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Brennan C, Al Bakry M, Fort-Schaale A, Jose J, Mizen K, Matteucci P, Kelemen N. Immediate lengthening temporalis myoplasty for facial palsy reconstruction following facial nerve inclusive total parotidectomy. Int J Oral Maxillofac Surg 2024; 53:724-730. [PMID: 38395687 DOI: 10.1016/j.ijom.2024.01.009] [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: 08/15/2022] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
Immediate lengthening temporalis myoplasty (Labbé procedure) for immediate dynamic facial reanimation after nerve-inclusive parotidectomy in the elderly population is undocumented in the literature. The aim of this work was to determine whether the Labbé approach could achieve immediate, good functional and static results in elderly patients with acquired facial palsy. A retrospective analysis of five patients with parotid malignancies involving the facial nerve who underwent parotidectomy and an immediate Labbé procedure was performed. The House-Brackmann and Sunnybrook scores for facial palsy were used as objective measurements of the functional outcome. All patients underwent total parotidectomy, neck dissection, Labbé procedure, immediate temporary tarsorrhaphy, brow lift, and postoperative radiotherapy. Mean patient age was 83 (range 73-87) years. The average resected tumour size was 3.54 cm. The mean duration of surgery was 324 min and length of hospital stay 4 days. All patients experienced an improvement in House-Brackmann of one grade postoperative (grade V to IV in four, grade VI to V in one); the Sunnybrook score improved by 31 points on average (mean preoperative 3.8 vs postoperative 34.8). An immediate Labbé procedure following ablative parotid malignancy resection is a reliable and safe reconstructive procedure in a carefully selected elderly population, providing acceptable immediate static and dynamic hemifacial mimetic function and eliminating an additional facial palsy correction procedure.
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Affiliation(s)
- C Brennan
- Plastic and Reconstructive Surgery Department, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, UK.
| | - M Al Bakry
- Hull York Medical School, Heslington, York, UK
| | - A Fort-Schaale
- Plastic and Reconstructive Surgery Department, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, UK
| | - J Jose
- Plastic and Reconstructive Surgery Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - K Mizen
- Plastic and Reconstructive Surgery Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - P Matteucci
- Plastic and Reconstructive Surgery Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
| | - N Kelemen
- Plastic and Reconstructive Surgery Department, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Hull, UK
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Martineau S, Perrin L, Kerleau H, Rahal A, Marcotte K. Comparison of Objective Facial Metrics on Both Sides of the Face Among Patients with Severe Bell's Palsy Treated with Mirror Effect Plus Protocol Rehabilitation Versus Controls. Facial Plast Surg Aesthet Med 2024; 26:172-179. [PMID: 37819748 DOI: 10.1089/fpsam.2023.0087] [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: 10/13/2023] Open
Abstract
Objective: The extent to which the healthy hemiface dynamically contributes to facial synchronization during facial rehabilitation has been largely unstudied. This study compares the synchronization of both hemifaces in severe Bell's palsy patients who either received facial rehabilitation called "Mirror Effect Plus Protocol" (MEPP) or basic counseling. Methods: Baseline and 1-year postonset data from 39 patients (19 = MEPP and 20 = basic counseling) were retrospectively analyzed using Emotrics+, a software that generates facial metrics with artificial intelligence (AI) algorithms. Paired t-tests were used for intrasubject comparisons of hemifaces, and mixed model analysis were used to compare between groups. Results: For voluntary movements, a significant difference in favor of the MEPP group was only found for smiling (p = 0.025*). However, at 1-year postonset, the control group showed significant variability between hemifaces for most synkinesis measurements [nasolabial fold (p = 0.029*); eye area (p = 0.043*); palpebral fissure (p = 0.011*)]. Conclusion: In this study, a better synchronization of both hemifaces was found in the MEPP group. Interestingly, motor adaptation in movement amplitude of the healthy hemiface seemed to contribute to this synchronization in MEPP patients. Further studies are needed to standardize the procedure of AI measurements and to adapt it for clinical use.
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Affiliation(s)
- Sarah Martineau
- Département de chirurgie et Direction des Services Multidisciplinaires, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Centre de recherche du Centre intégré universitaire de santé et services sociaux du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- École d'Orthophonie et d'Audiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Perrin
- Département universitaire d'enseignement et de formation en orthophonie, Faculté de Médecine, Université de Sorbonne, Paris, France
| | - Hélène Kerleau
- Département universitaire d'enseignement et de formation en orthophonie, Faculté de Médecine, Université de Sorbonne, Paris, France
| | - Akram Rahal
- Département de chirurgie et Direction des Services Multidisciplinaires, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- École d'Orthophonie et d'Audiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et services sociaux du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- École d'Orthophonie et d'Audiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
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Pouwels S. Response to: 'Cognitive Control and Weight Loss after Bariatric Surgery: the BARICO Study'. Obes Surg 2023; 33:4176-4177. [PMID: 37919531 DOI: 10.1007/s11695-023-06894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Sjaak Pouwels
- Department of General, Abdominal Surgery and Coloproktology, Helios St. Elisabeth Klinik, Josefstraße 3, 46045, Oberhausen, Germany.
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
- Faculty of Health, Witten/Herdecke University, Witten, Germany.
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Dagenais F, Neville C, Desmet L, Martineau S. Measuring the Potential Effects of Mirror Therapy Added to the Gold Standard Facial Neuromuscular Retraining in Patients With Chronic Peripheral Facial Palsy: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47709. [PMID: 37418307 PMCID: PMC10362495 DOI: 10.2196/47709] [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: 03/29/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Facial neuromuscular retraining (fNMR) is a noninvasive physical therapy widely used to treat peripheral facial palsies. It consists of different intervention methods that aim to reduce the debilitating sequelae of the disease. Recently, the use of mirror therapy in the acute facial palsy and postsurgical rehabilitation contexts has shown promising results, suggesting its use as an adjunct to fNMR in treating patients with later stages of paralysis, such as the paretic, early, or chronic synkinetic. OBJECTIVE The main aim of this study is to compare the efficacy of an added mirror therapy component with fNMR in patients with peripheral facial palsy (PFP) sequelae in 3 different stages. The specific objectives of this study are to measure the effects of combined therapy compared to fNMR alone on (1) participants' facial symmetry and synkinesis, (2) quality of life and psychological aspects of the participants, (3) motivation and treatment adherence, and (4) different stages of facial palsies. METHODS This study is a randomized controlled trial that compares the effect of fNMR combined with mirror therapy (experimental group: n=45) with fNMR alone (control group: n=45) in 90 patients with peripheral facial palsy presenting with sequelae 3-12 months after onset. Both groups will receive 6 months of rehabilitation training. Facial symmetry and synkinesis; participants' quality of life; and their psychological factors, motivation, and compliance will be assessed at baseline (T0), 3 months (T1), 6 months (T2), and 12 months (T3) postintervention. Outcome measures are (1) changes in facial symmetry and synkinesis assessed with facial grading tools, (2) quality of life changes with patient questionnaires, and (3) therapy motivation with a standardized scale, as well as adherence to treatment with metadata. Changes in facial symmetry and synkinesis will be judged by 3 assessors blinded to group assignment. Mixed models and Kruskal-Wallis, chi-square, and multilevel analyses will be conducted according to the appropriate variable type. RESULTS Inclusion will start in 2024 and is anticipated to be completed in 2027. The 12-month follow-up will be completed with the last patient in 2028. We expect patients included in this study to experience improvement in facial symmetry, synkinesis, and quality of life, regardless of group assignments. A potential benefit of mirror therapy for facial symmetry and synkinesis could be noted for patients in the paretic phase. We hypothesize better motivation and adherence to treatment for the mirror therapy group. CONCLUSIONS The results of this trial may provide new guidelines for PFP rehabilitation with patients dealing with long-term sequelae. It also fills the need for robust evidence-based data in behavioral facial rehabilitation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47709.
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Affiliation(s)
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
| | - Liesbet Desmet
- Department of Health and Care, Artevelde University of Applied Sciences, Gent, Belgium
- European Institute for Otorhinolaryngology - Head & Neck Surgery, Sint-Augustinus GZA Hospital, Antwerp, Belgium
| | - Sarah Martineau
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, École d'Orthophonie et d'Audiologie, Université de Montréal, Montreal, QC, Canada
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Martineau S, Rivest C, Rahal A, Marcotte K. Development of an open-source and free facial rehabilitation website for severe bell's palsy: a within-subject study on user experience and patient's compliance with the MEPP-website. Disabil Rehabil 2022; 44:8357-8366. [PMID: 34919488 DOI: 10.1080/09638288.2021.2012846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE An open source and free website called Mirror Effect Plus Protocol (MEPP)-website was developed with features to diminish cognitive load and support motor learning during facial exercises. Assessing patient's perceptions is crucial when developing rehabilitation tools because patients' willingness to use the tools strongly affect engagement in the rehabilitation process. This study compared clinicians' and patients' user experience with the MEPP-website versus a hobby-designed website. MATERIALS AND METHODS Ten patients with acute severe Bell's palsy and five clinicians were enrolled in a within-subject and crossover design. User experience was assessed with the Modular evaluation of Components of User Experience questionnaire. Wilcoxon-Signed-Rank test analysed user experience, and descriptive analyses explored the order effect. Therapeutic compliance was verified for the MEPP-website by an integrated feature. Clinicians' descriptive statistics and subjective observations were also reported. RESULTS Both patients and clinicians demonstrated a preference for the MEPP-website, whether they used it first or second. Despite this preference, compliance with the MEPP-website was reduced, although it tended to be better when used first. CONCLUSIONS MEPP- website during facial rehabilitation improved user experience. Better user experience likely optimizes how patients perform and facilitate their exercises. Factors affecting compliance with facial rehabilitation remain to be addressed.Implications for rehabilitationRecent data suggests that mirror effect therapy combined with drug therapy supports the recovery of severe Bell's Palsy.The specialized Mirror Effect Plus Protocol (MEPP)- website is a clinical computer-based tool developed to promote patients' motor learning and diminish cognitive load during mirror therapy.The MEPP-website increase clinicians' accessibility to a specialized facial rehabilitation tool for mirror therapy.Clinicians using the MEPP-website can also objectively and easily measure compliance to facial therapy with the MEPP-website.
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Affiliation(s)
- Sarah Martineau
- Hôpital Maisonneuve-Rosemont, Montréal, Canada.,Centre de Recherche du Centre Intégré Universitaire de Santé et Services Sociaux du Nord-de-l'île-de-Montréal, Montréal, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Camille Rivest
- Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Akram Rahal
- Hôpital Maisonneuve-Rosemont, Montréal, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Karine Marcotte
- Centre de Recherche du Centre Intégré Universitaire de Santé et Services Sociaux du Nord-de-l'île-de-Montréal, Montréal, Canada.,Faculté de Médecine, Université de Montréal, Montréal, Canada
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Martineau S, Rahal A, Piette E, Moubayed S, Marcotte K. The "Mirror Effect Plus Protocol" for acute Bell's palsy: A randomized controlled trial with 1-year follow-up. Clin Rehabil 2022; 36:1292-1304. [PMID: 35722671 PMCID: PMC9420890 DOI: 10.1177/02692155221107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the effects of the "Mirror Effect Plus Protocol" (MEPP) on global facial function in acute and severe Bell's Palsy. DESIGN Single blind and randomized controlled trial to compare the effects of basic counseling (control group) versus MEPP (experimental group) over one year. SETTING Outpatient clinic following referrals from Emergency or Otorhinolaryngology Departments. SUBJECTS 40 patients (n = 20 per group) with moderately severe to total palsy who received standard medication were recruited within 14 days of onset. Baseline characteristics were comparable between the groups. INTERVENTIONS The experimental group received the MEPP program (motor imagery + manipulations + facial mirror therapy) while the control group received basic counseling. Both groups met the clinician monthly until 6 months and at one-year post-onset for assessments. OUTCOME MEASURES Facial symmetry, synkinesis, and quality of life were measured using standardized scales. Perceived speech intelligibility was rated before and after therapy by naïve judges. RESULTS Descriptive statistics demonstrated improvements in favor of the MEPP for each measured variable. Significant differences were found for one facial symmetry score (House-Brackmann 2.0 mean (SD) = 7.40 (3.15) for controls versus 5.1 (1.44) for MEPP), for synkinesis measures (p = 0.008) and for quality-of-life ratings (mean (SD) score = 83.17% (17.383) for controls versus 98.36% (3.608) for MEPP (p = 0.002)). No group difference was found for perceived speech intelligibility. CONCLUSION The MEPP demonstrates promising long-term results when started during the acute phase of moderately severe to total Bell's Palsy.
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Affiliation(s)
- Sarah Martineau
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Centre de recherche du Centre intégré Universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Département d'oto-rhino-laryngologie, Centre Intégré Universitaire de Santé et Services Sociaux de l'Est-de-l'Île de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Akram Rahal
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Département d'oto-rhino-laryngologie, Centre Intégré Universitaire de Santé et Services Sociaux de l'Est-de-l'Île de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Eric Piette
- Centre de recherche du Centre intégré Universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Département de médecine d’urgence, Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Sami Moubayed
- Centre de recherche du Centre intégré Universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Département d’oto-rhino-laryngologie, Centre intégré universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Karine Marcotte
- Centre de recherche du Centre intégré Universitaire de santé et services sociaux du Nord-de-l’île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Département d'oto-rhino-laryngologie, Centre Intégré Universitaire de Santé et Services Sociaux de l'Est-de-l'Île de Montréal, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
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7
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Pediatric facial reanimation: An algorithmic approach and systematic review. Arch Plast Surg 2020; 47:382-391. [PMID: 32971589 PMCID: PMC7520236 DOI: 10.5999/aps.2020.00710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/15/2020] [Indexed: 12/04/2022] Open
Abstract
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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9
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Modified Lengthening Temporalis Myoplasty Involving an Extended Lazy-S Incision to Avoid Facial Scar Formation. J Craniofac Surg 2018; 29:572-577. [PMID: 29420377 DOI: 10.1097/scs.0000000000004247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lengthening temporalis myoplasty is a faster and less invasive alternative to free muscle transfer for smile reconstruction. However, it requires a nasolabial fold incision, which leaves a midfacial scar. Based on esthetic considerations, a modified approach, involving an extended lazy-S (parotidectomy) incision instead of a nasolabial fold incision, was developed. METHODS A cadaveric study involving 10 hemifaces was conducted. From February 2013 to March 2016, the modified lengthening temporalis myoplasty procedure was employed in 10 patients. The results were graded from 1 (poor) to 5 (excellent) according to the Terzis grading system. The excursion of the oral commissure was also measured. RESULTS The extended lazy-S incision provides easy and safe access to the coronoid process and good visibility. The patients' mean age was 56.5 years, and the mean duration of the postoperative follow-up period was 22.2 months. The patients' underlying conditions included acoustic neuroma (n = 2), Bell palsy (n = 3), congenital conditions (n = 2), brain infarction (n = 1), Ramsay Hunt syndrome (n = 1), and malignant parotid lymphoma (n = 1). One patient suffered a surgical site infection, which was successfully treated with irrigation. All the patients achieved improvements in smile symmetry: 2, 5, and 3 patients obtained excellent, good, and moderate results, respectively. The excursion of the oral commissure ranged from 5 to 10 mm. CONCLUSION The modified lengthening temporalis myoplasty procedure provides satisfactory functional outcomes without causing significant complications. It does not leave a facial scar and is a preferable option, especially for young and female patients, and patients who have undergone ablative surgery involving the parotid region.
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Panciera DT, Sampieri C, Deganello A, Danesi G. Lengthening Temporalis Myoplasty: Objective Outcomes and Site-Specific Quality-of-Life Assessment. Otolaryngol Head Neck Surg 2017; 157:966-972. [DOI: 10.1177/0194599817717458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes.
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Affiliation(s)
- Davide Thomas Panciera
- Otolaryngology Unit of Azienda Ospedaliera Giovanni XXIII, Ospedali Riuniti, Bergamo, Italy
| | - Claudio Sampieri
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Alberto Deganello
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Giovanni Danesi
- Otolaryngology Unit of Azienda Ospedaliera Giovanni XXIII, Ospedali Riuniti, Bergamo, Italy
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Smile Reanimation after Unilateral Facial Palsy by Lengthening Temporalis Myoplasty. Plast Reconstr Surg 2017; 139:984e-993e. [DOI: 10.1097/prs.0000000000003217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis. Plast Reconstr Surg 2016; 138:950e. [PMID: 27400432 DOI: 10.1097/prs.0000000000002692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Guerreschi P, Gabert PE, Labbé D, Martinot-Duquennoy V. [Facial palsy in children]. ANN CHIR PLAST ESTH 2016; 61:513-518. [PMID: 27637411 DOI: 10.1016/j.anplas.2016.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
Facial palsy (FP) in children is congenital or acquired. When present at birth (congenital), etiologies are mostly traumatic and rarely developmental. Acquired FP needs investigation. Research on the etiology helps to determine prognostic and treatment. At most times, no specific cause is found. Treatment of idiopathic FP consists of early oral corticosteroid therapy and ocular protection. Treating the sequelae is essential and the physician has to consider the dynamic balance of both sides of the face. Dynamic rehabilitation should mainly concern the inferior facial third. We recommend the lengthening temporalis myoplasty (LTM). This relevant technique ensures replicable and reliable results with a harmonious smile. Facial dynamic rehabilitation after surgical procedure (muscle tranfer or free muscle flap) must be directed toward control of voluntary movement, to move from a mandibular smile to a spontaneous and voluntary smile, thanks to brain plasticity. Furthermore, botulinum toxin is well tolerated and remains a great tool to treat a child who can support injections.
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Affiliation(s)
- P Guerreschi
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile-Laine, 59000 Lille, France.
| | - P-E Gabert
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile-Laine, 59000 Lille, France
| | - D Labbé
- 4, place Fontette, 14000 Caen, France
| | - V Martinot-Duquennoy
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger-Salengro, CHU de Lille, rue Émile-Laine, 59000 Lille, France
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14
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Panossian A. Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis. Plast Reconstr Surg 2016; 137:1251-1261. [PMID: 26761513 DOI: 10.1097/prs.0000000000002009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Free muscle transfer for dynamic smile reanimation in facial paralysis is not always predictable with regard to cosmesis. Hospital stays range from 5 to 7 days. Prolonged operative times, longer hospital stays, and excessive cheek bulk are associated with free flap options. Lengthening temporalis myoplasty offers single-stage smile reanimation with theoretical advantages over free tissue transfer. METHODS From 2012 to 2014, 18 lengthening temporalis myoplasties were performed in 14 children for smile reconstruction. A retrospective chart review was completed for demographics, operative times, length of hospital stay, and perioperative complications. RESULTS Fourteen consecutive patients with complete facial paralysis were included. Four patients underwent single-stage bilateral reconstruction, and 10 underwent unilateral procedures. Diagnoses included Möbius syndrome (n = 5), posterior cranial fossa tumors (n = 4), posttraumatic (n = 2), hemifacial microsomia (n = 1), and idiopathic (n = 2). Average patient age was 10.1 years. Average operative time was 410 minutes (499 minutes for bilateral lengthening temporalis myoplasty and 373 for unilateral lengthening temporalis myoplasty). Average length of stay was 3.3 days (4.75 days for bilateral lengthening temporalis myoplasty and 2.8 for unilateral lengthening temporalis myoplasty). Nine patients required minor revisions. CONCLUSIONS Lengthening temporalis myoplasty is a safe alternative to free tissue transfer for dynamic smile reconstruction in children with facial paralysis. Limited donor-site morbidity, shorter operative times, and shorter hospital stays are some benefits over free flap options. However, revisions are required frequently secondary to tendon avulsions and adhesions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Andre Panossian
- Los Angeles, Calif.,From the Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
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Guerreschi P, Labbé D. La myoplastie d’allongement du muscle temporal : raffinements techniques. ANN CHIR PLAST ESTH 2015; 60:393-402. [DOI: 10.1016/j.anplas.2015.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
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Facial reanimation by muscle-nerve neurotization after facial nerve sacrifice. Case report. ANN CHIR PLAST ESTH 2015; 61:886-891. [PMID: 26403616 DOI: 10.1016/j.anplas.2015.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Recovering a certain degree of mimicry after sacrifice of the facial nerve is a clinically recognized finding. The authors report a case of hemifacial reanimation suggesting a phenomenon of neurotization from muscle-to-nerve. CLINICAL CASE A woman benefited from a parotidectomy with sacrifice of the left facial nerve indicated for recurrent tumor in the gland. The distal branches of the facial nerve, isolated at the time of resection, were buried in the masseter muscle underneath. The patient recovered a voluntary hémifacial motricity. The electromyographic analysis of the motor activity of the zygomaticus major before and after block of the masseter nerve showed a dependence between mimic muscles and the masseter muscle. DISCUSSION Several hypotheses have been advanced to explain the spontaneous reanimation of facial paralysis. The clinical case makes it possible to argue in favor of muscle-to-nerve neurotization from masseter muscle to distal branches of the facial nerve. It illustrates the quality of motricity that can be obtained thanks to this procedure. CONCLUSION The authors describe a simple implantation technique of distal branches of the facial nerve in the masseter muscle during a radical parotidectomy with facial nerve sacrifice and recovery of resting tone but also a quality voluntary mimicry.
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Veyssière A, Labbé D, Bénateau H. Lengthening temporalis myoplasty and facial paralysis from birth. J Plast Reconstr Aesthet Surg 2015; 68:312-20. [DOI: 10.1016/j.bjps.2014.10.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
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