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Sun Q, Li X, Zhu Z, Xiang X, Zhang T. Dynamic Repair Surgery for Late-Stage Facial Paralysis: Advances in Restoring Movement and Function. J Clin Med 2024; 13:4955. [PMID: 39201095 PMCID: PMC11355731 DOI: 10.3390/jcm13164955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 09/02/2024] Open
Abstract
Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included "dynamic repair", "late-stage facial paralysis", "nerve and muscle transplantation", "muscle flap", and "tendon transposition". Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies.
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Affiliation(s)
- Qing Sun
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China
| | - Xing Li
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
| | - Zhihui Zhu
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
| | - Xiting Xiang
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
| | - Tao Zhang
- Division of Maxillofacial Surgery, Department of Stomatology, Peking Union Medical College Hospital & Chinese Academy of Medical Science, Beijing 100730, China; (Q.S.); (X.L.); (Z.Z.); (X.X.)
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2
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González-Woge OR, Salazar Trujillo BA, Elnecavé Olaiz A, González-Woge MÁ, Aragón Luna V, Loreto FS, González-Navarro M. Electrophysiological Changes in Patients with Postoperative Cross-facial Nerve Graft in a Tertiary Care Center. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5973. [PMID: 39015355 PMCID: PMC11250458 DOI: 10.1097/gox.0000000000005973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/16/2024] [Indexed: 07/18/2024]
Abstract
Background Facial nerve palsy is a multifaceted pathology that causes facial disfigurement, affecting eye closure, speech articulation, oral competence, and emotional expression, with functional, aesthetic, and psychological consequences. Standardized electrophysiological tests, such as electroneurography and electromyography, allow an objective evaluation of the functional state of the nerve. Here, we aimed to compare and correlate clinical findings with electromyography in patients with facial nerve palsy, before and after facial nerve reanimation with cross-facial nerve grafts. Methods Eight patients with traumatic or nontraumatic facial paralysis with complete clinical records who underwent surgical reanimation of facial nerve with cross nerve grafts. Results The median time from diagnosis to treatment was 173 days (interquartile range = 222). Outcomes were evaluated using standard clinical scales (House-Brackmann, Sunnybrook, and eFACE) and electromyography. The median time for postoperative outcome evaluation was 768 days (interquartile range = 1053). A statistically significant difference was found between pre- and postoperative outcomes according to eFACE (Δ median = 13, P = 0.003), House-Brackmann (Δ median = -2, P = 0.008), and electromyography (Δ mean = 855, P = 0.005). A positive correlation between electromyography and clinical evaluation with eFACE was observed (r = 0.751, 95% confidence interval = 0.174-0.944, P = 0.019). Conclusions Our results suggest that cross nerve grafts are associated with clinical and electromyographic improvement of the paralyzed face. Electromyography and eFACE scores validate the reliability of eFACE scale for measuring postoperative outcomes. We suggest postoperative electromyography as an objective measure of postoperative evaluation in patients with a delay in improvement at 6-9 months.
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Affiliation(s)
- Osmar R. González-Woge
- From the Division of Otorhinolaryngology Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Bruno A. Salazar Trujillo
- Division of Plastic Surgery, National Center for Reserch and Care of Burns, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Alejandro Elnecavé Olaiz
- From the Division of Otorhinolaryngology Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | - Victoria Aragón Luna
- School of Medicine Instituto Tecnológico de Estudios Superiores de Monterrey, Mexico City, Mexico
| | - Francisca S. Loreto
- Division of Peripheral Nerve Injury Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Mauricio González-Navarro
- From the Division of Otorhinolaryngology Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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Valencia-Sanchez BA, Li RJ, Wax MK, Ng J, Andersen PE, Loyo M. Masseteric Nerve Transfer for Facial Paralysis Secondary to Parotid Malignancy: A Retrospective Case Series. Facial Plast Surg Aesthet Med 2024; 26:103-108. [PMID: 37428610 DOI: 10.1089/fpsam.2023.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
Background: The objective outcomes of masseteric nerve transfer in the setting of parotid malignancy are unclear. Objective: To measure objective facial reanimation outcomes of masseteric nerve transfer in patients with parotid malignancy who underwent parotidectomy with facial nerve resection. Materials and Methods: Retrospective review of patients who underwent masseteric nerve transfer for facial paralysis secondary to parotid malignancy was carried out at a tertiary referral hospital from August 2017 to November 2021. Objective facial reanimation outcomes were analyzed using Emotrics. Minimal follow-up of 6 months was required for inclusion. Results: Eight patients (five males) with a median age of 75.5 years (range 53-91) met inclusion criteria. Fifty percent had metastatic squamous cell carcinoma, and 50% had primary parotid malignancy. Five patients underwent concomitant cancer resection with facial nerve reconstruction. Seven patients received postoperative adjuvant radiotherapy. After reinnervation, patients had improved oral commissure excursion (from 1.51 mm ±1.27 to 3.77 mm ±1.81; p < 0.01) and facial symmetry during smile. Conclusion: In this study, masseteric nerve transfer enhanced oral commissure excursion and facial symmetry during smile in patients with parotid malignancy and facial nerve resection.
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Affiliation(s)
- Bastien A Valencia-Sanchez
- School of Medicine and Health Sciences TecSalud, Monterrey Institute of Technology and Higher Education, Monterrey, Nuevo León, Mexico
| | - Ryan J Li
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark K Wax
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - John Ng
- Department of Ophthalmology, Oregon Health & Science Casey Eye Institute, Portland, Oregon, USA
| | - Peter E Andersen
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Myriam Loyo
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Bengur FB, Komatsu C, Fedor CN, Loder S, Baker JS, Totwani A, Irgebay Z, Nerone WV, Solari MG, Marra KG. Biodegradable Nerve Guide with Glial Cell Line-Derived Neurotrophic Factor Improves Recovery After Facial Nerve Injury in Rats. Facial Plast Surg Aesthet Med 2023; 25:478-486. [PMID: 36877591 PMCID: PMC10664574 DOI: 10.1089/fpsam.2022.0346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Background: Bioengineered nerve guides with glial cell line-derived neurotrophic factor (GDNF) support recovery after facial nerve injury by acting as regenerative scaffolds. Objective: To compare functional, electrophysiological, and histological outcomes after repair of rat facial nerve transection in control, empty nerve guide, and nerve guide with GDNF conditions. Methods: Rats underwent transection and primary repair of the buccal branch of the facial nerve and were divided into (1) transection and repair only, (2) transection and repair augmented with empty guide, (3) transection and repair augmented with GDNF-guide groups. Weekly measurements of the whisking movements were recorded. At 12 weeks, compound muscle action potentials (CMAPs) at the whisker pad were assessed, and samples were collected for histomorphometric analysis. Results: Rats in GDNF-guide group displayed the earliest peak in normalized whisking amplitude. CMAPs were significantly higher after GDNF-guide placement. Mean fiber surface area of the target muscle, axonal count of the injured branch, and the number of Schwann cells were highest with GDNF guides. Conclusion: The biodegradable nerve guide containing double-walled GDNF microspheres enhanced recovery after facial nerve transection and primary repair.
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Affiliation(s)
- Fuat Baris Bengur
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chiaki Komatsu
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caroline Nadia Fedor
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn Loder
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jocelyn S. Baker
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aanchal Totwani
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zhazira Irgebay
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - W. Vincent Nerone
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mario G. Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kacey G. Marra
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Cheng L, Li XL, Ying Y, Du SH, Zhang XD, Guo W, Mi SQ, Zhao JP. Should acupuncture therapy be used for acute facial paralysis? A protocol for systematic review. Syst Rev 2023; 12:43. [PMID: 36918972 PMCID: PMC10015935 DOI: 10.1186/s13643-023-02194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/16/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Peripheral facial paralysis (PFP) results in functional disorder and social dysfunction, when it is under a severe condition at onset, long-term poor outcomes do occur. Different acupuncture methods have been reported to be potentially effective for shortening the disease course and reducing the occurrence of sequelae when they are applied at an early stage. Neuro edema is a common pathological feature in the acute phase, and many clinical studies have suggested its effect of reducing facial nerve edema. It is of value to estimate the effectiveness and safety of acupuncture treatment at the onset, and to assess the most suitable acupuncture method for the acute period. METHODS AND ANALYSIS All the RCTs and quasi-RCTs on acupuncture therapy for patients who is during acute stage of PFP will be included. The recovery rate of facial function, the time it takes to restore facial function and the odds of sequelae occurring will be the key parts we focus on. Psychological well-being and quality of life will also be evaluated. Literature searching will be conducted until December 31th, 2022 from eight databases systematically. Two reviewers will screen the literature and extract the data independently. RevMan software will be used for data analysis, and the version 2 of the Cochrane risk-of-bias tool (RoB 2) will be used to assess the certainty of evidence. Forest plots and summary findings will be generated. If data permits, a meta-analysis will be conducted. ETHICS AND DISSEMINATION Since this study will not involve clinical treatment of patients, ethics approval is not required. The result of this study will be submitted to a peer-reviewed journal for publication and as a proposal for clinical practice and further study on acupuncture treatment at the early stage of PFP. DISCUSSION This review will summarize the evidence on the different type of acupuncture therapy for acute Bell's palsy and Ramsay-Hunt syndrome. We anticipate that it would be safe and effective when applied to the acute phase of PFP, and some specific suitable acupuncture methods would be found resulting from this review. SYSTEMATIC REVIEW REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO) number CRD42020205127.
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Affiliation(s)
- Lu Cheng
- Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Xiao-Lin Li
- Dongfang Hospital Beijing University of Chinese Medicine, No. 6 Fangxingyuan, Fengtai District, Beijing, China
| | - Yi Ying
- Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Shi-Hao Du
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xu-Dong Zhang
- Department of Traditional Chinese Medicine, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Wei Guo
- Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, No. 5 Haiyuncang, Dongcheng District, Beijing, China
| | - Shu-Qi Mi
- College of Acupuncture-Moxibustion and Tuina, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Luquan District, Shijiazhuang, Hebei Province, China
| | - Ji-Ping Zhao
- Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, No. 5 Haiyuncang, Dongcheng District, Beijing, China.
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Efficacy and safety of electric acupuncture in treatment of intractable facial paralysis: A protocol for systematic review and meta-analysis. PLoS One 2022; 17:e0278509. [PMID: 36454980 PMCID: PMC9714806 DOI: 10.1371/journal.pone.0278509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Facial paralysis is a common clinical disease, it was named intractable facial paralysis when the clinical course more than 2 months. Intractable facial paralysis will produce anxiety and depression, which will seriously affect patients' life and work. Electric acupuncture has been widely used in the treatment of intractable facial paralysis. However, the results of clinical studies on the efficacy and safety have been inconsistent. This study aims to evaluate the efficacy and safety of electric acupuncture for intractable facial paralysis patients by systematic review and meta-analysis, so as to provide clinical decision-making based on evidence-based medicine. METHODS The following databases will be searched by electronic methods: PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database, Wan-fang Data and Chinese Biomedical Database. All of them will be retrieved from the establishment date of the electronic database to March 2022, all included studies will be evaluated risk of bias by the Cochrane Handbook. The total effective rate will be the primary outcome. The systematic review will be conducted with the use of the RevMan5.3 software in this study. RESULTS This study will obtain efficacy and safety of electric acupuncture for the treatment of intractable facial paralysis. DISCUSSION This study will provide clinical decision-making based on evidence-based medicine that whether electric acupuncture could be used to treat intractable facial paralysis, and when and how it might be more effective and safety. It will help standardize electric acupuncture treatment strategies for intractable facial paralysis. PROSPERO REGISTRATION NUMBER CRD42021278541.
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Modified McLaughlin's Dynamic Muscle Support in the 21st Century? A Retrospective Study With a Prospective Follow-Up Analysis for Patients With Long Standing Facial Paralysis. J Craniofac Surg 2022; 33:e594-e598. [PMID: 35765144 DOI: 10.1097/scs.0000000000008668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/06/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Facial nerve paralysis can dramatically affect the life of a patient as it leads to significant alterations of the facial symmetry and functional limitations. Various methods exist including free neuromuscular flaps to reanimate patients suffering from uni- or even bilateral facial nerve paralysis. The more than 60-year-old technique described by McLaughlin continues to offer an alternative with distinct advantages for the individual patient. The present study aimed to evaluate clinical outcome and satisfaction of patients treated with a modified McLaughlin's Dynamic Muscle Support. MATERIALS AND METHODS A total of 13 patients (mean age of 58.4 years) who received a modified McLaughlin's Dynamic Muscle Support due to uni- or bilateral long-standing facial paralysis were included. Medical records were reviewed retrospectively, and patients were contacted for additional follow-up. Patients who agreed to participate in the follow-up study were asked to answer a self-developed questionnaire. RESULTS In all patients, a rehabilitation of facial symmetry with an improvement of the mimic expression could be achieved. Mean length of inpatient stay was 6.5 days and average duration of surgery was 121 minutes. No surgical site infection occurred. Mean follow-up was 23 months. Most of the patients were fully satisfied with the result and could experience functional and esthetic improvement.Patients who participated in the prospective follow-up study were very satisfied with the esthetic result and functional outcome. CONCLUSIONS Even in times of advanced microsurgical techniques, McLaughlin's Dynamic Muscle Support appears to be a good alternative for the successful treatment of long-standing facial paralysis.
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Hidaka T, Ogawa K, Tomioka Y, Yoshii K, Tomio J, Okazaki M. Change in Eyelid Closure in Spontaneous Blinking After Static Eyelid Reconstruction Surgery for Patients With Facial Paralysis. Ann Plast Surg 2022; 88:303-307. [PMID: 34510078 DOI: 10.1097/sap.0000000000002983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Static eyelid reconstruction surgery, such as ptosis repair or brow lift, is widely performed for patients with facial paralysis. Complications include exposure keratitis and possible vision loss mainly due to eyelid closure impairment in spontaneous blinking. However, no quantitative evaluation data has been available regarding postoperative closure deterioration. METHODS To elucidate factors associated with postoperative eyelid closure impairment, a retrospective study was performed for 51 patients who underwent an initial static eyelid reconstruction surgery from October 2017 to August 2020. A static eyelid reconstruction surgery consisted of either 1 or more of the following: (1) levator advancement, (2) brow lift, and (3) orbicularis oculi myectomy. Eyelid closure ratios (0% for complete closure impairment and 100% for perfect closure) at spontaneous blinks were measured on 6 occasions: before operation and at postoperative 1, 3, 6, 9, and 12 months. Comparison was made between preoperative and postoperative values by using mixed-effects model. RESULTS Overall, average closure ratio was significantly increased. However, 10 patients had >10% closure ratio decreases at at least 1 postoperative measurement point, and all those patients had undergone brow lift procedures. CONCLUSIONS Although eyelid closure at spontaneous blinks may, contrary to assumptions, generally be improved after static eyelid reconstruction surgery, brow lift was suggested to be associated with eyelid closure impairment.
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Affiliation(s)
- Takeaki Hidaka
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Kazuya Ogawa
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Yoko Tomioka
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Kengo Yoshii
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Jun Tomio
- Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo Japan
| | - Mutsumi Okazaki
- From the Departments of Plastic, Reconstructive and Aesthetic Surgery
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Hidaka T, Ogawa K, Tomioka Y, Yoshii K, Okazaki M. The Impact of Brow-Lift on Eyelid Closure in Patients with Facial Paralysis. Facial Plast Surg Aesthet Med 2021; 24:385-390. [PMID: 34861113 DOI: 10.1089/fpsam.2021.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Brow-lift-induced eyelid closure impairment is commonly discussed in patients with facial paralysis but has not been well quantified. Objective: To measure the limitation of eyelid closure in patients with facial paralysis using simulated brow-lift with tape. Design, Setting, and Participants: For 50 facial paralysis patients with brow ptosis who visited our institution from October 2017 to December 2020, brow-lift was simulated by elevating the paralyzed-side brow using surgical tape, and closed palpebral fissure heights in spontaneous blinking were measured using high-speed videography. The effect of several factors on the change in closed palpebral fissure height was evaluated by multiple linear regression analysis. Results: Greater patient age (p = 0.021), single eyelids (p = 0.003), higher value of closed palpebral fissure height before simulation (p = 0.004), and higher value of brow elevation (p = 0.013) were significant for the increase of closed palpebral fissure height. Conclusions: Brow elevation to the degree that achieves symmetrical brow height could be detrimental to eyelid closure in patients with facial paralysis, especially who are elderly, have single eyelids, or present with preoperative decreased lid-closure function. UMIN Clinical Trials (UMIN Registry No. 000042974).
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Affiliation(s)
- Takeaki Hidaka
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuya Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoko Tomioka
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kengo Yoshii
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mutsumi Okazaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Hidaka T, Miyamoto S, Ogawa K, Tomioka Y, Okazaki M. Factors Associated With Late Admission to Facial Plastic Surgery Among Patients With Long-Standing Facial Paralysis. Ann Plast Surg 2021; 87:547-551. [PMID: 33625023 DOI: 10.1097/sap.0000000000002754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial plastic surgeons often encounter patients experiencing untreated long-standing facial paralysis who are unaware that their condition can be managed by facial reconstructive procedures. To promote timely admission of patients with facial paralysis for facial plastic surgery, factors associated with late admission should be elucidated. METHODS A retrospective chart review was conducted on patients admitted to our facial paralysis clinic. Late admission was defined by an onset-to-admission interval longer than the median value. Multivariable logistic regression analysis was used to assess the odds ratio of late admission with age, sex, etiology, referring physician specialty, and the time of first admission. RESULTS A total of 199 cases from October 2017 to March 2020 were included. Onset-to-admission interval longer than 21 months (median) was considered late admission. Etiologies involving benign tumors and congenital diseases were significantly associated with late admission (odds ratio [95% confidence interval], 3.9 [1.0-14.4] and 31.7 [4.7-212.6], respectively). Most benign tumor cases were referred from nonplastic surgeons. CONCLUSIONS Benign tumors and congenital diseases were significantly related to late admission of patients with long-standing facial paralysis. As the majority of benign cases were referred from nonplastic surgeons, spreading awareness on facial plastic surgery as a treatment option may be necessary in promoting timely admission.
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Affiliation(s)
- Takeaki Hidaka
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the University of Tokyo Hospital, Tokyo, Japan
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Cao Z, Jiao L, Wang H, Li J, Zhong G, Zhu D, Xu W, Jin M. The efficacy and safety of cupping therapy for treating of intractable peripheral facial paralysis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25388. [PMID: 33879669 PMCID: PMC8078480 DOI: 10.1097/md.0000000000025388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Peripheral facial paralysis (PFP) is a common clinical neurological disease and the incidence of intractable peripheral facial paralysis is on the rise. Symptoms include crooked mouth and eyes, tearing and shallow nasolabial folds. The disease seriously affects the physical and mental health of patients. At present, a large number of clinical studies have shown that cupping is effective in treating intractable peripheral facial paralysis (IPFP). Therefore, the purpose of this review is to evaluate the effectiveness and safety of cupping in the treatment of refractory peripheral facial paralysis. METHODS We will conduct a comprehensive and systematic search of relevant documents in the following databases: Medline, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Chinese Biomedical Literatures Database, China National Knowledge Infrastructure (CNKI), Wang Fang Database, Chinese Scientific Journal Database from inception to February 2021 without any language restriction. The 2 reviewers will be independently completed select research, extract data, evaluate research quality and use the Cochrane risk of bias tool to assess methodological quality. Using revman5.4 software for statistical analysis. The degree of heterogeneity will be Determined through heterogeneity test, to definite whether to adopt a random effects model or a fixed-effects model. RESULTS The protocol for the meta-analysis will systematically evaluate the efficacy and safety of cupping therapy for intractable peripheral facial paralysis patients. CONCLUSION This study will explore whether or not cupping therapy can be used as one of the non-drug therapies to prevent or treat intractable peripheral facial paralysis.
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Affiliation(s)
- Zhiwen Cao
- Jiangxi University of Traditional Chinese Medicine
| | - Lin Jiao
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Hongyu Wang
- Jiangxi University of Traditional Chinese Medicine
| | - Jun Li
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Genping Zhong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Daocheng Zhu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Wei Xu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - MengKe Jin
- Jiangxi University of Traditional Chinese Medicine
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The Experience of a Facial Nerve Unit in the Treatment of Patients With Facial Paralysis Following Skull Base Surgery. Otol Neurotol 2021; 41:e1340-e1349. [PMID: 33492811 DOI: 10.1097/mao.0000000000002902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
: The management of facial paralysis following skull base surgery is complex and requires multidisciplinary intervention. This review shows the experience of a facial nerve (FN) unit in a tertiary university referral center. A multidisciplinary approach has led to the breaking of some old treatment paradigms. An overview of five FN scenarios is presented. For each setting a contemporary approach is proposed in contrast to the established approach. 1) For patients with an anatomically preserved FN with no electrical response at the end of surgery for vestibular schwannoma, watchful waiting is usually advocated. In these cases, reinforcement with an interposed nerve graft is recommended. 2) In cases of epineural FN repair, with or without grafting, and a poor expected prognosis, an additional masseter-to-facial transfer is recommended. 3) FN transfer, mainly hypoglossal-to-facial and masseter-to facial, are usually chosen based on the surgeons' preference. The choice should be based on clinical factors. A combination of techniques improves the outcome in selected patients. 4) FN reconstruction following malignant tumors requires a combination of parotid and temporal bone surgery, involving different specialists. This collaboration is not always consistent. Exposure of the mastoid FN is recommended for lesions involving the stylomastoid foramen, as well as intraoperative FN reconstruction. 5) In patients with incomplete facial paralysis and a skull base tumor requiring additional surgery, consider an alternative reinnervation procedure, "take the FN out of the equation" before tumor resection. In summary, to achieve the best results in complex cases of facial paralysis, a multidisciplinary approach is recommended.
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Bengur FB, Stoy C, Binko MA, Nerone WV, Fedor CN, Solari MG, Marra KG. Facial Nerve Repair: Bioengineering Approaches in Preclinical Models. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:364-378. [PMID: 33632013 DOI: 10.1089/ten.teb.2020.0381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Injury to the facial nerve can occur after different etiologies and range from simple transection of the branches to varying degrees of segmental loss. Management depends on the extent of injury and options include primary repair for simple transections and using autografts, allografts, or conduits for larger gaps. Tissue engineering plays an important role to create artificial materials that are able to mimic the nerve itself without extra morbidity in the patients. The use of neurotrophic factors or stem cells inside the conduits or around the repair site is being increasingly studied to enhance neural recovery to a greater extent. Preclinical studies remain the hallmark for development of these novel approaches and translation into clinical practice. This review will focus on preclinical models of repair after facial nerve injury to help researchers establish an appropriate model to quantify recovery and analyze functional outcomes. Different bioengineered materials, including conduits and nerve grafts, will be discussed based on the experimental animals that were used and the defects introduced. Future directions to extend the applications of processed nerve allografts, bioengineered conduits, and cues inside the conduits to induce neural recovery after facial nerve injury will be highlighted.
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Affiliation(s)
- Fuat Baris Bengur
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Conrad Stoy
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary A Binko
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Wayne Vincent Nerone
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caroline Nadia Fedor
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kacey G Marra
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Abstract
Facial paralysis is a devastating condition, encompassing a spectrum of disorders, with resultant psychosocial, functional, and aesthetic sequelae. With this in mind, an individualized treatment approach based on the cause, pattern, and duration of palsy is necessary. Treatment options include pharmacologic agents, corneal protective interventions, physical therapy, and surgical procedures. The use of steroids and antivirals in the setting of idiopathic facial paralysis or virus-associated facial paralysis is well supported. Despite the diversity of surgical interventions described, there is a lack of consensus regarding optimal treatment. This article provides an overview of the current management of facial paralysis. Medical, surgical, and physical treatment options are discussed with a review of the relevant literature.
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Affiliation(s)
- Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Babak Azizzadeh
- Department of Facial Plastic & Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California
- Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Christopher LH, Slattery WH, Smith EJ, Larian B, Azizzadeh B. Facial nerve management in patients with malignant skull base tumors. J Neurooncol 2020; 150:493-500. [PMID: 33113067 DOI: 10.1007/s11060-020-03635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The course of the facial nerve through the cerebellopontine angle, temporal bone, and parotid gland puts the nerve at risk in cases of malignancy. In contrast to Bell's palsy, which presents with acute facial paralysis, malignancies cause gradual or fluctuating weakness. METHODS We review malignancies affecting the facial nerve, including those involving the temporal bone, parotid gland, and cerebellopontine angle, in addition to metastatic disease. Intraoperative management of the facial nerve and long term management of facial palsy are reviewed. RESULTS Intraoperative management of the facial nerve in cases of skull base malignancy may involve extensive exposure, mobilization, or rerouting of the nerve. In cases of nerve sacrifice, primary neurorrhaphy or interposition grafting may be used. Cranial nerve substitution, gracilis free functional muscle transfer, and orthodromic temporalis tendon transfer are management options for long term facial paralysis. CONCLUSION Temporal bone, parotid gland, and cerebellopontine angle malignancies pose a tremendous risk to the facial nerve. When possible, the facial nerve is preserved. If the facial nerve is sacrificed, static and dynamic reanimation strategies are used to enhance facial function.
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Affiliation(s)
| | - William H Slattery
- House Ear Clinic, 2100 West Third Street, Los Angeles, CA, 90057, USA.,University of California, Los Angeles, USA.,University of Southern California, 2100 West Third Street, Los Angeles, CA, 90057, USA
| | - Erin J Smith
- Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, USA
| | - Babak Larian
- Center for Advanced Head & Neck Surgery, Beverly Hills, CA, USA.,Clinical Chief of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Babak Azizzadeh
- Facial Paralysis Institute, Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, USA.,Division of Head and Neck Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Ricciardi L, Stifano V, Pucci R, Stumpo V, Montano N, Della Monaca M, Lauretti L, Olivi A, Valentini V, Sturiale CL. Comparison between VII-to-VII and XII-to-VII coaptation techniques for early facial nerve reanimation after surgical intra-cranial injuries: a systematic review and pooled analysis of the functional outcomes. Neurosurg Rev 2020; 44:153-161. [PMID: 31912333 DOI: 10.1007/s10143-019-01231-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/05/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The surgical injury of the intracranial portion of the facial nerve (FN) is a severe complication of many skull base procedures, and it represents a relevant issue in terms of patients' discomfort, social interactions, risk for depression, and social costs. The aim of this study was to investigate the surgical and functional outcomes of the most common facial nerve rehabilitation techniques. The present study is a systematic review of the pertinent literature, according to the PRISMA guidelines. Two different online medical databases (PubMed, Scopus) were screened for studies reporting the functional outcome, measured by the House-Brackman (HB) scale, and complications, in FN early reanimation, following surgical injuries on its intracranial portion. Data on the VII-to-VII and XII-to-VII coaptation, the surgical technique, the use of a nerve graft, the duration of the deficit, and complications were collected and pooled. The XII-to-VII end-to-side coaptation seems to provide higher chances for functional restoration (HB 1-3) than the VII-to-VII (68.8% vs 60.6%), regardless of the duration of the palsy deficit, the use or not of a nerve graft, and the use of stitches or glues. However, its complication rate was as high as 28.6%, and a second procedure is then often needed. The XII-to-VII side-to-end coaptation is the most effective in providing a functional outcome (HB 1-3), even though it is associated to a higher complication rate. Further trials are needed to better investigate this relevant topic, in terms of health-related social costs and patients' quality of life.
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Affiliation(s)
- Luca Ricciardi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy.
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Resi Pucci
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Vittorio Stumpo
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Della Monaca
- Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, Università La Sapienza, Rome, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentino Valentini
- Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, Università La Sapienza, Rome, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Ali SA, Rosko AJ, Hanks JE, Stebbins AW, Alkhalili O, Hogikyan ND, Feldman EL, Brenner MJ. Effect of Motor versus Sensory Nerve Autografts on Regeneration and Functional Outcomes of Rat Facial Nerve Reconstruction. Sci Rep 2019; 9:8353. [PMID: 31175313 PMCID: PMC6555820 DOI: 10.1038/s41598-019-44342-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/13/2019] [Indexed: 02/07/2023] Open
Abstract
Cranial nerve injury is disabling for patients, and facial nerve injury is particularly debilitating due to combined functional impairment and disfigurement. The most widely accepted approaches for reconstructing nerve gap injuries involve using sensory nerve grafts to bridge the nerve defect. Prior work on preferential motor reinnervation suggests, however, that motor pathways may preferentially support motoneuron regeneration after nerve injury. The effect of motor versus sensory nerve grafting after facial nerve injury has not been previously investigated. Insights into outcomes of motor versus sensory grafting may improve understanding and clinical treatment of facial nerve paralysis, mitigating facial asymmetry, aberrant reinnervation, and synkinesis. This study examined motor versus sensory grafting of the facial nerve to investigate effect of pathway on regeneration across a 5-mm rodent facial nerve defect. We enrolled 18 rats in 3 cohorts (motor, sensory, and defect) and recorded outcome measures including fiber count/nerve density, muscle endplate reinnervation, compound muscle action potential, and functional whisker twitch analysis. Outcomes were similar for motor versus sensory groups, suggesting similar ability of sensory and motor grafts to support regeneration in a clinically relevant model of facial nerve injury.
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Affiliation(s)
- S Ahmed Ali
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - John E Hanks
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Aaron W Stebbins
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.,Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
| | - Osama Alkhalili
- Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
| | - Norman D Hogikyan
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Eva L Feldman
- Department of Neurology, Michigan Medicine, Ann Arbor, MI, USA
| | - Michael J Brenner
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.
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