Long-standing Facial Paralysis Research Articles

Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature.

BackgroundThis study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest.MethodsAn electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms “Bell's palsy,” “Ramsay-Hunt syndrome,” “Facial palsy,” “Facial paralysis,” “Facial paresis,” “Guideline,” “Meta-analysis,” “Systematic review,” and “Randomized controlled trial.” Only studies written in English were used.ResultsThe characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised.ConclusionFor peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.

A Modified Technique of Transposition of Temporalis Muscle in Selected Cases of Longstanding Facial Paralysis.

The authors present a modified technique of temporalis muscle transposition technique in cases of longstanding facial paralysis. Slips of the temporalis fascia were passed through the tunnels to reach the contralateral para-median plane. The procedure provides 2 point of fixation to the transferred muscle. Local flaps were used for temporal hollow obliteration and for temporalis muscle elongation.This case series included 11 patients. The modified technique was performed for all patients to reanimate the lower face while gold weight impanation in the upper eye lid was used for re-animation of the eye in 9 patients. By the end of follow up, the procedure was considered successful in 9 patients. Eight patients expressed their satisfaction and 7 patients were happy with the regained facial movement.The modified temporalis muscle transfer technique might be a valuable option in cases of longstanding facial paralysis. The lips would be camouflaged, non-stretched and would move with the whole mid-face.

Neurotized Platysma Graft: A New Technique for Functional Reanimation of the Eye Sphincter in Longstanding Facial Paralysis.

In 1984, Terzis reported on the potential use of a free platysma muscle transfer to reanimate the orbicularis oculi in longstanding paralysis of this unit. However, the vascularized platysma flap proved difficult to transfer, and this technique is not widely used today. In the present study, the authors have described the technique involving grafting of the platysma muscle to restore eyelid function and retrospectively discussed its clinical outcomes. This retrospective analysis included patients with longstanding facial paralysis who underwent orbicularis oculi reconstruction with neurotized platysma grafts. The authors have described the surgical technique and its retrospective clinical outcomes. Between 1992 and 2015, 38 consecutive patients underwent this procedure; of them, 34 [16 men (47 percent) and 18 women (53 percent)] completed the follow-up. The time between the first and second surgical stages was a mean 8.6 months (range, 6 to 22 months). The surgical results were good in 18 patients (53 percent) and the recovery was satisfactory in 13 (38 percent). This study confirmed the feasibility and effectiveness of grafted muscle functional recovery and the efficiency of neuromuscular neurotization. The presented surgical technique is safe and effective for treating longstanding facial palsy of the orbicularis oculi muscle. This is the only technique that is easy and reproducible, leads to facial nerve recovery, and places a similar muscle at the original site of the paralyzed muscle for functional recovery. Therapeutic, IV.

M-Mode Echomyography of Facial Muscle Function Following Facial Reanimation with Temporalis Muscle Galea Pedicled Flap: Analysis of Ten Cases with Review of Literature.

Facial palsy is a condition where the patients lack voluntary movement on the affected side of the face and are not able to convey their emotions. Besides that, they also succumb themselves to social isolation. Various techniques have been devised to overcome this devastating problem. The aim of this article is to evaluate and compare facial muscle function before and after facial reanimation with temporalis muscle galea pedicled flap by motion mode echomyography in patients with long-standing facial paralysis. Ten patients with long-standing facial paralysis were included in the study (six patients with LMN palsy and four patients with facial weakness involving specific peripheral branches), and they subsequently underwent facial reanimation surgery with temporalis galea pedicled flap. These patients were followed postoperatively for a period of 1-2years and were subjectively graded as excellent, good, fair and poor and objectively evaluated by M-mode echomyography, and the results were evaluated and statistically analyzed. Subjectively, out of 6 patients with LMN palsy, results were graded as excellent in 2 cases, good in 3 cases, fair in 1 case, and out of 4 patients with weakness in specific facial nerve branches, the subjective results were excellent in 2 cases, good in 1 case and fair in 1 case. Objectively, the effect of transposed temporalis galea on orbicularis occuli, levator labii superioris and orbicularis oris was found to be statistically significant in patients with LMN palsy. Our study proves the versatility of temporalis muscle galea pedicled flap in cases of long-standing facial paralysis by motion mode echomyography.

Treatment of Post-Facelift Facial Paralysis With Botulinum Toxin Type A

BACKGROUND: Nerve injuries post-facelifts are rare but cause serious functional and psychological impairment of self-esteem and quality of life.1,2 Despite being temporary in most cases, facial asymmetry typically lasts for 3 months. We present a treatment protocol for post-facelift facial nerve injuries using botulinum toxin type A (BTXA). MATERIALS AND METHODS: The study was conducted from January 2002 to June 2018. Nine patients (all female; mean age, 58 ± 8.4 years) with asymmetries due to post-rhytidectomy facial palsies were treated in the nonparalyzed side with abobotulinum toxin type A, with 6-month to 5-year follow-up. The 500-U vial was diluted in 4 ml of 0.9% saline. We considered 0.02 ml of the solution (2.5 abobotulinum toxin units) as 1 volume unit. Patients were examined after 15 days for outcomes evaluation. The dose applied to each muscle group1 varied from 1 to 2 volume unit per point. Patients were retreated after 5–6 months in case of asymmetry recurrence. RESULTS: Four patients sought early care (mean, 14.2 ± 6.4 days postoperative, ranging from 5 to 21 days). The others arrived later (mean, 225 ± 80.7 days postoperative, ranging from 150 to 360 days). Two patients had lesions affecting the upper third of the face, and symmetry was achieved after unilateral treatment of the frontalis muscle. Three patients had injury in the middle third; their treatment depended of analysis of the deviation vectors when smiling and frowning, as to decide which muscle groups should be treated (vertical: upper lip lifter muscles; upper oblique: lifters of the angle of the mouth muscles; and horizontal: risorius muscle). Four patients were affected in the lower third (inferior deviation vectors) and were treated with 2 points to paralyze the lower lip depressor muscles. Correction of asymmetry was achieved in all cases. Recovery from the nerve injury and BTXA application occurred symmetrically in both sides of the face in the following months. All patients with early onset of BTXA therapy (<30 days) had complete recovery of facial symmetry with a single application, evidence of neuropraxis. Patients with lesions of the upper third, those with late onset of BTXA treatment (>30 days), and those with >1 affected nervous branch presented definitive lesion, with partial recovery or improvement, and needed BTXA treatment every 6 months. CONCLUSION: Most facial nerve injuries post-facelifts presented favorable evolution for spontaneous resolution, except in the upper third of the face and in case of late lesions. Symmetry was achieved in all cases with low doses of BTXA in the suggested protocol points, avoiding an unhappy asymmetric patient in the following months. REFERENCES: 1. Salles AG, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: improvement of facial symmetry observed up to 6 months. Aesthetic Plast Surg. 2009;33:582–590. 2. do Nascimento Remigio AF, Salles AG, de Faria JCM, et al. Comparison of the efficacy of onabotulinumtoxinA and abobotulinumtoxinA at the 1: 3 conversion ratio for the treatment of asymmetry after long-term facial paralysis. Plast Reconstr Surg. 2015;135:239–249.

Functional results after facial reanimation in iatrogenic facial palsy.

Iatrogenic facial nerve injury is a common cause of long-standing facial palsy. This study aimed to assess functional results after facial reanimation in iatrogenic facial palsy and to determine correlating patient factors. The data of 128 iatrogenic facial palsy patients were analyzed for this case series. Inclusion criteria for assessment of facial function by three-dimensional video analysis were preoperative and postoperative (>18 months) video sets for facial marker tracking, which were available in 63 patients. Demographic factors and treatment concepts were analyzed and correlations to functional outcomes calculated. One hundred and twenty-eight patients with iatrogenic facial palsy underwent facial reanimation procedures and were included in this study. The mean duration of facial palsy was 7.8 years. The most common procedures leading to iatrogenic facial palsy were acoustic neuroma resection (29.7%), parotidectomy (21.1%), and brainstem/cerebellopontine angle tumor resection (21.1%). Selected functional results were significantly improved after facial reanimation surgery. The mean lagophthalmos during eyelid closure reduced from 7.3 ± 4.1 mm to 5.4 ± 4 mm (p < .001). The function of the mouth was significantly improved, both statically (static asymmetry: 10.3 ± 7.6 mm preoperatively, 0.8 ± 9.5 mm postoperatively; p < .001), and during smile movement ("Dynamic Symmetry Index": 0.16 preoperatively, 0.39 postoperatively; p < .001). The mean duration of facial palsy correlated with postoperative smiling function (r = .358, p = .011). Facial reanimation significantly improves facial function in iatrogenic facial palsy. Early referral to a facial nerve center is crucial as duration of facial palsy influences functional outcomes.

Obturator Nerve Split for Gracilis Free-flap Double Reinnervation in Facial Paralysis.

Summary:The use of a double-powered free muscle transfer for facial reanimation has been reported by several authors with different types of nerve coaptation. A new nerve coaptation strategy is presented herein. We performed a 1-stage double-powered free gracilis muscle flap transfer in a patient with long-standing facial paralysis by splitting the obturator nerve and anastomosing the 2 free ends to the contralateral facial nerve (through a sural graft) and to the masseteric nerve. Voluntary movement of the transferred muscle with teeth clenching was observed at 6 months after the operation and a symmetric smile with bilateral elevation of the mouth angle at 10 months. Our limited experience suggests that in case of a large cross-section of the obturator nerve, the latter can be split and sutured to the ipsilateral masseteric nerve and to the contralateral facial nerve with a sural graft by double end-to-end anastomosis.

Multivector functioning muscle transfer using superficial subslips of the serratus anterior muscle for longstanding facial paralysis

Various donor muscles have been identified for restoring facial function due to longstanding facial paralysis. Donor muscles such as the gracilis and latissimus dorsi are frequently used and often produce one or two reliable vectors of force. However, there are drawbacks of using these muscles, including the instability of separating multivector functioning muscle units and limited amount of muscle contraction. Serratus anterior muscle transfer has the advantages of multiple independently functioning motor units that can be created with a single neurovascular pedicle. This article describes multivector muscle transfer using two or three superficial subslips of the serratus anterior muscle on a single neurovascular pedicle to produce an esthetic smile that is customized to imitate the function of the contralateral mimetic muscles. Twelve patients who had longstanding unilateral facial paralysis underwent muscle transfer consisting of multivector superficial subslips of the serratus anterior muscle innervated by the ipsilateral masseteric nerve. The procedure had an uneventful postoperative course, and patients obtained excellent results, with sufficient upper lip excursion, mouth angle, and lower lip working simultaneously. Functioning muscle transfer using multivector superficial subslips of the serratus anterior muscle is effective for treating longstanding facial paralysis. This technique avoids postoperative bulkiness of the cheek muscle and achieves a more natural and symmetrical smile.

Blink Restoration in Long-standing Facial Paralysis: Use of Free Neurovascular Platysma Transfer.

Since 2004, microneurovascular platysma transfer has been used for dynamic eye closure in long-standing facial palsy. The idea was initially presented by Lee and Terzis in 1984 but abandoned owing to its transfer difficulty. This muscle transfer allows forceful closure and blink restoration. This study included 24 patients operated between 2004 and 2014 for long-standing facial palsy. In the first step of the procedure, a cross-facial nerve graft was employed to transfer the motor nerve fibers from the normal side to the paralyzed side responsible for eye closure. Simultaneously, a dynamic reanimation of the mouth was conducted. After 9 months, a 4 × 9-cm platysma was transferred on its neurovascular pedicle. Revascularization was performed on the temporal vessels. Nerve coaptation between the cross-facial nerve graft and motor nerve of the platysma was also performed. Twenty-one (88%) newly reconstructed orbicularis oculis displayed a good to excellent function. In 62% of the patients, a natural appearance and closure of the previously paralyzed eye and a return of spontaneous blinking were observed. Compared with classical techniques (eg, gold weight implantation and temporalis transfer), platysma transfer is the only feasible method of restoring eye closure because of its special architecture and fiber-type distribution.

Gracilis transplantation and temporalis transposition in longstanding facial palsy in adults: Patient-reported and aesthetic outcomes

BackgroundIn longstanding facial palsy, gracilis free functional muscle transfer (FFMT) is currently considered to be the gold standard in smile reanimation. An alternative to muscle free flaps is local muscle transposition, with the temporalis muscle transposition being the preferred procedure, because of its direction of pull when transposed. The present study aimed to compare outcomes of gracilis FFMT neurotised by the masseteric nerve and temporalis muscle transposition in longstanding facial palsy using patient-reported and aesthetic outcomes. MethodsA cross-sectional comparison of gracilis FFMT and temporalis muscle transpositions was performed. Pre- and postoperative excursion measures were obtained. Patients were asked to answer a satisfaction questionnaire, quality of life questionnaire (FaCE scale) and a depression and anxiety questionnaire (HADS). Laypeople were asked to rate the pre- and postoperative aesthetic appearance. ResultsOf 28 eligible patients, 10 gracilis and 12 temporalis patients participated. No significant differences were found between both groups in postoperative quality of life or depression/anxiety. Layperson observers judged the aesthetic appearance to be similar. ConclusionIn the present study, gracilis FFMT did not lead to superior quality of life and aesthetic outcomes compared to temporalis muscle transpositions. The facial nerve specialist should perform the procedure he or she expects to lead to optimal results for the patient.

Surgical Refinement Following Free Gracilis Transfer for Smile Reanimation.

Gracilis free muscle transfer is widely regarded as the gold standard functional smile reanimation in long-standing facial palsy. Although most patients achieve meaningful oral commissure movement, a subset has suboptimal aesthetic outcomes due to midfacial bulk or oral commissure malposition. Safe refinements that do not compromise excursion would be a welcome addition to the surgical armamentarium for this population. The goal of this study was to describe surgical approaches to the 3 most common postoperative sequelae that detract from the final result after gracilis facial reanimation and to examine how these surgical refinements affect aesthetic outcome, smile excursion, and quality of life. This was a retrospective case series. Tertiary care center (Massachusetts Eye and Ear Infirmary Facial Nerve Center). Of 260 gracilis transfers performed since 2003, meaningful excursion (>3 mm) but poor aesthetic outcome requiring additional surgery was noted in 21 patients and was related either to excess muscle bulk (9), resting inferior malposition of the oral commissure (9), or resting superior/lateral malposition of the oral commissure (3). Specific surgical interventions to address each of these negative sequelae were developed and refined, to preserve muscle functionality but eliminate the unsightly feature. Aesthetic status, determined by midfacial symmetry; quantitative smile excursion; and quality of life (using the FaCE instrument) were measured before and after revision. Patients who underwent gracilis refinement directed at either muscle debulking, or gracilis tightening or loosening experienced significantly improved aesthetics/midfacial symmetry and improved quality of life with no significant decrease in smile excursion. Improved aesthetics and quality of life can be achieved through targeted revision of the gracilis free tissue transfer, without significant loss of smile excursion.

Keeping the fat on the right spot prevents contour deformity in temporalis muscle transposition

The temporalis muscle transposition is a reliable, one-stage reanimation technique for longstanding facial paralysis. In the variation described by Rubin, the muscle is released from the temporal bone and folded over the zygomatic arch towards the modiolus. This results in unsightly temporal hollowing and zygomatic bulging. We present a modification of this technique, which preserves the temporal fat pad in its anatomical location as well as conceals temporal hollowing and prevents zygomatic bulging. The data of 23 patients treated with this modification were analysed. May classification was used for evaluation of mouth reanimation. Experts and patients scored visibility of the contour deformity on a 100-mm visual analogue scale (VAS) (score 0 = poor/100 = best). 3D images of the face were used to measure temporal hollowing and zygomatic bulging. 3D images were compared to those of controls with a similar gender and age distribution. After a median follow-up of 5.7 years, all patients achieved symmetry at rest. Eleven patients achieved symmetry while smiling with closed lips (May classification "Good"). A median (interquartile range [IQR]) VAS score of 19 (6; 41) was given by experts and 25 (5; 59) by patients themselves. 3D volumes of zygomatic bulging differed from those of control subjects, although all volume differences were small (median <3.3 ml) and temporal hollowing did not differ significantly. On the basis of our results, we conclude that our modified Rubin temporalis transposition technique provides an elegant way to conceal bulging over the zygomatic arch and prevents temporal hollowing, without the need for fascial extensions to reach the modiolus.

The Distal Stump of the Intramuscular Motor Branch of the Obturator Nerve Is Useful for the Reconstruction of Long-Standing Facial Paralysis Using a Double-Powered Free Gracilis Muscle Flap Transfer.

Double innervation of the transferred muscle with the contralateral facial nerve and the ipsilateral masseteric nerve has recently been reported by some authors. The aim of this study was to assess the utility of our procedure of double innervation of free gracilis muscle for reconstruction of long-standing facial palsy. In our department, 6 cases of long-standing facial paralysis (4 cases of complete palsy and 2 of incomplete palsy) were reconstructed using a free gracilis muscle double innervated with the masseteric and contralateral facial nerves. The patient age ranged from 37 to 79 years (average 56.7 ± 15.7). In our procedure, the intramuscular motor branch of the transferred muscle was identified and sutured to the ipsilateral masseteric nerve in an end-to-end fashion, and the obturator nerve of the transferred muscle was sutured to the cross-facial nerve graft, which was coapted with the contralateral facial nerve by end-to-end suturing. All patients were followed up for >18 months and recovered their smiling function. The voluntary movement of the transferred muscle with teeth clenching was observed at approximately 4.7 months, and this movement combined with contralateral mouth angle elevation was observed at approximately 9.5 months after the surgery. Our experience suggests that the distal stump of the intramuscular motor branch of the obturator nerve may be useful for facial reanimation via double-powered free gracilis muscle flap transfer.

Lengthening Temporalis Myoplasty vs Free Gracilis Muscle Transfer with Cross Face Nerve Graft for Long-Standing Facial Paralysis in Children: An Objective Measure of Outcomes Using Oral Commissure Excursion

Lengthening Temporalis Myoplasty vs Free Gracilis Muscle Transfer with Cross Face Nerve Graft for Long-Standing Facial Paralysis in Children: An Objective Measure of Outcomes Using Oral Commissure Excursion

Thread lifting: aminimally invasive surgical technique for long-standing facial paralysis.

Chronic facial paralysis induces degenerative facial muscle changes on the involved side, thus, making the individual seem as older than their actual age. Furthermore, contralateral facial hypertrophy aggravates facial asymmetry. Athread-lifting procedure has been used widely for correction of a drooping or wrinkled face due to the aging process. In addition, botulinum toxin injection can be used to reduce facial hypertrophy. The aim of study was to evaluate the effectiveness of thread lifting with botulinum toxin injection for chronic facial paralysis. Atotal 34 of patients with chronic facial paralysis were enrolled from March to October 2014. Thread lifting for elevating loose facial muscles on the ipsilateral side and botulinum toxinA for controlling the facial muscle hypertrophy on the contralateral side were conducted. Facial function was evaluated using the Sunnybrook grading system and dynamic facial asymmetry ratios 1year after treatment. All 34patients displayed improved facial symmetry and showed improvement in Sunnybrook scores (37.4 vs. 83.3) and dynamic facial asymmetry ratios (0.58 vs 0.92). Of the 34patients, 28 (82.4%) reported being satisfied with treatment. The application of subdermal suspension with a reabsorbable thread in conjunction with botulinum toxinA to optimize facial rejuvenation of the contralateral side constitutes an effective and safe procedure for face lifting and rejuvenation of adrooping face as aresult of long-lasting facial paralysis.

Patient-Reported Outcome Measures for Facial Plastic Surgery: A Specialty Finally Gets to Go to the PROM.

JAMA Facial Plastic SurgeryVol. 19, No. 2 Invited CommentaryPatient-Reported Outcome Measures for Facial Plastic SurgeryA Specialty Finally Gets to Go to the PROMSam P. Most and Sami P. MoubayedSam P. MostCorresponding Author: Sam P. Most, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Stanford, CA 94305 E-mail Address: smost@stanford.eduDivision of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CaliforniaSearch for more papers by this author and Sami P. MoubayedDivision of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CaliforniaSearch for more papers by this authorPublished Online:16 Mar 2017https://doi.org/10.1001/jamafacial.2016.1429AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Patient-Reported Outcome Measures for Facial Plastic Surgery." JAMA Facial Plastic Surgery, 19(2), p. 101FiguresReferencesRelatedDetailsCited byVisual Attention to Facial Defects Predicts Willingness to Pay for Reconstructive Surgery John F. Ryan, Lisa E. Ishii, Jacob K. Dey, Kofi D.O. Boahene, Patrick J. Byrne, and Masaru Ishii8 November 2022 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 24, No. 6Commentary on “Interpreting Quality-of-Life Questionnaires in Patients with Long-Standing Facial Palsy” by Bruins et al: Measuring Meaningful Change for Individual Patients with Facial Palsy: An Elusive Target John F. Ryan and Lisa E. Ishii15 March 2022 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 24, No. 2The 10-Item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) for Functional and Cosmetic Rhinoplasty Sami P. Moubayed, John P. A. Ioannidis, Mikhail Saltychev, and Sam P. Most18 January 2018 | JAMA Facial Plastic Surgery, Vol. 20, No. 1 Volume 19Issue 2Mar 2017 InformationCopyright 2017 American Medical Association. All Rights Reserved.To cite this article:Sam P. Most and Sami P. Moubayed.Patient-Reported Outcome Measures for Facial Plastic Surgery.JAMA Facial Plastic Surgery.Mar 2017.101-101.http://doi.org/10.1001/jamafacial.2016.1429Published in Volume: 19 Issue 2: March 16, 2017PDF download

Facial Reanimation: Basic Surgical Tools and Creation of an Effective Toolbox for Treating Patients with Facial Paralysis. Part A: Functional Muscle Transfers in the Long-Term Facial Palsy Patient.

The literature on facial paralysis is vast; however, detailed videos of the basic tools of dynamic reanimation within the context of patient scenarios accompanied by detailed narrative emphasizing both technique and thought processes are not common. Although not all scenarios of facial paralysis can be discussed in one setting, videographic visualization of basic surgical procedures, including facial marking, facial dissection, donor nerve preparation, cross-facial nerve graft, nerve transfers, and muscle harvest and inset, may provide a strong toolbox. Using these tools in various combinations depending on the unique case details enables the surgeon to treat a great majority of facial palsy patients. Part A, with the first of two videos, concentrates on free functional muscle transfer in the setting of longstanding facial paralysis. It includes preoperative markings, preparation of the patient in the operating room before incision, facial dissection including exposure of the masseter nerve, partial gracilis muscle harvest, and perhaps most importantly, the inset of the muscle on the paralyzed side. Part B (with the second video) concentrates on the cross-facial nerve graft and nerve transfers, used in the context of acute facial palsy, providing the short-term goal of mimetic musculature salvage in addition to longer term specific regional reinnervation by means of cross-facial nerve grafting. We hope that these videos provide a strong learning tool for enthusiastic novice medical students, residents, and fellows wishing to prepare for their cases, and faculty level physicians who wish to use them as a refresher before surgery.

Abstract: 15.20 Revisited Fascia Lata In Facial Palsy

INTRODUCTION: Fascia lata suspension for static surgical treatment of the nasolabial region in long-standing facial paralysis is well established. The objective of this study was to evaluate, from a retrospective viewpoint, the functional and cosmetic effectiveness of static suspension in facial paralysis by introducing a new way to insert the fascial graft in patients with different indications, such as: onset of paralysis, age, general conditions, etiopathogenesis, expectations, and combination with reanimation procedures. We considered the stability, in time, of the results of this ancillary procedure present in every facial reconstructive surgeonÕs armamentarium, and we thought it should be re-evaluated and utilized either alone or in combination with techniques that reanimate the paralyzed face. MATERIALS AND METHODS: In our series, 55 patients with facial paralysis underwent static suspension with fascia lata, advanced in the same fashion as the temporalis muscle in Labbé’s myoplasty, between February 2009 and November 2015. The surgical technique is reported together with preoperative and postoperative records (photographs and videos reviewed for feasibility of the technique), symmetry, aesthetic results. Complications, need for further minor revisions, patients degree of satisfaction and role in improvement of the facial reanimation techniques were also considered. RESULTS: In all the patients the procedure was uneventful and none developed surgery-related complications, including donor-site problems. During follow-up, all the patients achieved improved symmetry at rest and showed satisfaction. The cosmetic outcome was satisfactory, too. Eight patients needed small revision in local anaesthesia. CONCLUSIONS: The results show immediate, aesthetic, stable in time improvement, thus confirming this method as a simple technique for static restoration in patients who have lost any functional reconstructive possibility. The method also works in patients who underwent facial reanimation requiring slight aesthetic improvement. The application of the modified technique has led to a new appraisal and re-evaluation of an almost obsolete method.

Assessment of functional outcomes of temporalis muscle transfers for patients with longstanding facial paralysis.

Usually, clinical evaluation of facial reanimation provides accurate information about contraction of the mimetic muscles and phonation but fails to identify smile recovery and to quantify the motility of the lower third of the face during a smile. The purpose of this study was to verify that, in longstanding facial palsy, the modified temporalis muscle transfer (MTMT) can result in the ability to smile, not only voluntarily with chewing, but also spontaneously with a sudden emotional stimulus, and to confirm that a symmetric smile can be obtained. Ten patients of the treated group (group T; 4 women and 6 men) were randomly selected from a population of 24 patients with longstanding facial palsy treated by MTMT. Five normal subjects of the control group (group C; 3 women and 2 men) were enrolled as the control population. Functional outcomes after transposed temporalis muscle were examined and measured through clinical assessment by using a scored smile symmetry grading system, video recording, and surface electromyography (sEMG). In addition, the voluntary smile test (VST) and the not-voluntary smile test (NVST) were performed to study voluntary and spontaneous smiling. Subjects in the VST group (group T) were able to smile voluntarily and the expression was characterized by symmetry. In the NVST group, they were able to smile spontaneously and the symmetry of the smile was maintained for 8 subjects and only partially for 2 subjects. During both tests, the temporalis muscle of the treated side and the orbicularis oris muscle of the not-treated side were activated during smiling, indicating spontaneous activity of the transposed temporalis muscle with an emotional stimulus. For the control group, smiles during VST and NVST were symmetric and the temporalis muscles were not activated during smiling, whereas the orbicularis oris muscles were. Our study shows that the Morrison MTMT is able to restore the voluntary smile ability. Particularly, this technique allows for recovery of the spontaneous smile with symmetry. This assessment would seem to suggest that the transposed temporalis muscle might adapt from a chewing to a mimetic muscle. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1535-E1543, 2016.

Lower Eyelid Retraction Repair with Resorbable Polydioxanone Implants.

PURPOSE:To report a unique technique to repair lower eyelid retraction using resorbable polydioxanone implants.PATIENTS AND METHODS:This was a retrospective, consecutive, nonrandomized interventional case series. Patients with lower eyelid retraction after trauma repaired facial fracture, thyroid eye disease, lower eyelid blepharoplasty, and long-standing facial palsy were treated with middle lamellar spacer using absorbable polydioxanone implant. All patients were recruited from the King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only patients with minimum follow-up of 12 months were included in the study.RESULTS:Eight patients (4 males and 4 females) underwent lower eyelid retraction repair using absorbable polydioxanone implant. The mean age was 43 years (range, 23–63 years). All patients noted improved ocular surface symptoms. The improvement in eyelid retraction ranged from 1.5 to 4 mm with an average of 2.7 mm postoperatively. The implant was well tolerated with no major complications.CONCLUSIONS:Several options for spacer materials are available. Absorbable polydioxanone implants seem to be an effective middle lamellar spacer that is a good alternative for repairing middle lamella related lower eyelid retraction and lower eyelid support.