaInicial" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18331633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum toxin in the treatment of facial synkinesis and hyperkinesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Filipo"
                            1 => "I&#46; Spahiu"
                            2 => "E&#46; Covelli"
                            3 => "M&#46; Nicastri"
                            4 => "G&#46;A&#46; Bertoli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lary.22404"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope&#46;"
                        "fecha" => "2012"
                        "volumen" => "122"
                        "paginaInicial" => "266"
                        "paginaFinal" => "270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22252570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating buccinator with botulinum toxin in patients with facial synkinesis&#58; a previously overlooked target"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Wei"
                            1 => "J&#46; Diels"
                            2 => "M&#46;J&#46; Lucarelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ophtalmic Plast Reconstr Surg&#46;"
                        "fecha" => "2016"
                        "volumen" => "32"
                        "paginaInicial" => "138"
                        "paginaFinal" => "141"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46;D&#46; Toffola"
                            1 => "F&#46; Furini"
                            2 => "C&#46; Redaelli"
                            3 => "E&#46; Prestifilippo"
                            4 => "M&#46; Bejor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/09638280903514697"
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                        "tituloSerie" => "Disabil Rehabil&#46;"
                        "fecha" => "2010"
                        "volumen" => "32"
                        "paginaInicial" => "1414"
                        "paginaFinal" => "1418"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20156046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum toxin injection in long-standing facial paralysis patients&#58; improvement of facial symmetry observed up to 6 months"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;G&#46; Salles"
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                            2 => "M&#46;C&#46; Ferreira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00266-009-9337-9"
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                        "tituloSerie" => "Aesthetic Plast Surg&#46;"
                        "fecha" => "2009"
                        "volumen" => "33"
                        "paginaInicial" => "582"
                        "paginaFinal" => "590"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19330369"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum toxin injection of both sides of the face to treat post-paralytic facial synkinesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;H&#46; Choi"
                            1 => "S&#46;H&#46; Rho"
                            2 => "J&#46;M&#46; Lee"
                            3 => "J&#46;H&#46; Jeon"
                            4 => "S&#46;Y&#46; Park"
                            5 => "J&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bjps.2013.04.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Plast Reconstr Aesthet Surg&#46;"
                        "fecha" => "2013"
                        "volumen" => "66"
                        "paginaInicial" => "1058"
                        "paginaFinal" => "1063"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23683725"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contralateral botulinum toxin injection to improve facial asymmetry after acute facial paralysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/mao.0b013e31827c9f58"
                      "Revista" => array:6 [
                        "tituloSerie" => "Otol Neurotol&#46;"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "319"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23444480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of a sensitive clinical facial grading system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;G&#46; Ross"
                            1 => "G&#46; Fradet"
                            2 => "J&#46;M&#46; Nedzelski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0194-59989670206-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Otolaryngol Head Neck Surg&#46;"
                        "fecha" => "1996"
                        "volumen" => "114"
                        "paginaInicial" => "380"
                        "paginaFinal" => "386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8649870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of a patient-graded instrument for facial nerve paralysis&#58; the FaCE scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;B&#46; Kahn"
                            1 => "R&#46;E&#46; Gliklich"
                            2 => "K&#46;P&#46; Boyev"
                            3 => "M&#46;G&#46; Stewart"
                            4 => "R&#46;B&#46; Metson"
                            5 => "M&#46;J&#46; McKenna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00005537-200103000-00005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope&#46;"
                        "fecha" => "2001"
                        "volumen" => "111"
                        "paginaInicial" => "387"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11224766"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of the Synkinesis Assessment Questionnaire"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;P&#46; Mehta"
                            1 => "M&#46; WernickRobinson"
                            2 => "T&#46;A&#46; Hadlock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MLG.0b013e3180412460"
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                        "tituloSerie" => "Laryngoscope&#46;"
                        "fecha" => "2007"
                        "volumen" => "117"
                        "paginaInicial" => "923"
                        "paginaFinal" => "926"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17473697"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rostros&#46; Ensayo de antropolog&#237;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Le Breton"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2010"
                        "editorial" => "Editorial Letra Viva"
                        "editorialLocalizacion" => "Buenos Aires"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Las proporciones divinas"
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                            0 => "F&#46; Blanco D&#225;vila"
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                        "volumen" => "15"
                        "paginaInicial" => "118"
                        "paginaFinal" => "124"
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                    ]
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                ]
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            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estigma&#46; La identidad deteriorada"
                      "autores" => array:1 [
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                            0 => "E&#46; Goffman"
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1963"
                        "editorial" => "Amorrortu Editores"
                        "editorialLocalizacion" => "Buenos Aires"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subjective and objective outcome measures in the tratment of facial nerve synkinesis with onabotulinumtoxinA &#40;Botox&#41;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            2 => "J&#46;B&#46; Holds"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IOP.0000000000000086"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmic Plast Reconstr Surg&#46;"
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                        "volumen" => "30"
                        "paginaInicial" => "246"
                        "paginaFinal" => "250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24807539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
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                0 => array:2 [
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                      "titulo" => "Does botulinum toxin therapy improve quality of life in patients with facial palsy&#63;"
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                        ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aesthetic Plastic Surg&#46;"
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                        "volumen" => "44"
                        "paginaInicial" => "1811"
                        "paginaFinal" => "1819"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health-related quality of life in 794 patients with a peripheral facial palsy using the FaCE Scale&#58; a retrospective cohort study"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "I&#46;J&#46; Kleiss"
                            1 => "M&#46;H&#46; Hohman"
                            2 => "S&#46;M&#46; Susarla"
                            3 => "H&#46;A&#46; Marres"
                            4 => "T&#46;A&#46; Hadlock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/coa.12434"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Otolaryngol&#46;"
                        "fecha" => "2015"
                        "volumen" => "40"
                        "paginaInicial" => "651"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25858429"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Botulinum toxin and quality of life in patients with facial paralysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;P&#46; Mehta"
                            1 => "T&#46;A&#46; Hadlock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archfaci.10.2.84"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Facial Plast Surg&#46;"
                        "fecha" => "2008"
                        "volumen" => "10"
                        "paginaInicial" => "84"
                        "paginaFinal" => "87"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18347234"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Facial Disability Index&#58; reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; VanSwearingen"
                            1 => "J&#46;S&#46; Brach"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Physical Ther&#46;"
                        "fecha" => "1996"
                        "volumen" => "76"
                        "paginaInicial" => "1288"
                        "paginaFinal" => "1298"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of the effificacy of onabotulinumtoxinA and abobotulinumtoxinA at the 1&#58; 3 conversion ratio for the treatment of asymmetry after long-term facial paralysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;F&#46; do Nascimento Remigio"
                            1 => "A&#46;G&#46; Salles"
                            2 => "J&#46;C&#46; de Faria"
                            3 => "M&#46;C&#46; Ferreira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PRS.0000000000000800"
                      "Revista" => array:6 [
                        "tituloSerie" => "Plast Reconstr Surg&#46;"
                        "fecha" => "2015"
                        "volumen" => "135"
                        "paginaInicial" => "239"
                        "paginaFinal" => "244"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25285681"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of the body image of patients with facial palsy before and after the application of botulinum toxin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "A&#46;P&#46;S&#46; Vieira"
                            2 => "A&#46;O&#46; Paggiaro"
                            3 => "A&#46;G&#46; Salles"
                            4 => "R&#46; Gemperli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Intern J Dermatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "58"
                        "paginaInicial" => "1175"
                        "paginaFinal" => "1183"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Encuesta de satisfacci&#243;n del paciente con secuelas de par&#225;lisis facial perif&#233;rica en tratamiento con toxina botul&#237;nica A"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            1 => "Z&#46; Hachoue"
                            2 => "E&#46; Abdel-Muti"
                            3 => "G&#46; Ruiz"
                            4 => "J&#46; D&#237;ez Sebasti&#225;n"
                            5 => "L&#46; Lasaletta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rh.2020.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rehabilitaci&#243;n&#46;"
                        "fecha" => "2020"
                        "volumen" => "54"
                        "paginaInicial" => "254"
                        "paginaFinal" => "259"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32441261"
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                    ]
                  ]
                ]
              ]
            ]
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Original language: English
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es en pt

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