Evaluation of Societal Health Utility of Facial Palsy and Facial Reanimation

Abstract Objective: Facial palsy may still occur after removal of large vestibular schwannomas. The aim of this paper is to describe the outcome of patients submitted to facial reanimation and make a concise revision about modern techniques available to reanimate a paralyzed face. Methods: A retrospective study of was performed about the surgical results of 12 patients submitted to hypoglossal-facial neurorrhaphy. These patients were submitted to radical removal of large vestibular schwannomas (> 3 cm) before and anatomic preservation of the facial nerve was not possible. Results: In 10 cases (83%) patients had a good outcome with House-Brackmann facial grading III. In two other cases the facial grading was IV and VI. All patients were follow-up for at least one year after the reanimation procedure. Conclusion: Hypoglossal-facial neurorrhaphy is a very useful technique to restore facial symmetry and minimize the sequela of a paralyzed face. Long last palsy seemed to be the main reason of poor outcome in two cases.

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Static suspension technique with alloplastic suture material for facial reanimation in facial palsy

IP Indian Journal of Anatomy and Surgery of Head Neck and Brain ◽

10.18231/2455-846x.2018.0007 ◽

2018 ◽

Vol 4 (1) ◽

pp. 20-23

Keyword(s):

Facial Palsy ◽

Suture Material ◽

Facial Reanimation

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Facial Palsy, Radiographic and Other Workup Negative: FROWN

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001020 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000001020

Author(s):

Jacqueline J Greene ◽

Reza Sadjadi ◽

Nate Jowett ◽

Tessa Hadlock

Keyword(s):

Facial Nerve ◽

Facial Palsy ◽

Malignant Tumors ◽

Malignant Neoplasm ◽

Acute Onset ◽

Peripheral Facial Palsy ◽

Facial Reanimation ◽

Term Evaluation ◽

Slow Onset

AbstractObjectives:Slow-onset peripheral facial palsy is far less common than acute-onset peripheral facial palsy and necessitates diagnostic evaluation for a benign or malignant tumors, or other less common etiologies. In the rare scenario when no clarifying etiology is discovered following long-term evaluation (no radiographic or hematologic abnormalities and an otherwise unremarkable evaluation), a diagnostic and management dilemma occurs. We present a series of patients with this possible new clinical entity: facial palsy, radiographic and other workup negative (FROWN), and propose a management strategy for this diagnosis of exclusion.Methods:A series of 3,849 patients presenting with facial palsy to a tertiary Facial Nerve Center was retrospectively assessed to identify those with progressive loss of facial function over at least 1 month. Exclusion criteria included history, physical or hematologic findings indicative of known diseases associated with facial palsy, and radiographic studies demonstrating a benign or malignant tumor.Results:Patients with slow-onset facial palsy constituted 5% (190 patients) of the cohort and were ultimately diagnosed with either a benign or malignant neoplasm or other facial nerve pathology. Fourteen patients with slow-onset facial palsy remained without a diagnosis following long-term evaluation and serial imaging. Eleven patients underwent dynamic facial reanimation surgery and facial nerve and muscle biopsy, with no clear histopathologic diagnosis.Conclusion:Patients with slow-onset facial palsy with negative radiographic and medical evaluations over several years may be characterized as having FROWN, an idiopathic and as yet poorly understood condition, which appears to be amenable to facial reanimation, but which requires further investigation as to its pathophysiology.

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Facial Reanimation Surgery With Micro-vascular Gracilis Free Flap for Unilateral Facial Palsy

Acta Otorrinolaringologica (English Edition) ◽

10.1016/j.otoeng.2014.03.003 ◽

2014 ◽

Vol 65 (2) ◽

pp. 69-75 ◽

Cited By ~ 1

Author(s):

Ivan Doménech Juan ◽

Jordi Tornero ◽

Paula Cruz Toro ◽

Nuria Ortiz Laredo ◽

Jorge Vega Celiz ◽

...

Keyword(s):

Free Flap ◽

Facial Palsy ◽

Facial Reanimation

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Safe and effective use of free tissue transfer for facial reanimation in complex facial palsy

European Journal of Plastic Surgery ◽

10.1007/s00238-018-1465-5 ◽

2018 ◽

Vol 42 (1) ◽

pp. 11-18

Author(s):

Stephen E. Morley

Keyword(s):

Facial Palsy ◽

Free Tissue Transfer ◽

Tissue Transfer ◽

Facial Reanimation ◽

Effective Use

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Dual Coaptation of Facial Nerve Using Masseteric Branch of Trigeminal Nerve for Iatrogenic Facial Palsy: Preliminary Reports

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419893722 ◽

2019 ◽

Vol 129 (5) ◽

pp. 505-511

Author(s):

Yoon Se Lee ◽

Joong Ho Ahn ◽

Hong Ju Park ◽

Ho Jun Lee ◽

Mi Rye Bae ◽

...

Keyword(s):

Facial Nerve ◽

Trigeminal Nerve ◽

Facial Palsy ◽

Recovery Period ◽

Interposition Graft ◽

Dynamic Movement ◽

Facial Reanimation ◽

Group A ◽

Group B ◽

Eye Closure

Objectives: Immediate facial nerve substitution or graft technique has been used for the repair of facial nerve defects occurring as a result of tumour dissection. However, some patients report unsatisfactory outcomes, such as difficulty in maintaining resting or smiling symmetry, due to persistent flaccid facial palsy. Here we evaluated the functional outcomes of transferring the masseteric branch of the trigeminal nerve to the facial nerve adjunct to facial nerve graft. Methods: We reviewed the medical records of seven patients who underwent facial reanimation surgery between 2014 and 2016. The patients were divided into two groups according to the type of facial reanimation surgery: group A, masseteric nerve innervation with interposition graft; group B, interposition graft only. The postoperative resting symmetry and dynamic movement were compared. Results: Facial contraction was first observed in group A at 4 months and in group B at 7.3 months. Most of the patients achieved reliable resting symmetry; however, one patient in group B exhibited unsatisfactory facial weakness on the affected side. Group A patients showed better dynamic movement than group B patients. Eye closure, oral excursion and oral continence were better in group A than in group B patients. Smile symmetry in both groups was similar due to hyperkinetic movement in group A patients and flaccidity in group B patients. Conclusions: Dual innervation of the masseteric branch of the trigeminal nerve improves the dynamic movement of paralysed facial muscles and shortens the recovery period in patients with iatrogenic facial palsy.

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Pediatric facial reanimation: An algorithmic approach and systematic review

Archives of Plastic Surgery ◽

10.5999/aps.2020.00710 ◽

2020 ◽

Vol 47 (5) ◽

pp. 382-391

Author(s):

Paul J. Deramo ◽

Matthew R. Greives ◽

Phuong D. Nguyen

Keyword(s):

Facial Palsy ◽

Clinical Presentation ◽

Growth Potential ◽

Algorithmic Approach ◽

Facial Reanimation ◽

Surgical Options ◽

Tailored Approach ◽

And Function ◽

Technical Considerations ◽

Future Growth

Facial palsy has a broad clinical presentation and the effects on psychosocial interaction and facial functions can be devastating. Pediatric facial palsy, in particular, introduces unique familial and technical considerations as anatomy, future growth potential, and patient participation influence treatment planning. Though some etiologies of pediatric facial palsy are self-limiting, congenital and long-standing facial palsies pose difficult challenges that require a combination of surgical, adjunctive, and rehabilitative techniques to achieve facial reanimation. Given the spectrum of ages and symptom severity, as well as the various surgical options available for facial palsy, a tailored approach needs to be developed for each child to restore facial balance and function. Here, we review the etiologies, workup, and treatment of pediatric facial palsy and present our novel algorithmic approach to treatment.

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