Suspension statique commissurale labiale par fascia lata en traitement palliatif de la paralysie faciale. Un résultat stable dans le temps

Tips and Pearls for Recovering Symmetry after Facial Palsy Using a Tendon Sling: Our 20-Year Experience

Background: In facial palsy reconstruction, static techniques with the use of slings can improve the appearance and functionality of the paralyzed face and may be used in patients who cannot undergo complex surgeries or as an ancillary procedure to a dynamic reconstruction. The objective of this study was to assess the improvement in facial symmetry and quality of life among older patients with flaccid facial palsy with the use of a plantaris tendon sling. Methods: A total of 46 patients who had undergone a static reconstruction with the plantaris tendon sling were studied. The surgical technique is detailed emphasizing the tips and pearls. Results: The displacement of the oral commissure was assessed with the FACIAL CLIMA demonstrating a mean elevation of 1.5 ± 0.4 cm and an improvement of 97 ± 7% in the recovery of oral commissure symmetry 2 years after the surgery, whereas the Sunnybrook Facial Grading System showed an improvement of symmetry at rest (-15 ± 5) at 2 years. The Facial Disability Score indicated an improvement of the physical disability (+73.5 ± 14) as well as the social impairment (+21 ± 7) at 1 year postoperatively. Patients were followed for a median of 2 years (range 2-6 years). Conclusions: The use of tendon slings for static facial paralysis reconstruction is a reliable technique with no functional sequelae and good long-term results.

[Facial paralysis sequelae: Long term follow-up revision surgery, redo, continuing care]

Facial paralysis sequelae have an intense psycho-social impact which imposes an optimal care in the long run. The surgical challenges are numerous, and the therapeutic weapons are multiple. We propose an analysis of these treatments by the prism of their pitfalls and their limits. The complications of the main surgical procedures are described as well as the details of the rework necessary to cope with them or to quickly correct the defects. Moreover, the result limits are detailed with suggestions to improve them. Finally, we develop the necessary iterative treatments or new therapeutic proposals that are essential for the long-term care of these patients whose sequelae of facial paralysis evolve with time and aging. The surgery of facial paralysis is not unequivocal. It requires humility, patience and tenacity to support the patient throughout his life.

Facial Nerve Trauma: Clinical Evaluation and Management Strategies

The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles, using a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomical levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, by means of either direct repair, grafting, or nerve transfers, whereas longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury, are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures cannot be overstated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside.

Minimally invasive fascia lata harvesting in ASCR does not produce significant donor site morbidity

PURPOSE

The aim of this study was to prospectively evaluate donor site morbidity in arthroscopic superior capsular reconstruction using a minimally invasive harvested fascia lata autograft.

METHODS

Fifteen consecutive patients underwent arthroscopic superior capsular reconstruction by the senior author using a fascia lata autograft harvested in a minimally invasive fashion. All patients were prospectively evaluated at 1 week, 6 and 18 months postoperatively. The subjects' body mass index, age, actual or previous corticosteroid therapy history and active smoking habits were evaluated. Functional outcomes were assessed by the non-arthritic hip score applied to the harvested and contralateral thighs. Every patient completed standardized subjective satisfaction questionnaires at all evaluations. The median patient age was 65.5 years (range 47-77). Nine patients (60%) were females, and six (40%) were males. One patient (6.7%) was within the normal range of weight, nine (60%) were overweight, four (27%) were obese, and one (6.7%) was extremely obese. Two patients (13%) were active smokers. No patients had an active or previous record of corticosteroid therapy. No patients required postoperative lower limb physical therapy.

RESULTS

In terms of overall and cosmetic satisfaction, most patients reported that they were satisfied or very satisfied at all evaluations, and the proportion of very satisfied patients increased over time (p < 0.001). The harvested thigh's functional scores were 91% (p = 0.003) and 94% (p = 0.008) of the healthy thigh's score at 6 and 18 months, respectively. The complications reported were mild, and their proportions decreased in the first 18 months after surgery (p = 0.04).

CONCLUSIONS

The minimally invasive fascia lata harvesting technique for arthroscopic superior capsular reconstruction leads to donor site satisfactory subjective results and good functional outcomes at 18 months after surgery. According to these findings, donor site morbidity is not a valid argument against the use of this autograft for arthroscopic superior capsular reconstruction.

LEVEL OF EVIDENCE

Case series, level IV.