3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study.

Gerd Fabian Volk,Mira Finkensieper,Orlando Guntinas-Lichius,Martin Pohlmann,Heather J Chalmers

doi:10.1186/1472-6815-14-4

Gerd Fabian Volk, Mira Finkensieper + Show 3 more

Open Access

https://doi.org/10.1186/1472-6815-14-4

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Abstract

BackgroundWhile standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking.MethodsA 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions.ResultsThe US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side.Conclusion3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment.

Highlights

While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking
In the present pilot study we explored the possibilities of modern Three dimensional (3D) ultrasonography to allow a fast assessment of regional muscle volume changes in patients with facial palsy
In three patients (#1, #2, #3; Figure 3A-F) reanimation of the affected hemiface was performed by hypoglossal-facial jump nerve suture (HFJ) 2 to 18 months before the 3D ultrasonographic examination

Summary

Introduction

While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. Long-term denervation causes loss of the resting tone accompanied by progressive facial muscle atrophy. According to a general doctrine, facial nerve reconstruction surgery is not recommended beyond two to three years after degenerative facial nerve lesion [3]. This rule of thumb is rough as the time. Ultrasonography allows individual cross-sections optimized for every muscle during real time imaging. It can detect distinctive patterns in muscles affected by a neuromuscular disease [6]. The additional application of three dimensional (3D) ultrasonography produces volumetric data that might simplify the quantification of muscle atrophy [7]

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