Incorporating Local Muscle and Tendon for Facial Reanimation

We conducted a retrospective case review at our tertiary care academic medical center to assess the long-term results of microvascular free-tissue transfer to achieve facial reanimation in 3 patients. These patients had undergone wide-field parotidectomy with facial nerve resection. Upper facial reanimation was accomplished with a proximal facial nerve–sural nerve graft, and lower facial movement was achieved through proximal facial nerve–long thoracic (serratus muscle) nerve anastomosis. Outcomes were determined by grading postoperative facial nerve function according to the House-Brackmann system. All 3 patients were able to close their eyes independent of lower facial movement, and all 3 had achieved House-Brackmann grade III function. We conclude that reanimating the paralyzed face with microvascular free-tissue transfer provides anatomic coverage and mimetic function after wide-field parotidectomy. Synkinesis is reduced by separating upper-and lower-division reanimation.

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Revision Surgery Following Gracilis Transplantation for Pediatric Facial Reanimation

Plastic & Reconstructive Surgery Global Open ◽

10.1097/01.gox.0000584648.26680.1d ◽

2019 ◽

Vol 7 ◽

pp. 76-77

Author(s):

Terence Kwan-Wong ◽

Erin Klar ◽

Emily S. Ho ◽

Christine Novak ◽

Gregory H. Borschel ◽

...

Keyword(s):

Revision Surgery ◽

Facial Reanimation

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Facial Reanimation of Patients With Neurofibromatosis Type 2

Operative Neurosurgery ◽

10.1227/neu.0b013e31823a819f ◽

2011 ◽

Vol 70 (suppl_2) ◽

pp. ons237-ons243 ◽

Cited By ~ 2

Author(s):

Kalpesh T. Vakharia ◽

Doug Henstrom ◽

Scott R. Plotkin ◽

Mack Cheney ◽

Tessa A. Hadlock

Keyword(s):

Facial Paralysis ◽

Neurofibromatosis Type ◽

Neurofibromatosis Type 2 ◽

Gracilis Muscle ◽

Single Stage ◽

Care Plan ◽

Muscle Transfer ◽

Facial Reanimation ◽

Oral Commissure

ABSTRACT BACKGROUND: Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome defined by bilateral vestibular schwannomas. Facial paralysis, from either tumor growth or surgical intervention, is a devastating complication of this disorder and can contribute to disfigurement and corneal keratopathy. Historically, physicians have not attempted to treat facial paralysis in these patients. OBJECTIVE: To review our clinical experience with free gracilis muscle transfer for the purpose of facial reanimation in patients with NF2. METHODS: Five patients with NF2 and complete unilateral facial paralysis were referred to the facial nerve center at our institution. Charts and operative reports were reviewed; treatment details and functional outcomes are reported. RESULTS: Patients were treated between 2006 and 2009. Three patients were men and 2 were women. The age of presentation of debilitating facial paralysis ranged from 12 to 50 years. All patients were treated with a single-stage free gracilis muscle transfer for smile reanimation. Each obturator nerve of the gracilis was coapted to the masseteric branch of the trigeminal nerve. Measurement of oral commissure excursions at rest and with smile preoperatively and postoperatively revealed an improved and nearly symmetric smile in all cases. CONCLUSION: Management of facial paralysis is oftentimes overlooked when defining a care plan for NF2 patients who typically have multiple brain and spine tumors. The paralyzed smile may be treated successfully with single-stage free gracilis muscle transfer in the motivated patient.

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Outcomes of Microneurovascular Facial Reanimation Using Masseteric Innervation in Patients With Long-Standing Facial Palsy Resulting From Cured Brainstem Lesions

Neurosurgery ◽

10.1227/01.neu.0000375531.77489.79 ◽

2010 ◽

Vol 67 (3) ◽

pp. 663-674 ◽

Cited By ~ 15

Author(s):

Kartik G. Krishnan ◽

Gabriele Schackert ◽

Volker Seifert

Keyword(s):

Loss Of Function ◽

Muscle Flaps ◽

Self Evaluation ◽

Möbius Syndrome ◽

Evaluation Scores ◽

Facial Nerves ◽

Facial Reanimation ◽

Masseteric Nerve ◽

Natural Emotion ◽

The Individual

Abstract BACKGROUND The functions of the human face are not only of esthetic significance but also extend into metaphoric nuances of psychology. The loss of function of one or both facial nerves has a remarkable impact on patients' lives. OBJECTIVE To retrospectively analyze the functional outcomes of microneurovascular facial reanimation using masseteric innervation. METHODS Seventeen patients with irreparable facial paralysis resulting from benign lesions involving the facial nuclei (n = 14) or Möbius syndrome (n = 3) were treated with free muscle flaps for oral commissural reanimation using ipsilateral masseteric innervation and using temporalis muscle transfer for eyelid reanimation. Results were analyzed by the absolute commissural excursion and commissural excursion index and by a patient self-evaluation score. Presence of synkinesis was documented. Follow-up ranged from 8 to 48 months (mean, 26.4 months). RESULTS Normalization of the commissural excursion index was observed in 8 of 17 patients (47%), an improvement was seen in 7 of 17 (41%), and failure was observed in 2 of 17 (12%). The individual dynamics of absolute commissural excursion and commissural excursion index changes are presented. A natural smiling response was observed in 10 of 17 patients (59%) but not in the remaining 7 (41%). This response reflected the patient's ability to relay the natural emotion of smiling through the masseteric nerve. Patients' self-evaluation scores were a level higher than objective indices. CONCLUSIONS Innervation of free muscle flaps with the masseteric nerve for oral commissure reanimation might play an important role in patients with lesions of the facial nuclei (as in Möbius syndrome). Synkinesis persists for long periods after surgery. However, most of the patients learned to express their emotions by overcoming this phenomenon. Despite hypercorrection or inadequate correction, patients evaluated themselves favorably.

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Assessing Outcomes in Facial Reanimation: Evaluation and Validation of the SMILE System for Measuring Lip Excursion During Smiling

Archives of Facial Plastic Surgery ◽

10.1001/archfacial.2010.69 ◽

2010 ◽

Vol 12 (5) ◽

Cited By ~ 46

Author(s):

Dominic Bray ◽

Douglas K. Henstrom ◽

Mack L. Cheney ◽

Tessa A. Hadlock

Keyword(s):

Facial Reanimation

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A Critical Assessment and Review of Artificial Intelligence in Facial Paralysis Analysis: Uncovering the Truth

FACE ◽

10.1177/27325016211022805 ◽

2021 ◽

pp. 273250162110228

Author(s):

David T. Mitchell ◽

David Z. Allen ◽

Matthew R. Greives ◽

Phuong D. Nguyen

Keyword(s):

Artificial Intelligence ◽

Facial Paralysis ◽

Critical Assessment ◽

Facial Emotion ◽

Data Systems ◽

Computer Algorithms ◽

Future Directions ◽

Sample Data ◽

Before And After ◽

Facial Reanimation

Machine learning is a rapidly growing subset of artificial intelligence (AI) which involves computer algorithms that automatically build mathematical models based on sample data. Systems can be taught to learn from patterns in existing data in order to make similar conclusions from new data. The use of AI in facial emotion recognition (FER) has become an area of increasing interest for providers who wish to quantify facial emotion before and after interventions such as facial reanimation surgery. While FER deep learning algorithms are less subjective when compared to layperson assessments, the databases used to train them can greatly alter their outputs. There are currently many well-established modalities for assessing facial paralysis, but there is also increasing interest in a more objective and universal measurement system to allow for consistent assessments between practitioners. The purpose of this article is to review the development of AI, examine its existing uses in facial paralysis assessment, and discuss the future directions of its implications.

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