1
|
Fearington FW, Rodriguez G, Randall NR, Dey JK. Surgical Treatments for Facial Aberrant Reinnervation Syndrome: A Systematic Review. Facial Plast Surg Aesthet Med 2024. [PMID: 39505694 DOI: 10.1089/fpsam.2024.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2024] Open
Abstract
Background: Facial aberrant reinnervation syndrome is characterized by aberrant facial muscle reinnervation after facial nerve injury producing facial synkinesis, hypertonicity, and muscle spasm. Objective: To systematically review the surgical treatments for facial aberrant reinnervation syndrome and assess their effectiveness as measured by patient-reported outcomes, physician-graded outcomes, or computer-automated grading systems. Methods: We conducted a systematic review using PubMed, Embase, and Cochrane CENTRAL in accordance with PRISMA guidelines. Texts reporting outcomes of any surgical treatment for facial aberrant reinnervation syndrome from 2003 to 2023 were included. Results: After screening, 25 studies with 731 patients were included. Surgical procedures included selective neurectomy (SN), selective myectomy (SM), cross-facial nerve graft, masseter nerve transfer, and gracilis muscle transfer. All surgical techniques and combinations showed significant improvement in at least one clinical outcome measure from baseline (p < 0.05), although one study found no significant improvement. Thirty different outcome measures were used, the most common being the FaCE and eFACE scales (seven studies each). Conclusions: All surgical procedures in this review yield improved clinical outcome measures for facial aberrant reinnervation syndrome, with SN and SM being the dominant surgical treatments. Standardized outcome assessment and more nuanced patient evaluation are necessary to determine the most effective surgical treatments.
Collapse
Affiliation(s)
| | - Gloria Rodriguez
- College of Biological Sciences, University of California Davis, Davis, California, USA
| | - Nicholas R Randall
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob K Dey
- Department of Otolaryngology, Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Facial Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
2
|
Wei EX, Green A, Akkina SR, Pepper JP. Facial Nerve Disorders: Sociodemographic Predictors and Temporal Trends in Dynamic Facial Reanimation in a National Administrative Claims Database. Facial Plast Surg Aesthet Med 2024. [PMID: 39446693 DOI: 10.1089/fpsam.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024] Open
Abstract
Background: Recent surgical innovations have increased treatment options for patients with facial nerve disorders (FNDs), leading to substantial improvements in functional and psychosocial outcomes. However, it is unclear whether sociodemographic factors are associated with the likelihood of undergoing dynamic facial reanimation procedures. Objective: In patients undergoing FND surgical treatment, what sociodemographic variables are associated with undergoing dynamic facial reanimation compared with static facial reanimation within a 16-year period? Methods: This was a retrospective study of adults undergoing surgical management for FND from 2007 to 2022 using the Merative™ Marketscan® Research Databases. Chi-squared and logistic regression analyses were performed. Results: Among 4,730 adults who underwent FND surgical intervention, 1,390 (34.2%) underwent dynamic facial reanimation. In multivariable regression analyses, more recent treatment year, younger age, and living in the Northeast United States were significant predictors of undergoing dynamic reanimation. Secondary analysis demonstrated that FND patients who were younger, female, and living in the Northeast United States were more likely to undergo concurrent selective neurectomy. Conclusions: These analyses demonstrate significant sociodemographic and temporal associations in the surgical management of FND. Future work is needed to evaluate how sociodemographic factors might influence access and decisions to pursue different types of reanimation procedures.
Collapse
Affiliation(s)
- Eric X Wei
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Allen Green
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Sarah R Akkina
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jon-Paul Pepper
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| |
Collapse
|
3
|
Fujiwara T, Hato N, Kasahara T, Kasuya D, Shida K, Tanabe M, Nakano H, Haginomori SI, Hamada M, Hayashi A, Furuta Y, Matsuda K, Morishima N, Yamada T, Nakagawa T. Summary of Japanese clinical practice guidelines for Bell's palsy (idiopathic facial palsy) - 2023 update edited by the Japan Society of Facial Nerve Research. Auris Nasus Larynx 2024; 51:840-845. [PMID: 39079445 DOI: 10.1016/j.anl.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/23/2024] [Accepted: 07/07/2024] [Indexed: 09/14/2024]
Abstract
OBJECTIVE The "Summary of Japanese clinical practice guidelines for Bell's palsy (idiopathic facial palsy) - 2023 update edited by the Japan Society of Facial Nerve Research" aims to review the latest evidence regarding the treatment of Bell's palsy and to provide appropriate recommendations. METHOD Regarding the treatment of Bell's palsy, a guideline panel identified key clinical questions using an analytic PICO framework. The panel produced recommendations following the standards for trustworthy guidelines and the GRADE approach. The panel considered the balance of benefits, harm, and preferences when making recommendations. RESULTS The panel identified nine key clinical questions: systemic (high/standard dose) corticosteroids, intratympanic corticosteroids, systemic antivirals, decompression surgery, acupuncture, physical therapy, botulinum toxin, and reanimation surgery. CONCLUSION These guidelines strongly recommend systemic standard-dose corticosteroids for the clinical management of Bell's palsy. Other treatments are weakly recommended due to insufficient evidence. The absolute risk reduction of each treatment differed according to the disease severity. Therefore, physicians and patients should decide on treatment based on the disease severity.
Collapse
Affiliation(s)
- Takashi Fujiwara
- Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital. 1-1-1 Miwa, Kurashiki City, Okayama Prefecture, 710-8602, Japan.
| | - Naohito Hato
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University. Shizukawa 454, Toon city, Ehime Prefecture, 791-0295 Japan
| | - Takashi Kasahara
- Department of Rehabilitation Medicine, Tokai University School of Medicine. 143, Shimokasuya, Isehara, Kanagawa Prefecture, 259-1193, Japan
| | - Daichi Kasuya
- Department of Acupuncture Health, Niigata University of Health and Welfare. 1398 Shimami-cho, Kita-ku, Niigata city, Niigata Prefecture, 950-3198, Japan
| | - Kenji Shida
- Department of Anesthesiology, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki-Ku, Yokohama city, Kanagawa Prefecture, 224-8503, Japan
| | - Makito Tanabe
- Oiki Ear & Nose Surgicenter. Yayoi-cho 2-14-13, Izumi city, Osaka, Japan
| | - Haruki Nakano
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University, Daigakumachi 2-7, Takatsuki city, Osaka, Japan
| | - Shin-Ichi Haginomori
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University. Takatsuki city, Osaka Prefecture, 569-8686, Japan
| | - Masashi Hamada
- Department of Otolaryngology and Head and Neck Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa Prefecture, 259-1193, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital. 3-9 Fukuura, Kanazawa-ku, Yokohama city, Kanagawa Prefecture, 236-0004, Japan
| | - Yasushi Furuta
- Department of Otolaryngology-Head and Neck Surgery, Teine-Keijinkai Hospital. 1-12, Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Ken Matsuda
- Department of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medicine. 1-757, Asahimachi-Dori, Chuo-ku, Niigata city, Niigata Prefecture, 951-8510, Japan
| | - Naohito Morishima
- Department of Rehabilitation, Toyohashi Municipal Hospital. 50 Hachikennishi, Aotake-cho, Toyohashi city, Aichi Prefecture, 441-8570, Japan
| | - Takechiyo Yamada
- Department of Otorhinolaryngology, Head and Neck Surgery, Akita University, Graduate School of Medicine, Akita, 010-8543, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582 Japan
| |
Collapse
|
4
|
Namavarian A, Cheng EY, Shapiro J, Ziai H, Talei B, Pai A, Enepekides D, Gantous AM. Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review. Facial Plast Surg 2024; 40:525-537. [PMID: 38806148 DOI: 10.1055/s-0044-1786824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The mainstay treatment for postfacial paralysis synkinesis (PFPS) is chemodenervation and physiotherapy, which requires long-term maintenance neurotoxin injections. This can lead to treatment resistance. Selective neurectomy of the distal branches of the facial nerve has been suggested as an effective surgical treatment of PFPS. This study aims to provide a comprehensive systematic review evaluating the efficacy of selective neurectomy for patients presenting with PFPS. Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL were searched from inception until July 2022. Studies that investigated postoperative outcomes of pediatric and/or adult patients who underwent selective neurectomy as a treatment for PFPS were included. The database search identified 1,967 studies, and 11 were ultimately included based on inclusion and exclusion criteria. These 11 studies represented 363 patients. Studies reported on outcomes following selective neurectomy with or without adjuvant therapies for patients with PFPS. The main outcome categories identified were clinician-reported outcomes and patient-reported outcomes. The studies that used clinician-reported outcomes found an improvement in both synkinesis and facial nerve paralysis (FNP) outcomes following selective neurectomy according to their respective grading systems. Three studies looked at patient-reported outcomes and found increased patient-reported quality of life and satisfaction following selective neurectomy. The most reported complications were upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence. Selective neurectomy has demonstrated stable or improved synkinesis, FNP, and quality of life outcomes in patients with PFPS. This approach should be considered for patients with PFPS, particularly for patients with refractory symptoms or those who are unable to undergo continued medical management.
Collapse
Affiliation(s)
- Amirpouyan Namavarian
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Emily YiQin Cheng
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Shapiro
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Talei
- Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
| | - Akshat Pai
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andres M Gantous
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Zubler C, Punreddy A, Mayorga-Young D, Leckenby J, Grobbelaar AO. Approaches to the Management of Synkinesis: A Scoping Review. Facial Plast Surg 2024; 40:514-524. [PMID: 38604247 PMCID: PMC11259496 DOI: 10.1055/a-2305-2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
Postparalysis facial synkinesis (PPFS) can develop in any facial palsy and is associated with significant functional and psychosocial consequences for affected patients. While the prevention of synkinesis especially after Bell's palsy has been well examined, much less evidence exists regarding the management of patients with already established synkinesis. Therefore, the purpose of this review is to summarize the available literature and to provide an overview of the current therapeutic options for facial palsy patients with established synkinesis. A systematic literature review was undertaken, following the Preferred Reporting Items of Systematic Reviews and Meta-analyses 2020 guidelines. MEDLINE via PubMed and Cochrane Library were searched using the following strategy: ([facial palsy] OR [facial paralysis] OR [facial paresis]) AND (synkinesis) AND ([management] OR [guidelines] OR [treatment]). The initial search yielded 201 articles of which 36 original papers and 2 meta-analyses met the criteria for inclusion. Overall, the included articles provided original outcome data on 1,408 patients. Articles were divided into the following treatment categories: chemodenervation (12 studies, 536 patients), facial therapy (5 studies, 206 patients), surgical (10 studies, 389 patients), and combination therapy (9 studies, 278 patients). Results are analyzed and discussed accordingly. Significant heterogeneity in study population and design, lack of control groups, differences in postoperative follow-up, as well as the use of a variety of subjective and objective assessment tools to quantify synkinesis prevent direct comparison between treatment modalities. To date, there is no consensus on how PPFS is best treated. The lack of comparative studies and standardized outcome reporting hinder our understanding of this complex condition. Until higher quality scientific evidence is available, it remains a challenge best approached in an interdisciplinary team. An individualized multimodal therapeutic concept consisting of facial therapy, chemodenervation, and surgery should be tailored to meet the specific needs of the patient.
Collapse
Affiliation(s)
- Cédric Zubler
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ankit Punreddy
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Danielle Mayorga-Young
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Jonathan Leckenby
- Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
- Department of Plastic and Reconstructive Surgery, The Great Ormond Street for Sick Children, London, United Kingdom
| | - Adriaan O. Grobbelaar
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
- Department of Plastic and Reconstructive Surgery, The Great Ormond Street for Sick Children, London, United Kingdom
| |
Collapse
|
6
|
Miller MQ. Invited Commentary: Ozucer et al.'s "Tips and Tricks for Safe and Precise Decision-Making during Modified Selective Neurectomy Surgery": An Innovative Technique That Improves but Does Not Resolve Unpredictability in Neurectomy Surgery. Facial Plast Surg Aesthet Med 2024. [PMID: 39058668 DOI: 10.1089/fpsam.2024.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Affiliation(s)
- Matthew Q Miller
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
7
|
Shokri T, Patel S, Ziai K, Harounian J, Lighthall JG. Facial synkinesis: A distressing sequela of facial palsy. EAR, NOSE & THROAT JOURNAL 2024; 103:NP382-NP391. [PMID: 34836457 DOI: 10.1177/01455613211054627] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with enduring facial paralysis, there is still a lack of complete understanding of this debilitating condition, leading to functional limitations and decreased quality of life.1 This article reviews the diagnostic assessment, etiology, pathophysiology, rehabilitation, and nonsurgical and surgical treatments for facial synkinesis. METHODS A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "facial," "synkinesis," "palsy," and various combinations of the terms. RESULTS The resultant inability to control the full extent of one's facial movements has functional and psychosocial consequences and may result in social withdrawal with a significant decrease in quality of life. An understanding of facial mimetic musculature is imperative in guiding appropriate intervention. While chemodenervation with botulinum toxin and neurorehabilitation have continued to be the primary treatment strategy for facial synkinesis, novel techniques such as selective myectomy, selective neurolysis, free-functioning muscle transfer, and nerve grafting techniques are becoming increasingly utilized in treatment regimens. Facial rehabilitation, including neuromuscular retraining, soft tissue massage, and relaxation therapy in addition to chemodenervation with botulinum toxin, remains the cornerstone of treatment. In cases of severe, intractable synkinesis and non-flaccid facial paralysis, surgical interventions, including selective neurectomy, selective myectomy, nerve grafting, or free muscle transfer, may play a more significant role in alleviating symptoms. DISCUSSION A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes. Ultimately, therapy should be tailored to the severity and pattern of synkinesis, and each patient approached on a case-by-case basis. A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes.
Collapse
Affiliation(s)
- Tom Shokri
- Facial Plastic and Reconstructive Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Jonathan Harounian
- Department of Otolaryngology-Head and Neck Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Jessyka G Lighthall
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| |
Collapse
|
8
|
Park TH, Park IS, Kim J. How to Enhance the Success of Selective Neurectomy for Facial Synkinesis by Considering the Patient's Preferences: Lesson Learned from a Retrospective Analysis of 122 Cases. Aesthetic Plast Surg 2024; 48:1249-1257. [PMID: 37726398 DOI: 10.1007/s00266-023-03620-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/10/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Facial synkinesis can result in facial tightness, smile dysfunction, and eyelid aperture narrowing due to overactive and uncoordinated muscle activity. We hypothesized that the outcome of a selective neurectomy could rely on the patient's chief complaints. METHODS We retrospectively reviewed 122 patients who underwent selective neurectomy at our hospital. Preoperatively, the patients were asked nine questionnaires to identify their two major chief complaints (treatment priorities). Postoperatively, facial tightness, limited mouth movement, and eyelid aperture narrowing were measured. RESULTS The most common chief complaints in our series were facial tightness (n=38), eyelid narrowing (n=32), and limited mouth movement (n=28); the second most common chief complaints (second priority) were limited mouth movement (n=47), facial tightness (n=21), and eyelid narrowing (n=20). The mean score for facial tightness significantly improved from 4.3 to 1.1 in the first priority group. Among the 28 patients whose corners of the mouth constituted the top priority of surgical correction, the vertical inclination on the affected side significantly improved from 74.1 ± 7.6° to 55.5 ± 6.0°, and the horizontal angles were changed from 4.2 ± 2.7° to 2.0 ± 1.3° after selective neurectomy without statistically significant. Among the 32 patients for whom eyelid narrowing constituted the top priority, the mean eyelid narrowing score improved from 4.5 ± 1.1 to 1.5 ± 1.2. CONCLUSIONS Selective neurectomy can provide a significantly satisfactory outcome regarding facial tightness and eyelid aperture narrowing. The vertical inclination of the mouth corner can be significantly improved, while the improvement of horizontal angles can be suboptimal. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, 18450, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Il Seok Park
- Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, 18450, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jin Kim
- Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, 18450, South Korea.
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea.
| |
Collapse
|
9
|
Fatani B, Alshalawi HS, Alsuhaibani LA, Alrasheed TM, Alislimah GA, Al-Safadi A. Facial Paralysis Treatment Using Selective Neurectomy: A Comprehensive Review. Cureus 2024; 16:e51809. [PMID: 38187021 PMCID: PMC10771824 DOI: 10.7759/cureus.51809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/09/2024] Open
Abstract
Facial paralysis can affect patients undergoing full mouth rehabilitation, regardless of what caused their paralysis. A procedure known as modified selective neurectomy of the facial nerve can enhance the movement of facial muscles in individuals with facial synkinesis safely and effectively. This approach is proposed as an alternative to more invasive surgical options when used independently as a treatment for incomplete facial palsy. Selective neurectomy offers a promising surgical option for managing nonflaccid facial paralysis and synkinesis, enhancing patients' quality of life. However, treatment plans should be individually tailored considering the complexity of facial paralysis and the unique needs of each patient, taking into account the timing and type of treatment. The objective of this review is to explore the use of selective neurectomy as a treatment for facial paralysis based on previously published papers.
Collapse
Affiliation(s)
- Bader Fatani
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
| | | | | | | | | | - Afraa Al-Safadi
- Surgery and Pharmacy, King Khaled University Hospital, King Saud University Medical City, Riyadh, SAU
| |
Collapse
|
10
|
Tikhtman R, Hsieh TY. Minimization of facial synkinesis. Curr Opin Otolaryngol Head Neck Surg 2023; 31:293-299. [PMID: 37610981 DOI: 10.1097/moo.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW To summarize the treatment options available for the management of postparalytic facial synkinesis which include facial rehabilitation, chemodenervation, and a spectrum of surgical interventions. RECENT FINDINGS Facial rehabilitation and botulinum toxin chemodenervation represent the foundation of facial synkinesis management, with specific treatment paradigms directed by individual patient needs. Evolving surgical approaches range from isolated selective myectomies or neurectomies to combination approaches which may incorporate various types of nerve transfer with gracilis free muscle transplantation. SUMMARY Postparalytic facial synkinesis bears significant patient morbidity due to aesthetic and functional implications. Management strategies must balance patient goals with treatment risks and typically progress stepwise from the least to most invasive interventions. Emerging techniques reveal a convergence in approaches to facial reanimation and synkinesis mitigation.
Collapse
Affiliation(s)
- Raisa Tikhtman
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | |
Collapse
|
11
|
Ovaitt AK, Chweya CM, Flynn J. Selective neurectomy for nonflaccid facial palsy. Curr Opin Otolaryngol Head Neck Surg 2023:00020840-990000000-00064. [PMID: 37144494 DOI: 10.1097/moo.0000000000000898] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW To review the evolving role of selective neurectomy in the management of patients with synkinesis including the history of selective neurectomy, operative techniques, and clinical outcomes. RECENT FINDINGS Modified selective neurectomy alone or in conjunction with other procedures achieves more durable outcomes based on objective measures such as time to recurrence of symptoms and units of botulinum toxin required postoperatively. This is also reflected on patient reported quality of life outcome measures. Regarding operative technique, lower rates of oral incompetence are reported with division of an average of 6.7 nerve branches as opposed to more branches. SUMMARY Chemodenervation has long been the mainstay of treatment in facial synkinesis, but in recent years, the paradigm has begun to shift in favor of incorporating interventions with more durable outcomes such as modified selective neurectomy. Modified selective neurectomy is often performed with other simultaneous surgeries such as nerve transfer, rhytidectomy, lid surgery and static facial reanimation primarily to address periocular synkinesis and synkinetic smile. The outcomes have been favorable with improvement in quality-of-life measures and a decrease in botulinum toxin requirements.
Collapse
Affiliation(s)
- Alyssa K Ovaitt
- Department of Otolaryngology-Head and Neck Surgery. University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | |
Collapse
|
12
|
Shikara M, Bridgham K, Ludeman E, Vakharia K, Justicz N. Selective Neurectomy for Treatment of Post-Facial Paralysis Synkinesis: A Systematic Review. Facial Plast Surg 2023; 39:190-200. [PMID: 36155895 DOI: 10.1055/a-1950-4483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Synkinesis is commonly encountered after flaccid facial paralysis and can have a detrimental impact on a patient's life. First-line treatment of synkinesis is chemodenervation with botulinum toxin (Botox) and neuromuscular retraining. Surgical options include selective myectomy, selective neurectomy (SN), cross-facial nerve grafting, nerve substitution, and free gracilis muscle transfer. Data on surgical management of synkinesis using SN is limited. EVIDENCE REVIEW PubMed, Embase, Cochrane CENTRAL, Cochrane Neuromuscular Register, Clinicaltrials.gov, and World Health Organization International Clinical Trials Registry Platform were searched using a comprehensive keyword strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All English-only texts published in the past 20 years were included. Two independent investigators reviewed 906 abstracts and 7 studies met inclusion criteria. Demographics, etiology of paralysis, time to surgery, and primary outcomes studied were collected. FINDINGS A total of 250 patients were included across 7 studies. In 6 out of 7 studies, Botox was used prior to surgical intervention. Two studies showed significant reduction in Botox dosage postoperatively, while one study showed no difference. Other primary outcomes included the House-Brackmann Score, palpebral fissure width, electronic clinician-graded facial function scale (eFACE) score, Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Three studies showed significant improvement in the eFACE score, two studies showed significant improvement in the FaCE scale, while one study showed improvement in quality of life measured by the SAQ. CONCLUSION SN can be considered as an adjunct to other management options including neuromuscular retraining, Botox, selective myectomy, and reanimation procedures. While there is great heterogeneity of study design in the studies included, many cohorts showed improvement in facial symmetry, facial function, and quality of life. There remains a great gap in knowledge in this subject matter and a need for large well-designed prospective studies comparing this technique to other management options.
Collapse
Affiliation(s)
- Meryam Shikara
- Department of Otorhinolaryngology- Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland
| | - Kelly Bridgham
- Department of Otorhinolaryngology- Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Emilie Ludeman
- Health Sciences and Human Services Library, University of Maryland Graduate School, Baltimore, Maryland
| | - Kalpesh Vakharia
- Department of Otorhinolaryngology- Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Natalie Justicz
- Department of Otorhinolaryngology- Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland
- University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
13
|
Guntinas-Lichius O, Prengel J, Cohen O, Mäkitie AA, Vander Poorten V, Ronen O, Shaha A, Ferlito A. Pathogenesis, diagnosis and therapy of facial synkinesis: A systematic review and clinical practice recommendations by the international head and neck scientific group. Front Neurol 2022; 13:1019554. [PMID: 36438936 PMCID: PMC9682287 DOI: 10.3389/fneur.2022.1019554] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Post-paralytic facial synkinesis after facial nerve injury produces functional disabilities and mimetic deficits, but also cosmetic and non-motor psychosocial impairments for the patients. These patients typically have a high and continuous high motivation for rehabilitation. The aim is to inform the affected patients and their therapeutic professionals (otorhinolaryngologist - head and neck surgeons; oral-maxillofacial surgeons, plastic and reconstructive surgeons, neurosurgeons, neurologists, and mime therapists be it speech and language therapy- or physiotherapy-based) and to provide practical recommendations for diagnostics and a stepwise systematic treatment approach of facial synkinesis. Methods In the first phase, a systematic literature search on the topic in PubMed and ScienceDirect starting in 2008 resulted in 132 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostic tests and treatment options. In the second phase, one consensus article circulated among the membership of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations. Results Diagnostics should include a standardized assessment of the degree of synkinesis using validated clinician-graded instruments and synkinesis-specific patient-reported outcome measures. Treatments for facial synkinesis include facial training mainly based on facial biofeedback retraining, chemodenervation with botulinum toxin, selective neurectomy, myectomy, and any combination treatment of these options. Conclusion A basic understanding of the pathomechanisms of synkinesis is essential to understand the treatment strategies. A standardized assessment of the synkinetic symptoms and the individual synkinesis pattern is needed. The first-line treatment is facial training, followed by botulinum toxin. Surgery is reserved for individual cases with unsatisfactory first-line treatment.
Collapse
Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial Nerve Center, Jena University Hospital, Jena, Germany,Multidisciplinary Salivary Gland Society, Geneva, Switzerland,*Correspondence: Orlando Guntinas-Lichius
| | - Jonas Prengel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial Nerve Center, Jena University Hospital, Jena, Germany
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Affiliated With Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Vincent Vander Poorten
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium,Otorhinolaryngology, Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Affiliated With Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
14
|
Relationship between serum gonadal hormone levels and synkinesis in postmenopausal women and man with idiopathic facial paralysis. Auris Nasus Larynx 2022; 49:782-789. [DOI: 10.1016/j.anl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/17/2022] [Accepted: 02/13/2022] [Indexed: 11/22/2022]
|
15
|
Miller MQ, Hadlock TA. Deep Dive into Denervation: Institutional Experience with Selective Denervation in Nonflaccid Facial Palsy. Facial Plast Surg Aesthet Med 2021; 23:241-247. [DOI: 10.1089/fpsam.2020.0325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew Q. Miller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A. Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Azizzadeh B, Hjelm N. Modified Selective Neurectomy: A New Paradigm in the Management of Facial Palsy with Synkinesis. Facial Plast Surg Clin North Am 2021; 29:453-457. [PMID: 34217449 DOI: 10.1016/j.fsc.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
All patients with postparalytic facial paralysis are at risk of developing synkinesis due to aberrant nerve regeneration. Synkinesis can result in smile dysfunction, tension, and eyelid aperture narrowing due to overactive and uncoordinated muscle activity. When the synkinesis causes an asymmetric smile, there are several treatment modalities including neurotoxin, neuromuscular retraining, and surgery. Modified selective neurectomy of the facial nerve is a treatment option that potentially can improve the smile mechanism by reducing the activity of counterproductive facial muscles while preserving the natural neural pathway.
Collapse
Affiliation(s)
- Babak Azizzadeh
- The Facial Paralysis Institute, 9401 Wilshire Boulevard, Suite 650, Beverly Hills, CA 90212, USA
| | - Nikolaus Hjelm
- The Facial Paralysis Institute, 9401 Wilshire Boulevard, Suite 650, Beverly Hills, CA 90212, USA.
| |
Collapse
|
17
|
Epineurectomy of Facial Nerve Trunk for Refractory Oral-Ocular and Oculo-Oral Synkinesis Following Bell Palsy. J Craniofac Surg 2021; 32:e822-e826. [PMID: 34260463 DOI: 10.1097/scs.0000000000007979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Synkinesis is a common sequelae after incomplete recovery from Bell palsy. Current first-line treatments include botulinum toxin injection and physical therapy. However, patients unresponsive to these treatments may require further surgery. Various surgical treatments have been reported, but no consensus has been reached for the optimal surgery. In a guinea pig model of synkinesis, the facial nerve trunk (FNT) was observed using a scanning electron microscope. Based on the results of scanning electron microscope and clinical ultrasonography, the authors chose FNT as the therapeutic target. METHODS The authors performed epineurectomy of FNT for 11 patients with refractory oral-ocular and oculo-oral synkinesis under abnormal muscle response and facial electromyography monitoring. The postoperative assessments at 1 year were conducted using Sunnybrook Facial Grading System and Facial Disability Index scale. Furthermore, the epineurium excised during the operation was collected as the specimen and submitted for histopathological examination; the cadaveric FNT served as the control group. RESULTS The follow-up results showed significant relief from synkinesis (4.91 ± 0.37 versus 10.18 ± 0.64, P < 0.01), improvement of physical (84.55 ± 1.96 versus 73.18 ± 3.65, P < 0.01) and social functions (77.09 ± 3.24 versus 61.82 ± 6.28, P < 0.01), with no worsening of facial paralysis in the patients. The histopathological examination revealed many nerve fibers in the epineurium, suggesting that FNT was the area of aberrant axon regeneration. CONCLUSIONS Epineurectomy of FNT is a safe and effective surgical remedy. It can be considered as a surgical option for patients with refractory oral-ocular and oculo-oral synkinesis following Bell palsy.
Collapse
|
18
|
Assessment of eye closure and blink with facial palsy: A systematic literature review. J Plast Reconstr Aesthet Surg 2021; 74:1436-1445. [PMID: 33952434 DOI: 10.1016/j.bjps.2021.03.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/22/2020] [Accepted: 03/11/2021] [Indexed: 02/05/2023]
Abstract
Facial palsy can cause the impairment of eye closure and affect blink, ocular health, communication, and esthetics. Dynamic surgical procedures can restore eye closure in patients with decreased facial nerve function. There are no standardized measures of voluntary and spontaneous eye closure that are used to evaluate the outcomes of blink restoration procedures. The purpose of this systematic literature review was to identify the measures used to assess normal and abnormal eye closure and blinking in patients with facial palsy. A literature search of the PubMed database using the keyword "facial nerve/surgery" was conducted. Only English language articles that pertain to the use of facial paralysis assessment systems published in the past 20 years, which involve eyelid closure were included. There were 57 articles that used a facial paralysis classification system with an eyelid closure component: House-Brackmann Facial Nerve Grading Scale (n = 43, 67%); Sunnybrook Facial Grading Scale (n = 9); palpebral fissure heights (n = 4), and the electronic clinician-graded facial function tool (n = 3) and three additional measures were reported once. Although the Terzis and Bruno Scoring System, blink ratio, and electronic, clinician-graded facial function scale(eFACE) Clinician-Graded Scoring System were valid measures of eyelid closure, there was no one comprehensive eye assessment that demonstrated all aspects of eye closure in facial palsy, which include closure amplitude, spontaneity, and quality of life. For blink assessment, eFACE is the most comprehensive tool currently available and recommended to be used with a patient-reported quality of life supplement that captures the specific domains related to facial nerve dysfunction.
Collapse
|
19
|
Miller MQ, Hadlock TA. Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy. Facial Plast Surg Aesthet Med 2020; 22:65-70. [DOI: 10.1089/fpsam.2020.0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew Q. Miller
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Tessa A. Hadlock
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
20
|
Vincent AG, Bevans SE, Robitschek JM, Wind GG, Hohman MH. Masseteric-to-Facial Nerve Transfer and Selective Neurectomy for Rehabilitation of the Synkinetic Smile. JAMA FACIAL PLAST SU 2020; 21:504-510. [PMID: 31465094 DOI: 10.1001/jamafacial.2019.0689] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Synkinesis is the involuntary movement of 1 area of the face accompanying volitional movement of another; it is commonly encountered in patients affected by facial palsy. Current treatments for synkinesis include biofeedback for muscular retraining and chemodenervation via the injection of botulinum toxin. Chemodenervation is effective in reducing unwanted muscle movement, but it requires a commitment to long-term maintenance injections and may lose effectiveness over time. A permanent solution for synkinesis remains elusive. Objective To evaluate masseteric-to-facial nerve transfer with selective neurectomy in rehabilitation of the synkinetic smile. Design, Setting, and Participants In this case series, 7 patients at a tertiary care teaching hospital underwent masseteric-to-facial nerve transfer with selective neurectomy for synkinesis between September 14, 2015, and April 19, 2018. The medical records of these patients were retrospectively reviewed and demographic characteristics, facial palsy causes, other interventions used, and changes in eFACE scores were identified. Intervention Masseteric-to-facial nerve transfer. Main Outcomes and Measures Changes in eFACE scores (calculated via numeric scoring of many sections of the face, including flaccidity, normal tone, and hypertonicity; higher scores indicate better function and lower scores indicate poorer function) and House-Brackmann Facial Nerve Grading System scores (range, 1-6; a score of 1 indicates normal facial function on the affected side, and a score of 6 indicates absence of any facial function [complete flaccid palsy] on the affected side). Results Among the 7 patients in the study (6 women and 1 man; median age, 49 years [range, 41-63 years]), there were no postoperative complications; patients were followed up for a mean of 12.8 months after surgery (range, 11.0-24.5 months). Patients experienced a significant improvement in mean (SD) eFACE scores in multiple domains, including smile (preoperative, 65.00 [8.64]; postoperative, 76.43 [7.79]; P = .01), dynamic function (preoperative, 62.57 [15.37]; and postoperative, 75.71 [8.48]; P = .03), synkinesis (preoperative, 52.70 [4.96]; and postoperative, 82.00 [6.93]; P < .001), midface and smile function (preoperative, 60.71 [13.52]; and postoperative, 78.86 [14.70]; P = .02), and lower face and neck function (preoperative, 51.14 [16.39]; and postoperative, 66.43 [20.82]; P = .046). Preoperative House-Brackmann Facial Nerve Grading System scores ranged from 3 to 4, and postoperative scores ranged from 2 to 3; this change was not significant. Conclusion and Relevance This study describes the application of masseteric-to-facial nerve transfer with selective neurectomy for smile rehabilitation in patients with synkinesis, with statistically significant improvement in smile symmetry and lower facial synkinesis as measured with the eFACE tool. This technique may allow for long-term improvement of synkinesis and smile. This study is only preliminary, and a larger cohort will permit more accurate assessment of this therapeutic modality. Level of Evidence 4.
Collapse
Affiliation(s)
- Aurora G Vincent
- Division of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Scott E Bevans
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Jon M Robitschek
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Gary G Wind
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Marc H Hohman
- Division of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| |
Collapse
|
21
|
Lapidus JB, Lu JCY, Santosa KB, Yaeger LH, Stoll C, Colditz GA, Snyder-Warwick A. Too much or too little? A systematic review of postparetic synkinesis treatment. J Plast Reconstr Aesthet Surg 2019; 73:443-452. [PMID: 31786138 DOI: 10.1016/j.bjps.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 11/17/2022]
Abstract
Synkinesis is a negative sequela of facial nerve recovery. Despite the need for effective treatment, controversy exists regarding optimal management and outcome reporting measures. The goals of this study were to evaluate the current synkinesis literature and compare the effectiveness of treatment modalities. A search of biomedical databases was performed in May 2019. Full-text English language articles of cohort studies or randomized controlled trials on synkinesis treatment were eligible for inclusion. Reviews, animal studies, and those without assessment of treatment effect were excluded. We found 592 unique citations; 33 articles were included in the final analyses. Nine studies focused on botulinum toxin (BTX-A), 7 on surgery, 5 on physical therapy (PT), and 12 on multimodal therapy. The Sunnybrook Facial Grading System was the most frequently used outcome measure (17 studies, 51.5%). All treatment modalities improved outcomes. Chemodenervation studies showed an average improvement of 17.8% (range 11-33.3%) in the respective outcome measures after treatment. PT improved by 29.7% (range 14.6-41.2%), surgery by 16.6% (range 4.7-41%), and combination therapy by 20.4% (range 5.13-37.5%). Only 21 studies (63.6%) provided data on adverse outcomes. There is lack of high-evidence level data for robust comparisons of postparetic synkinesis treatments; however, this condition is likely effectively treated nonsurgically and requires the support of a specialized multidisciplinary team. Adoption of standardized patient evaluation and outcome reporting methods is necessary for robust comparative effectiveness studies.
Collapse
Affiliation(s)
- Jodi B Lapidus
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, United States
| | - Johnny Chuieng-Yi Lu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, United States; Division of Reconstructive Microsurgery, Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Katherine B Santosa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, United States; Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Lauren H Yaeger
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, United States
| | - Carolyn Stoll
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, United States
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, United States
| | - Alison Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8238, St. Louis, MO 63110, United States.
| |
Collapse
|
22
|
Ali SA, Hanks JE, Stebbins AW, Cohen ST, Hunter DA, Snyder-Warwick AK, Mackinnon SE, Kupfer RA, Hogikyan ND, Feldman EL, Brenner MJ. Comparison of Myelin-Associated Glycoprotein With Vincristine for Facial Nerve Inhibition After Bilateral Axotomy in a Transgenic Thy1-Gfp Rat Model. JAMA FACIAL PLAST SU 2019; 21:426-433. [PMID: 31219545 PMCID: PMC6587147 DOI: 10.1001/jamafacial.2019.0398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Aberrant synkinetic movement after facial nerve injury can lead to prominent facial asymmetry and resultant psychological distress. The current practices of neuroinhibition to promote greater facial symmetry are often temporary in nature and require repeated procedures. OBJECTIVE To determine whether myelin-associated glycoprotein (MAG), a specific neuroinhibitor, can prevent neuroregeneration with efficacy comparable with that of vincristine, a well-established neurotoxin. DESIGN, SETTING, AND PARTICIPANTS Rats transgenic for Thy-1 cell surface antigen-green fluorescent protein (Thy1-Gfp) were randomized into 3 groups. Each rat received bilateral crush axotomy injuries to the buccal and marginal mandibular branches of the facial nerves. The animals received intraneural injection of saline, MAG, or vincristine. MAIN OUTCOMES AND MEASURES The animals were imaged via fluorescent microscopy at weeks 1, 3, 4, and 5 after surgery. Quantitative fluorescent data were generated as mean intensities of nerve segments proximal and distal to the axotomy site. Electrophysiological analysis, via measurement of compound muscle action potentials, was performed at weeks 0, 3, 4, and 5 after surgery. RESULTS A total of 12 rats were included in the study. Administration of MAG significantly reduced fluorescent intensity of the distal nerve in comparison with the control group at week 3 (mean [SD], MAG group: 94 [11] intensity units vs control group: 130 [11] intensity units; P < .001), week 4 (MAG group: 81 [19] intensity units vs control group: 103 [9] intensity units; P = .004), and week 5 (MAG group: 76 [10] intensity units vs control group: 94 [10] intensity units; P < .001). In addition, rats treated with MAG had greater fluorescent intensity than those treated with vincristine at week 3 (mean [SD], MAG group: 94 [11] intensity units vs vincristine group: 76 [6] intensity units; P = .03), although there was no significant difference for weeks 4 and 5. At week 5, both MAG and vincristine demonstrated lower distal nerve to proximal nerve intensity ratios than the control group (control group, 0.94; vs MAG group, 0.82; P = .01; vs vincristine group; 0.77; P < .001). There was no significant difference in amplitude between the experimental groups at week 5 of electrophysiological testing. CONCLUSIONS AND RELEVANCE Lower facial asymmetry and synkinesis are common persistent concerns to patients after facial nerve injury. Using the Thy1-Gfp rat, this study demonstrates effective inhibition of neuroregeneration via intraneural application of MAG in a crush axotomy model, comparable with results with vincristine. By potentially avoiding systemic toxic effects of vincristine, MAG demonstrates potential as an inhibitor of neural regeneration for patients with synkinesis. LEVEL OF EVIDENCE NA.
Collapse
Affiliation(s)
- S. Ahmed Ali
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | - John E. Hanks
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | - Aaron W. Stebbins
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
- Department of Neurology, Michigan Medicine, Ann Arbor
| | - Samantha T. Cohen
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | - Daniel A. Hunter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Alison K. Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Robbi A. Kupfer
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | - Norman D. Hogikyan
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | | | - Michael J. Brenner
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| |
Collapse
|
23
|
Raslan A, Guntinas-Lichius O, Volk GF. Altered facial muscle innervation pattern in patients with postparetic facial synkinesis. Laryngoscope 2019; 130:E320-E326. [PMID: 31237361 DOI: 10.1002/lary.28149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/26/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS Using surface electrostimulation, we aimed to use facial nerve mapping (FNM) in healthy subjects and patients with postparetic facial synkinesis (PPFS) to define functional facial target regions that can be stimulated selectively. STUDY DESIGN Single-center prospective cohort study. METHODS FNM was performed bilaterally in 20 healthy subjects and 20 patients with PPFS. Single-pulse surface FNM started at the main trunk of the facial nerve and followed the peripheral branches in a distal direction. Stimulation started with 0.1 mA and increased in 0.1 mA increments. The procedure was simultaneously video recorded and evaluated offline. RESULTS A total of 1,873 spots were stimulated, and 1,875 facial movements were evaluated. The stimulation threshold was higher on the PPFS side (average = 9.8 ± 1.0 mA) compared to the contralateral side (4.1 ± 0.8 mA) for all stimulation sites or compared to healthy subjects (4.1 ± 0.5 mA; all P < .01). In healthy subjects, selective electrostimulation ± one unintended coactivation was possible at all sites in >80% of cases, with the exception of pulling up the corner of the mouth (65%-75%). On the PPFS side, stimulation was possible for puckering lips movements in 60%/75% (selective stimulation ± one coactivation, respectively), blinking in 55%/80%, pulling up the corner of the mouth in 50%/85%, brow raising in 5%/85, and raising the chin in 0%/35% of patients, respectively. CONCLUSIONS FNM mapping for surgical planning and selective electrostimulation of functional facial regions is possible even in patients with PPFS. FNM may be a tool for patient-specific evaluation and placement of electrodes to stimulate the correct nerve branches in future bionic devices (e.g., for a bionic eye blink). LEVEL OF EVIDENCE 2b Laryngoscope, 130:E320-E326, 2020.
Collapse
Affiliation(s)
- Ashraf Raslan
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Department of Otorhinolaryngology, Assiut University Hospital, Assiut, Egypt.,Department of Otorhinolaryngology, Ilm-Kreis Clinics, Arnstadt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| |
Collapse
|