Functional results after facial reanimation in iatrogenic facial palsy

Microsurgery ◽  
2020 ◽  
Vol 40 (2) ◽  
pp. 145-153 ◽  
Author(s):  
Eva Györi ◽  
Marcel Mayrhofer ◽  
Benedikt M. Schwaiger ◽  
Igor Pona ◽  
Chieh Han Tzou
Keyword(s):  
Facial Palsy ◽  
Functional Results ◽  
Facial Reanimation

scholarly journals Dynamic Facial Reanimation in an Overweight Patient and with Significant Comorbidities: An Objective Analysis of Labbè Technique

2021 ◽  
Vol 07 (04) ◽  
pp. e342-e346
Author(s):  
Ricardo Horta ◽  
Francisca Frias ◽  
Diogo Barreiro ◽  
Ana Gerós ◽  
Paulo Aguiar
Keyword(s):  
Facial Palsy ◽  
Movement Control ◽  
Standard Technique ◽  
Horizontal Displacement ◽  
Functional Results ◽  
Preoperative Period ◽  
Muscle Transfer ◽  
Cardiovascular Comorbidities ◽  
Facial Reanimation ◽  
Almost All

AbstractGracilis free muscle transfer is considered the gold standard technique for facial reanimation in cases of facial palsy. However, it is limited by its long operative and recovery times, the need for a second surgical site, and its outcomes that can sometimes show midfacial bulk and oral commissure malposition. Facial reanimation with lengthening temporalis myoplasty (LTM)—Labbé technique— carries the advantage of having a shorter surgical time, a faster recovery, and being a less invasive surgery. Almost all patients included in studies of LTM were evaluated by subjective methods, and very little quantifiable data was available. A 64-year-old woman presented with long-standing incomplete right facial palsy secondary to acoustic neuroma surgery. Since she was overweight (body mass index [BMI]: 43.9) and had several cardiovascular comorbidities (hypertension, dyslipidemia), she was not a good candidate for gracilis free muscle transfer. She was submitted to facial reanimation with LTM. Fourteen months after surgery, she presented excellent facial symmetry, both at rest and in contraction, while smiling. She was evaluated with the Facegram-3D, a technology that we have developed for dynamic evaluation of facial muscle contraction. The analysis showed symmetry at rest and contraction, according to Terzis and Noah. Regarding vertical and horizontal displacement, the postoperative movement was synchronized and with less fluctuations when compared with the preoperative period. Notably, the anatomical pair's trajectories were smoother. Similar velocity profiles were found between anatomical pairs, with less abrupt changes in velocity values, further supporting improved movement control. Comparing the symmetry index, which takes a theoretical maximum of 1.0 for perfect 3D symmetry, its value was 0.56 for the commissures and 0.5 for the midpoints in the preoperative period, having improved to 0.91 and 0.82, respectively, 3 months postoperatively. Good aesthetic and functional results were achieved using the Labbè technique. LTM is a good option in cases of long-standing facial paralysis, if the patient desires a single-stage procedure with almost immediate dynamic function. Moreover, this technique assumes extreme importance in facial reanimation of patients of advanced age, overweight, or those who have several comorbidities.

scholarly journals Facial reanimation with masseter nerve–innervated free gracilis muscle transfer in established facial palsy patients

2019 ◽  
Vol 46 (2) ◽  
pp. 122-128 ◽  
Author(s):  
Tae Suk Oh ◽  
Hyung Bae Kim ◽  
Jong Woo Choi ◽  
Woo Shik Jeong
Keyword(s):  
Facial Palsy ◽  
Gracilis Muscle ◽  
Muscle Transfer ◽  
Facial Reanimation

scholarly journals Facial reanimation by hypoglossal-facial neurorrhaphy

2014 ◽  
Vol 33 (01) ◽  
pp. 17-21
Author(s):  
Yvens Barbosa Fernandes ◽  
Ricardo Ramina ◽  
Hélio Sérgio Fernandes Cyrino ◽  
Marcílio Silva Prôa Júnior
Keyword(s):  
Retrospective Study ◽  
Facial Nerve ◽  
Facial Palsy ◽  
Vestibular Schwannomas ◽  
Surgical Results ◽  
Good Outcome ◽  
Facial Reanimation ◽  
Radical Removal ◽  
One Year

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.

Facial Palsy, Radiographic and Other Workup Negative: FROWN

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.

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

2014 ◽  
Vol 65 (2) ◽  
pp. 69-75 ◽  
Author(s):  
Ivan Doménech Juan ◽  
Jordi Tornero ◽  
Paula Cruz Toro ◽  
Nuria Ortiz Laredo ◽  
Jorge Vega Celiz ◽  
...  
Keyword(s):  
Free Flap ◽  
Facial Palsy ◽  
Facial Reanimation

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

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.

Facial Reanimation with the VII–XII Anastomosis: Analysis of the Functional and Psychologic Results

1986 ◽  
Vol 94 (3) ◽  
pp. 305-310 ◽  
Author(s):  
Myles L. Pensak ◽  
C. Gary Jackson ◽  
Michael E. Glasscock ◽  
Aina Julianna Gulya
Keyword(s):  
Skull Base ◽  
Retrospective Review ◽  
Patient Population ◽  
Cerebellopontine Angle ◽  
Functional Results ◽  
Technical Performance ◽  
Photographic Documentation ◽  
Facial Reanimation ◽  
Psychosocial Perspective ◽  
Detailed Questionnaire

The VII-XII anastomosis has been employed for more than a decade by The Otology Group, P.C., In the facial reanimation of patients undergoing extirpation of tumors involving the cerebellopontine angle and the skull base. A retrospective review based upon a detailed questionnaire and submitted photographic documentation from 61 patients forms the basis for this review. Details and analysis of the functional results include (1) onset of function, (2) synkinetic activity, (3) corneal irritation and associated ophthalmologic problems, (4) facial tone and symmetry, and (5) volitional mimetic function. From a psychosocial perspective, evaluation was made regarding (1) workplace and home acceptance, (2) self consciousness, (3) adaption, and (4) overall satisfaction. Because of the nature of its technical performance and reliability, the VII-XII anastomosis is an important technique for the otolaryngologist to be familiar with. Cognizance of the functional and psychologic results with this procedure will ensure optimal (yet realistic) rehabilitation for this patient population.

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