Diferentes Frequências de Laser nos Resultados Neuropáticos em Pacientes com Paralisia de Bell

Comparador Ativo: terapia com laser simulado

20 participantes receberão um dispositivo laser simulado, que será aplicado nos oito pontos do rosto. E será aplicado num total de 18 sessões de tratamento durante um período de 6 semanas consecutivas (três sessões/semana).

Dispositivo: terapia com laser simulado

a irradiação laser será desativada no dispositivo laser simulado pelo seu fabricante, mas as suas funções de luz visual e acústica serão mantidas. A potência de saída da luz infravermelha do laser simulado será zero mW e será aplicada nos oito pontos do rosto

Outro: Exercises

Patients in all treatment groups received the same standardized rehabilitation programme consisting of facial massage, mirror exercises, and resisted facial and neck exercise

Experimental: Terapia a Laser de Baixa Intensidade

20 participantes receberão Terapia a Laser de Baixa Intensidade (LLLT) durante 5 minutos em oito pontos da face, totalizando 18 sessões de tratamento ao longo de 6 semanas consecutivas (três sessões/semana)

Outro: Exercises

Patients in all treatment groups received the same standardized rehabilitation programme consisting of facial massage, mirror exercises, and resisted facial and neck exercise

Dispositivo: Low-Level Laser Therapy

Low-Level Laser Therapy (LLLT) for 5 min over eight points over the face, with the laser probe in direct contact with the superficial roots of the facial nerve. The parameters will be used wavelength of 808 nm (Polaris HP, Astar, Bielsko-Biała, Poland) and 980 nm (TheraLASER max, TheraMarkt, Germany), frequency of 1 kilohertz, the duty cycle of 80%, and energy density of 10 J/cm'. During each session, the total energy will be delivered to the patient are 1440 J per session (8 treatment points × 180 J per point; 3 W average power over a 6 cm² applicator, 60 s per point).

Experimental: laser de diodo de arseneto de gálio

20 participantes receberão laser de díodo de arsenieto de gálio (GaAs) (laser BTL-5000) para um total de 18 sessões de tratamento durante um período de 6 semanas consecutivas (três sessões/semana)

Dispositivo: gallium arsenide diode laser (BTL-5000 laser)

gallium arsenide diode laser (BTL-5000 laser) will be used with infrared probes of 830 nm wavelength and 100 mW output power, average energy density of 10 J/em?, a frequency of 1 kilohertz, and a duty cycle of 80 %. In all cases, the laser will be in direct contact with the superficial roots of the facial nerve on the affected side and will be applied for 2 min and 5 s per point for 8 points with a total energy of 1440 J per session (8 treatment points × 180 J per point; 3 W average power over a 6 cm² applicator, 60 s per point)

Comparador Ativo: tratamento com laser de alta intensidade

20 participantes receberão tratamento com laser de alta intensidade com um laser de ítrio-alumínio-granada dopado com neodímio pulsado, num total de 18 sessões de tratamento ao longo de um período de 6 semanas consecutivas (três sessões/semana)

Outro: Exercises

Patients in all treatment groups received the same standardized rehabilitation programme consisting of facial massage, mirror exercises, and resisted facial and neck exercise

Dispositivo: high intensity laser treatment

High intensity laser therapy treatment with pulsed neodymium doped: yttrium aluminum garnet laser. The apparatus provided the following options: pulsed emission (1,064 nm), very high peak powers (3 kW), high levels of fluency (energy density) (810-1,780 mJ/cm), brief duration (120-150 Ms), low frequency (10-40 Hertz), and a duty cycle of approximately 0.1 %. High intensity laser therapy will be applied with contact and perpendicular to the superficial roots of the facial nerve of the affected side. The time of application will be 7 s/per point with an energy density of 10 J/em'. The total energy delivered to the patient during one session will be 1440 J per session (8 treatment points × 180 J per point; 3 W average power over a 6 cm² applicator, 60 s per point). The device calculates the number of pulses, energy received for each session, and the total energy delivered to the patient during the treatment session

assessment of Compound motor action potential of facial nerve

Compound motor action potential of the facial nerve was evaluated using electroneurography. This involved measuring latency and amplitude differences between the affected and non-affected sides of the nasalis muscle. Latency was calculated from the baseline to the initial deflection, while amplitude was determined as peak-to-peak measurements, with both measures yielding Facial-nerve distal latency and CMAP amplitude at the nasalis.

secondary Outcome

Facial Disability Index - Physical subscale; Facial Disability Index - Social subscale