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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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Noguera Tomás J, González Otero T. Facial Nerve Reconstruction after Oncologic Resections: Grafts and Double Innervation. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:1-8. [PMID: 36754502 DOI: 10.1016/j.cxom.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Jorge Noguera Tomás
- Division of Facial Palsy and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery. Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid 28046, Spain.
| | - Teresa González Otero
- Division of Facial Palsy and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery. Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid 28046, Spain
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Fliss E, Yanko R, Zaretski A, Tulchinsky R, Arad E, Kedar DJ, Fliss DM, Gur E. Facial Nerve Repair following Acute Nerve Injury. Arch Plast Surg 2022; 49:501-509. [PMID: 35919546 PMCID: PMC9340172 DOI: 10.1055/s-0042-1751105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background
Acute facial nerve iatrogenic or traumatic injury warrants rapid management with the goal of reestablishing nerve continuity within 72 hours. However, reconstructive efforts should be performed up to 12 months from the time of injury since facial musculature may still be viable and thus facial tone and function may be salvaged.
Methods
Data of all patients who underwent facial nerve repair following iatrogenic or traumatic injury were retrospectively collected and assessed. Paralysis etiology, demographics, operative data, postoperative course, and outcome were examined.
Results
Twenty patients underwent facial nerve repair during the years 2004 to 2019. Data were available for 16 of them. Iatrogenic injury was the common category (
n
= 13, 81%) with parotidectomy due to primary parotid gland malignancy being the common surgery (
n
= 7, 44%). Nerve repair was most commonly performed during the first 72 hours of injury (
n
= 12, 75%) and most of the patients underwent nerve graft repair (
n
= 15, 94%). Outcome was available for 12 patients, all of which remained with some degree of facial paresis. Six patients suffered from complete facial paralysis (50%) and three underwent secondary facial reanimation (25%). There were no major operative or postoperative complications.
Conclusion
Iatrogenic and traumatic facial nerve injuries are common etiologies of acquired facial paralysis. In such cases, immediate repair should be performed. For patients presenting with facial paralysis following previous surgery or trauma, nerve repair should be considered up to at least 6 months of injury. Longstanding paralysis is best treated with standard facial reanimation procedures.
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Affiliation(s)
- Ehud Fliss
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ravit Yanko
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arik Zaretski
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roei Tulchinsky
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Arad
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel J Kedar
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan M Fliss
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Affiliated Tel-Aviv University, Tel Aviv, Israel
| | - Eyal Gur
- Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Fabiana A, Carlotta L, Dimitri R, Federico B, Valeria B, Federico B. Minimally invasive temporalis tendon transposition and upper lid lipofilling for immediate and secondary facial reanimation in patients treated for malignant tumors of the parotid gland. J Craniomaxillofac Surg 2022; 50:419-425. [DOI: 10.1016/j.jcms.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/21/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022] Open
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Mangialardi ML, Honart JF, Qassemyar Q, Guyon A, Li SS, Benmoussa N, Beldarida V, Temam S, Kolb F. Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap. J Reconstr Microsurg 2020; 37:282-291. [PMID: 33142333 DOI: 10.1055/s-0040-1719050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cancer involving the parotid gland region may originates from parotid parenchyma itself or from locoregional organs and in rare cases, the facial nerve (FN) has to be sacrificed during tumor resection. In these cases, cancer extension often goes beyond the parotid compartment and requires extensive local resection responsible for complex multitissular defects. The goals of reconstruction may be summarized in the following two components: (1) restoration of the volumetric tissue defect and (2) FN reconstruction. The aim of this study is to describe our surgical technique and our cosmetic results using the chimeric scapulodorsal vascularized nerve (SDVN) flap to reconstruct extensive maxillofacial defects associated with FN sacrifice. METHODS All patients undergone an extensive maxillofacial resection with FN sacrifice and primarily reconstructed with a SDVN flap were included. We classified the maxillofacial defects into six groups based on the type of resection. Intraoperative data including flap composition, topography of FN injury, length of nerve gap, and number of nervous anastomosis were recorded. RESULTS Twenty-nine patients were included. Mean follow-up was 38.7 months. The harvested flaps included the SDVN combined with different components according to the defect group. A satisfactory volumetric restoration was obtained in 93% of cases. The mean number of distal nervous anastomosis was 4.5. The length of the vascularized grafted nerve ranged from 7 to 10 cm. CONCLUSION This is largest series presented in literature on primary FN reconstruction utilizing a vascularized nerve graft. We believe that the chimeric SDVN flap should be highly considered for these cases due to its versatility. The surgeon is able to use single donor site available soft and hard tissues components along with a vascular motor nerve graft, which offers a great length and number of distal branches, and easily matches with the extracranial FN trunk and its peripheral ramifications.
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Affiliation(s)
- Maria L Mangialardi
- Department of Plastic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Fracois Honart
- Department of Plastic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Quentin Qassemyar
- Faculty of Medicine, Sorbonne Université, Paris, France.,Department of Plastic, Reconstructive and Burn Surgery, Hopital Armand-Trousseau, Paris, France
| | - Alice Guyon
- Department of Plastic Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Sean S Li
- Department of Plastic Surgery, UCSD, San Diego, California
| | - Nadia Benmoussa
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Vincent Beldarida
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, Villejuif, France
| | - Frédéric Kolb
- Department of Plastic Surgery, Gustave Roussy Cancer Campus, Villejuif, France.,Department of Plastic Surgery, UCSD, San Diego, California
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Orbicularis Oculi Muscle Reinnervation Confers Corneal Protective Advantages over Static Interventions Alone in the Subacute Facial Palsy Patient. Plast Reconstr Surg 2020; 145:791-801. [PMID: 32097327 DOI: 10.1097/prs.0000000000006608] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Corneal protection is a priority in flaccid facial palsy patients. Denervation of the orbicularis oculi muscle results in weak palpebral closure and predisposes patients to severe corneal sequelae. While periorbital static procedures enhance corneal coverage in repose, voluntary closure is only regained through dynamic reinnervation of the muscle. This study aims to elucidate the added effect of dynamic reinnervation of the orbicularis oculi muscle on long-term corneal integrity as well as on dynamic closure of the palpebral aperture. METHODS Retrospective review was performed on two groups of complete palsy patients: those who received solely periorbital static procedures and those who underwent concomitant orbicularis oculi muscle reinnervation and static lid procedures. Only patients with complete ophthalmic examinations were included. Corneal punctate epithelial erosions in addition to static and dynamic palpebral measurements were serially assessed preoperatively and postoperatively. RESULTS Of 272 facial palsy patients, 26 fit the inclusion criteria. Eleven patients underwent combined muscle reinnervation involving facial-to-masseteric nerve coaptation in addition to static eye procedures, and 15 patients underwent solely static interventions. Analysis revealed a 65.3 percent lower mean punctate epithelial erosion score in reinnervation patients as compared with static patients when evaluated at more than 9 months postoperatively (p < 0.01). Reinnervation patients were also found to have 25.3 percent greater palpebral aperture closure (p < 0.05) and 32.8 percent higher closure velocity (p < 0.01) compared with static patients. CONCLUSION In patients with subacute facial palsy, dynamic reanimation of the orbicularis oculi muscle with concomitant static interventions provides lasting corneal protection not seen in patients who receive solely static interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery. Eur Arch Otorhinolaryngol 2020; 277:2315-2318. [PMID: 32215738 DOI: 10.1007/s00405-020-05931-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Unexpected facial nerve damage can occur during parotid gland tumor surgery. We sought to determine the incidence and treatment outcomes of unexpected facial nerve injuries in patients with parotid gland tumor surgery. METHODS We retrospectively enrolled in this study five patients, who underwent facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery January 2012-August 2019. RESULTS There were five patients (0.008%) with unexpected facial nerve injuries during the parotid gland tumor surgery of 577 patients in our hospital for approximately 8 years. The most common injury site of facial nerve was the marginal mandibular branch (n = 3), followed by the buccal branch (n = 1), and the cervicofacial division (n = 1). In the case of unexpected facial nerve damage, our treatment is immediate primary neurorrhaphy and steroid treatment. Three patients of five recovered and two did not worsen immediately after surgery. CONCLUSION Unexpected facial nerve injury during parotid gland tumor surgery is extremely unfortunate. In this case, immediate primary neurorrhaphy and systemic steroids are recommended to restore facial function and reduce cosmetic deficits.
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Biglioli F, Allevi F, Rabbiosi D, Cupello S, Battista VMA, Saibene AM, Colletti G. Triple innervation for re-animation of recent facial paralysis. J Craniomaxillofac Surg 2018; 46:851-857. [DOI: 10.1016/j.jcms.2018.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 02/10/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022] Open
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9
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Biglioli F, Bolognesi F, Allevi F, Rabbiosi D, Cupello S, Previtera A, Lozza A, Battista VMA, Marchetti C. Mixed facial reanimation technique to treat paralysis in medium-term cases. J Craniomaxillofac Surg 2018; 46:868-874. [PMID: 29625866 DOI: 10.1016/j.jcms.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 02/20/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022] Open
Abstract
Recent facial paralyses, in which fibrillations of the mimetic muscles are still detectable by electromyography (EMG), allow facial reanimation based on giving new neural stimuli to musculature. However, if more time has elapsed, mimetic muscles can undergo irreversible atrophy, and providing a new neural stimulus is simply not effective. In these cases function is provided by transferring free flaps into the face or transposing masticatory muscles to reinstitute major movements, such as eyelid closure and smiling. In a small number of cases, patients affected by paralysis are referred late - more than 18 months after onset. In these cases, reinnervating the musculature carries a high risk of failure because some or all of the mimetic muscles may atrophy irreversibly while axonal ingrowth is taking place. A mixed reanimation technique to address this involves a neurorrhaphy between the masseteric nerve and a facial nerve branch for the orbicularis oculi, to ensure a stronger innervation to that muscle, associated with the transposition of the temporalis muscle to the nasiolabial sulcus. This gives good symmetry in the rest of the midface, while smiling movement is achievable, but not guaranteed. This one-time facial reanimation is particularly indicated for those who refuse major free-flap surgery or when that may be risky, as in previously operated and irradiated fields. More extensive procedures based on utilizing a free flap to recover smiling, while adding a cross-face nerve graft to restore blinking, may be proposed for motivated patients. Between 2010 and 2015, five patients affected by complete unilateral facial palsy underwent this technique in the Maxillofacial Surgery Department, San Paolo Hospital (Milan, Italy). Symmetry of the middle-third of the face at rest and recovery of smiling was quite good. Complete voluntary eyelid closure was obtained in all cases. Combining temporalis flap rotation and a masseteric-to-orbicularis-oculi-facial-nerve branch neurorrhaphy seems to be a valid solution for those medium-term referred patients.
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Affiliation(s)
- Federico Biglioli
- Maxillo-Facial Surgery Department. (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Federico Bolognesi
- Maxillo-Facial Surgery Department. (Head: Professor C. Marchetti), Sant'Orsola-Malpighi Hospital, University of Bologna, via Albertoni 15, Bologna, Italy
| | - Fabiana Allevi
- Maxillo-Facial Surgery Department. (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy.
| | - Dimitri Rabbiosi
- Maxillo-Facial Surgery Department. (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Silvia Cupello
- Rehabilitation Medicine Department. (Head: Professor A. Privitera), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Antonino Previtera
- Rehabilitation Medicine Department. (Head: Professor A. Privitera), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Alessandro Lozza
- Service of Neurophysiopathology - National Neurological Institute C. Mondino. (Head: Dr R. Manni), via Mondino 2, Pavia, Italy
| | - Valeria M A Battista
- Maxillo-Facial Surgery Department. (Head: Professor F. Biglioli), San Paolo Hospital, University of Milan, via di Rudini' 8, Milan, Italy
| | - Claudio Marchetti
- Maxillo-Facial Surgery Department. (Head: Professor C. Marchetti), Sant'Orsola-Malpighi Hospital, University of Bologna, via Albertoni 15, Bologna, Italy
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Biglioli F, Kutanovaite O, Rabbiosi D, Colletti G, Mohammed MAS, Saibene AM, Cupello S, Privitera A, Battista VMA, Lozza A, Allevi F. Surgical treatment of synkinesis between smiling and eyelid closure. J Craniomaxillofac Surg 2017; 45:1996-2001. [PMID: 29033208 DOI: 10.1016/j.jcms.2017.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/04/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022] Open
Abstract
Synkinetic movements are common among patients with incomplete recovery from facial palsy, with reported rates ranging from 9.1% to almost 100%. The authors propose the separation of the neural stimulus of the orbicularis oculi from that of the zygomatic muscular complex to treat eyelid closure/smiling synkinesis. This technique, associated with an anastomosis between the masseteric nerve and a central branch of the facial nerve, as well as with the use of a cross-facial nerve graft, resolves most of the spasms of the midface musculature, leading to a more relaxed tone when the mimic muscle is at rest and enhancing muscle excursion during voluntary and spontaneous smiling. Between 2011 and 2016, 18 patients affected by segmental paresis of the middle of the face underwent surgical treatment at the Maxillofacial Surgery Department of the San Paolo Hospital (Milan, Italy). Of these patients, 72.22% of cases with hypertone obtained partial to complete relaxation. Synkinesis was completely resolved in 83.33% of cases, and a significant improvement in facial movement was achieved in all patients. Neurorrhaphy of the masseteric nerve and the central branch of the facial nerve appears to produce favorable results. These initial data should be confirmed by further studies.
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Affiliation(s)
- Federico Biglioli
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Otilija Kutanovaite
- Maxillo-Facial Surgery Department, Vilnius University Hospital Zalgiris Clinics, Zalgirio, Vilnius, Lithuania
| | - Dimitri Rabbiosi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giacomo Colletti
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Alberto M Saibene
- Otolaryngology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Silvia Cupello
- Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonino Privitera
- Rehabilitation Medicine Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Valeria M A Battista
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessandro Lozza
- Service of Neurophysiopathology - National Neurological Institute C. Mondino, Pavia, Italy
| | - Fabiana Allevi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
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