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Frank E, Bailey T, Lee NH, Cress V, Kam K, Inman JC. Lip Wedge Resection with Orbicularis Oris Plication for Facial Paralysis: A Novel Technique. Plast Surg (Oakv) 2024; 32:64-69. [PMID: 38433804 PMCID: PMC10902477 DOI: 10.1177/22925503221085086] [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: 03/05/2024] Open
Abstract
Introduction: Oral incompetence (OI) following facial nerve injury or sacrifice remains a frustrating problem for patients and clinicians alike. Dynamic procedures for facial paralysis often do not fully address OI and static surgeries are frequently needed. Current static options frequently involved multiple facial incisions. Methods: We describe a novel technique to address OI due to lower division facial nerve paralysis and report outcomes in an initial series of patients. Results: OI symptoms improved in 94% of patients following a single-stage surgery. Revision was required in one patient with subsequent resolution of symptoms. Major complications (19%) included persistent OI, wound dehiscence, and bothersome lip "bulk". Conclusion: Lip wedge resection with orbicular oris plication resolves OI in facial paralysis patients with the added benefit of only a single incision on the face.
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Affiliation(s)
- Ethan Frank
- Loma Linda University Medical Center, CA, USA
| | | | - Nathan H. Lee
- Division of Otolaryngology, University of New Mexico School of Medicine, New Mexico, USA
| | - Victoria Cress
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kelli Kam
- Loma Linda University Medical Center, CA, USA
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2
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Knoedler S, Knoedler L, Hoch CC, Kauke-Navarro M, Kehrer A, Friedman L, Prantl L, Machens HG, Orgill DP, Panayi AC. An ACS-NSQIP Data Analysis of 30-Day Outcomes Following Surgery for Bell's Palsy. J Craniofac Surg 2024; 35:23-28. [PMID: 37695075 PMCID: PMC10841222 DOI: 10.1097/scs.0000000000009739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND There exists a paucity of large-scale, multi-institutional studies that investigate the outcomes of surgery for Bell's palsy (BP). Here, we utilize a large, multi-institutional database to study the risk factors and early-stage outcomes following surgical procedures in BP. METHODS We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008-2019) to identify patients who underwent surgery for the diagnosis of BP. We extracted data on comorbidities and preoperative blood values, and 30-day postoperative outcomes. RESULTS Two hundred fifty-seven patients who underwent surgery for BP symptoms over the 12-year review period were identified. Muscle grafts (n=50; 19%) and fascial grafts (n=48; 19%) accounted for the majority of procedures. The most common comorbidities were hypertension (n=89; 35%) and obesity (n=79; 31%). Complications occurred in 26 (10.1%) cases. Additionally, length of hospital stay was significantly associated with both surgical and medical complications (3.9±4.7 versus 1.5±2.0; P <0.01) and (3.2±3.8 versus 1.4±2.0; P <0.01), respectively. Preoperative creatinine, blood urea nitrogen, and alkaline phosphatase were identified as potential predictors of poor postoperative outcomes. CONCLUSION Based on multi-institutional analysis, complication rates following surgery for BP were found to be overall low and seen to correlate with length of hospital stay. Reoperations and readmissions were the most frequent complications after surgery for BP. The preoperative evaluation of routine laboratory values may help refine patient eligibility and risk stratification. In addition, our findings call for future large-scale prospective studies in the field of facial palsy surgery to further improve the quality of care and optimize perioperative protocols.
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Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Cosima C. Hoch
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Leigh Friedman
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Hans-Guenther Machens
- Department of Plastic and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dennis P. Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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La Padula S, Ponzo M, Lombardi M, de Gregorio L, D'Andrea F, Coiante E, Pensato R, Hersant B, Meningaud JP. Assessment of deep plane facelift combined with fascia lata graft for the static treatment of facial palsy: A preliminary report. J Plast Reconstr Aesthet Surg 2024; 88:457-465. [PMID: 38091689 DOI: 10.1016/j.bjps.2023.11.011] [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: 08/31/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 01/02/2024]
Abstract
Addressing facial palsy (FP) presents intricate challenges in achieving natural expressions. Although free functional muscle transfers (FFMT) offer effective smile restoration, age impacts their efficacy. The optimal FFMT age range of 5-55 years is limited by physical fitness, which extends beyond age boundaries. Unilateral FP demands vary; younger patients require dynamic solutions like FFMT, whereas older individuals prioritize public appearance due to baseline distortion. The aim of this study is to describe and to assess a new static technique combining deep plane facelift and fascia lata graft for FP treatment. We conducted a prospective pilot study enrolling unilateral FP patients aged >55 and declining FFMT. Exclusions encompassed prior FP surgery, recent injections, uncontrolled diabetes cognitive deficits, and patients unable to quit smoking. To evaluate this technique, the Glasgow Benefit Inventory (GBI), along with two objective scales, the Face- and Neck-Lift Objective Photo-Numerical Assessment Scale and the eFACE scale, were used. Interrater reliability and intrarater reliability were assessed. Fifteen patients (mean age: 60.9 years) underwent the procedure. Both static and dynamic symmetry significantly improved (p < 0.05), including check volume and position, oral commissure, and jawline. Notably, eye closure enhancement was observed. GBI scores also significantly increased (p < 0.05). Interrater reliability and intrarater reliability were minimal (p = 0.12 and p = 0.13). This combined approach offers a static FP treatment option, especially for the elderly or FFMT-ineligible patients. The relatively brief procedure yields immediate and satisfactory results, suggesting its potential value in FP management. Further comprehensive studies are encouraged to validate the technique's long-term efficacy and applicability across larger populations.
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Affiliation(s)
- Simone La Padula
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy; Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
| | - Martina Ponzo
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Mariagiovanna Lombardi
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Ludovica de Gregorio
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Francesco D'Andrea
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Edoardo Coiante
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Rosita Pensato
- Department of Plastic and Reconstructive Surgery, Università degli studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Barbara Hersant
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Jean Paul Meningaud
- Department of Plastic, Reconstructive and Maxillo facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
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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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Park JH, Park SO, Chang H. Facial reanimation using free partial latissimus dorsi muscle transfer: Single versus dual innervation method. J Craniomaxillofac Surg 2022; 50:S1010-5182(22)00128-7. [PMID: 36257900 DOI: 10.1016/j.jcms.2022.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/20/2021] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of the present study was to analyze the consequences of partial free latissimus dorsi muscle flap with nerve splitting technique (Partial LD transfer) for facial reanimation and compare outcomes according to innervation method (singer versus dual innervation). Patients with complete unilateral facial paralysis underwent either the single (ipsilateral masseteric nerve only) or dual (ipsilateral masseteric nerve plus contralateral buccal branch of the facial nerve) nerve innervation method for facial reanimation. An assessment was carried out to compare the outcomes between the single and dual innervation. Total of 21 patients were involved in this study. In the single innervation group, 7 out of 8 patients developed a voluntary smile. However, none were able to achieve a spontaneous smile. On the other hand, 9 out of 13 patients developed a voluntary smile and 3 out of 13 patients achieved a spontaneous smile. The mean increases of smile excursion assessed by Emotrics software and Terzis grades showed no significant differences between two groups. Within the limitations of the study it seems that partial LD transfer approach utilizing the dual innervation method has a positive effect on achieving a spontaneous smile and could be a valuable option for facial reanimation.
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Affiliation(s)
- Jun Ho Park
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
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Cabañas Weisz LM, Guarin DL, Townley WA. A Comparative Study of Autologous and Acellular Dermal Matrix Static Cheek Slings in Corrective Surgery for Facial Palsy. Ann Plast Surg 2021; 87:669-675. [PMID: 34117139 DOI: 10.1097/sap.0000000000002933] [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: 11/25/2022]
Abstract
BACKGROUND Facial palsy causes devastating disability due to loss of facial function as well as social and psychological impairment. Cheek slings are a secondary technique that provide static support to the midface. This study aimed to describe our technique and compare a traditional sling material (tensor fascia lata) with a porcine-derived acellular dermal matrix alternative (Strattice). METHODS A 5-year case-control retrospective review of consecutive static cheek slings in a tertiary cancer and facial palsy center was performed. Demographic data, risk factors, and complications were collected and compared. Improvement in static smile position was assessed by Emotrics (Massachusetts Eye and Ear Infirmary, Boston, MA) at 3 months. Long-term sling failure was assessed by need for reoperation. RESULTS The study group comprised 41 patients on which 33 autogenous fascia lata slings and 12 Strattice slings were performed. Medium-term improvement in static smile position was similar between the 2 groups (judged by the Emotrics software), as was complication rate (P = 0.496). Need for revision due to stretching was higher in the Strattice group but did not achieve significance (P = 0.087). Mean follow-up was 38.02 ± 19.17 months. Twelve of 41 patients were deceased at study conclusion. CONCLUSIONS Fascia lata and Strattice slings provide satisfactory results in restoring symmetry at rest and functional oral competence. Our results suggest that Strattice is a safe sling material with an acceptable risk profile and comparable medium-term maintenance of tensile strength to fascia lata, and should be considered where life expectancy, donor site morbidity, and procedure length are important considerations.
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Affiliation(s)
- Laura M Cabañas Weisz
- From the Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; and Department of Plastic Surgery and Burns Unit, Cruces University Hospital, Baracaldo, Spain
| | - Diego L Guarin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - William A Townley
- Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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7
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Total Lower Lip Reconstruction Using the Anterolateral Thigh Donor Site: A Technique to Improve Oral Competence in Thin Patients. Plast Reconstr Surg 2021; 148:688e-690e. [PMID: 34495912 DOI: 10.1097/prs.0000000000008393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Kofler B, Ingels KJAO. [Dynamic procedures for facial nerve reconstruction]. Laryngorhinootologie 2021; 100:738-750. [PMID: 34461655 DOI: 10.1055/a-1376-2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this article the indications and surgical treatment options for patients with facial nerve palsy are discussed. A distinction is made between static and dynamic surgical procedures. Static reconstructions for example are used to restore the eyelid closure function. For smile reconstruction, which is important for the psychosocial life of the patient, dynamic procedures are used. Depending on the duration of the facial nerve paralysis, there are several possibilities to restore the smile. In this work the masseteric branch transposition to the buccal branch, the hypoglossal-facial nerve anastomosis, the Labbé procedure and the gracilis flap as a free muscle transplant are discussed. The surgical procedures are compared and the advantages and disadvantages of the intervention are presented. A spontaneous smile is aimed, this cannot always be achieved. With the masseteric branch transposition to the buccal branch and the Labbé procedure the smile is initially triggered by chewing. A spontaneous smile is possible through cortical adaptation. With the gracilis flap, however, a nerve anastomosis with the contralateral 'healthy' facial nerve is possible, either directly or via a so-called cross facial nerve grafting, whereby a spontaneous smile can be achieved.
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9
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Hontanilla B, Vicente-Ruiz M. Tips and Pearls for Recovering Symmetry after Facial Palsy Using a Tendon Sling: Our 20-Year Experience. Facial Plast Surg Aesthet Med 2021; 23:449-454. [PMID: 33606554 DOI: 10.1089/fpsam.2020.0580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Bernardo Hontanilla
- Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Miriam Vicente-Ruiz
- Department of Plastic and Reconstructive Surgery, Clinica Universidad de Navarra, Pamplona, Spain
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10
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House AE, Han M, Strohl MP, Park AM, Seth R, Knott PD. Temporalis Tendon Transfer/Lengthening Temporalis Myoplasty for Midfacial Static and Dynamic Reanimation After Head and Neck Oncologic Surgery. Facial Plast Surg Aesthet Med 2021; 23:31-35. [DOI: 10.1089/fpsam.2020.0069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Adrian E. House
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mary Han
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Madeleine P. Strohl
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Andrea M. Park
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - P. Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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11
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Vincent AG, Hohman MH, Moe KS. Modiolar rotational cheiloplasty: Addressing the central oval in facial paralysis. Laryngoscope 2018; 129:2262-2268. [PMID: 30592307 DOI: 10.1002/lary.27700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 10/01/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Current static reanimation of the midface fails to provide adequate functional and aesthetic improvement; there is a need for more effective static correction of the ptotic midface. Our objective herein was to describe a novel method of static midface suspension that produces improved functional and aesthetic outcomes compared to previous techniques. Specifically, our goal was to describe the technique of alar and oral commissure repositioning via modiolar rotational cheiloplasty with alar base transposition, and gingivobuccal sulcoplasty. STUDY DESIGN Retrospective case series. METHODS We retrospectively reviewed the results of a series of adult patients desiring surgical intervention for paralysis of the central oval of the face at a tertiary care referral center. We present our technique of modiolar rotational cheiloplasty first with an example case, including subjective outcomes reported by the patient and objective improvements in facial appearance using Massachusetts Eye and Ear Infirmary Facial Assessment by Computer Evaluation Program (MEEI FACE-Gram) software, then demonstrate long-term outcomes from the series. RESULTS Clinically, patients noted subjective improvement in drooling, buccal stasis of food, dysarthria, nasal obstruction, and overall appearance. Patients with significant atrophy and lateral displacement of the lower lip underwent concomitant wedge resection, which further improved the symmetry and position of the lips. The MEEI FACE-Gram software demonstrated objective improvement in symmetry of smile and position of the philtrum and nasal base in an example case. CONCLUSIONS Modiolar rotational cheiloplasty with alar base transposition is an effective and efficient static procedure for midface palsy that improves both function and appearance. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2262-2268, 2019.
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Affiliation(s)
- Aurora G Vincent
- the Department of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Marc H Hohman
- the Department of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Kris S Moe
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
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Guntinas-Lichius O, Silver CE, Thielker J, Bernal-Sprekelsen M, Bradford CR, De Bree R, Kowalski LP, Olsen KD, Quer M, Rinaldo A, Rodrigo JR, Sanabria A, Shaha AR, Takes RP, Vander Poorten V, Zbären P, Ferlito A. Management of the facial nerve in parotid cancer: preservation or resection and reconstruction. Eur Arch Otorhinolaryngol 2018; 275:2615-2626. [PMID: 30267218 DOI: 10.1007/s00405-018-5154-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/26/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Management of the facial nerve is instrumental in the surgical treatment of parotid cancer. METHODS A literature search was conducted using PubMed and ScienceDirect database. A total of 195 articles were finally included into the analysis, based on relevance, scientific evidence and actuality. RESULTS In the majority of cases the facial nerve is not involved by tumor. In these cases, identification and preservation of the nerve, in addition to complete tumor removal, are essential for successful surgery. When the nerve is infiltrated by tumor, the affected portion of the nerve must be resected as part of radical parotidectomy. Primary nerve reconstruction or other reanimation techniques give the best long-term functional and cosmetic results. A comprehensive diagnostic evaluation with current imaging and electrophysiological studies will provide the surgeon with the best knowledge of the relationship of the facial nerve to the tumor. Several standardized methods are helpful in finding, dissecting and preserving the nerve during parotid cancer surgery. When radical parotidectomy is indicated, the initial diagnostic work-up can assist in defining the need for adjuvant postoperative therapy and facial reanimation. The aim of rehabilitation is to restore tone, symmetry, and movement to the paralyzed face. CONCLUSIONS The surgical management of facial paralysis has undergone many improvements in recent years. This review gives an overview of recent advances in the diagnostic work-up, surgical techniques and any necessary rehabilitation of the facial nerve in parotid cancer surgery.
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Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Facial Nerve Center, Jena University Hospital, Jena, Germany.
- European Salivary Gland Society, Geneva, Switzerland.
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, USA
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
| | | | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, USA
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luis P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Miquel Quer
- European Salivary Gland Society, Geneva, Switzerland
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Juan R Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias and Instituto Universitario de Oncología del Principado de Asturias, CIBERONC, Oviedo, Spain
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Clinica Vida, Universidad de Antioquia, Medellín, Colombia
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent Vander Poorten
- European Salivary Gland Society, Geneva, Switzerland
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Peter Zbären
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Berne, Switzerland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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14
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Müller B, Volk GF, Guntinas-Lichius O. [Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma]. HNO 2016; 65:724-734. [PMID: 27072637 DOI: 10.1007/s00106-016-0125-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients' quality of life. OBJECTIVE This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo. METHODS The present review describes a PubMed-based search of the literature of the past 10 years. RESULTS There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control. CONCLUSION There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.
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Affiliation(s)
- B Müller
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland
| | - G F Volk
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland
| | - O Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland.
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15
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Irvine LE, Larian B, Azizzadeh B. Locoregional Parotid Reconstruction. Otolaryngol Clin North Am 2016; 49:435-46. [DOI: 10.1016/j.otc.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Abstract
Facial nerve paralysis is a devastating condition arising from several causes with severe functional and psychological consequences. Given the complexity of the disease process, management involves a multispecialty, team-oriented approach. This article provides a systematic approach in addressing each specific sequela of this complex problem.
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Affiliation(s)
- Ali Razfar
- Division of Facial Plastic and Reconstructive Surgery, Center for Facial Cosmetic Surgery, University of Michigan School of Medicine, 19900 Haggerty Hwy, Livonia, MI 48152, USA
| | - Matthew K Lee
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, CA, 94305 USA
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, 9401 Wilshire Blvd., Suite 650, Beverly Hills, CA 90212, USA
| | - Babak Azizzadeh
- Department of Head and Neck Surgery, Center for Advanced Facial Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles, 9401 Wilshire Blvd., Suite 650, Beverly Hills, CA 90212, USA.
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17
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18
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Kejner AE, Rosenthal EL. Lower facial reanimation techniques following cancer resection and free flap reconstruction. Laryngoscope 2016; 126:1990-4. [PMID: 26808491 DOI: 10.1002/lary.25852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 11/22/2015] [Accepted: 12/07/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate outcomes of the standard static sling and orthodromic temporalis tendon transfer reanimation for facial nerve paralysis. STUDY DESIGN Retrospective case series at a tertiary care hospital of head and neck cancer patients with facial nerve palsy secondary to malignancy or resection. METHODS From 2004 to 2014, patients undergoing resection of malignancy that involved facial nerve palsy requiring facial reanimation were identified. All procedures were performed by the senior author (e.l.r.). Demographics, methods, revision rates, combination with other procedures, and complications were evaluated. RESULTS A total of 77 patients underwent 92 procedures, with two patients requiring more than one revision, for a total of 20 revisions. Average time to revision was 9 months. Age, sex, race, side of repair, paralysis prior to procedure, sling type or method, timing of procedure, and radiation therapy were not significantly different between those requiring revision and those who did not. There was no difference in complications between patients who received radiation and those who did not (P = .5), nor between static versus orthodromic temporalis muscle transfer (P = .5). Complication rate was low at 5.4%. CONCLUSIONS Sling procedures can be successfully performed in patients with facial nerve palsy secondary to cancer resection with radiation therapy, with a low revision rate and few complications. LEVEL OF EVIDENCE 4 Laryngoscope, 126:1990-1994, 2016.
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Affiliation(s)
- Alexandra E Kejner
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, and the Department of Medicine, Division of Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Eben L Rosenthal
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, and the Department of Medicine, Division of Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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19
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Suspension statique commissurale labiale par fascia lata en traitement palliatif de la paralysie faciale. Un résultat stable dans le temps. ANN CHIR PLAST ESTH 2015; 60:442-7. [DOI: 10.1016/j.anplas.2015.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
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20
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Henn D, Nissen A, Menon N, Lee GK. Restoration of oral competence in double free flap reconstructions of massive lower facial defects with fascia lata slings - Case series and review of the literature. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2015; 2:67-72. [PMID: 27252975 PMCID: PMC4793788 DOI: 10.3109/23320885.2015.1100967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/23/2015] [Indexed: 11/20/2022]
Abstract
Restoration of adequate oral competence is especially challenging in double free flap reconstructions of massive head and neck defects resulting from composite resections. Our report illustrates that oral competence in double free flap reconstructions of extensive oromandibular defects can be successfully restored with tensor fascia lata suspension slings.
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Affiliation(s)
- Dominic Henn
- Stanford Division of Plastic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Andreas Nissen
- Stanford Division of Plastic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Nathan Menon
- Stanford Division of Plastic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Gordon K Lee
- Stanford Division of Plastic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
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