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Shamil E, Tan DJY, Grobbelaar A. Outcomes of Free Flap Transfer in Facial Reanimation: A Review. Facial Plast Surg 2024; 40:418-423. [PMID: 38336000 DOI: 10.1055/s-0044-1779628] [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: 02/12/2024] Open
Abstract
Free functional muscle transfer is is an option for reanimating the face in chronic facial nerve paralysis. The optimal outcome in these patients is the ability to restore a spontaneous smile in response to emotion. We discuss the role of free functional muscle transfer in facial paralysis treatment, the choices of nerve used in reconstruction surgery, and the application of different types of muscle flaps in facial reanimation. In this paper, we review the relevant and up-to-date academic literature regarding the outcomes of free functional muscle flap transfer in facial paralysis patients.
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Affiliation(s)
- Eamon Shamil
- ENT Surgery Department, The Royal National ENT Hospital, University College London Hospital, London, United Kingdom
| | - Denise Jia Yun Tan
- ENT Surgery Department, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Adriaan Grobbelaar
- Department of Plastic Surgeon, Great Ormond Street Hospital, London, United Kingdom
- Division of Surgery and Interventional Science, University College of London, London, United Kingdom
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland
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van der Lely JN, Nieuwdorp NJ, Smits ICAW, van Zijl FVWJ, Corten EML, Mureau MAM. Quality of life after surgical treatments for facial palsy: A systematic review and meta-analysis. Head Neck 2024. [PMID: 38597121 DOI: 10.1002/hed.27772] [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: 12/21/2023] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Facial palsy profoundly affects patients' quality of life (QoL). We evaluated the effect of various surgical procedures on QoL using patient-reported outcome measures (PROMs) to provide evidence-based recommendations for improved care. METHODS Embase, Medline, Web of Science, Cochrane, and CINAHL were searched for studies on QoL in patients with facial palsy who had undergone reconstructive surgery with preoperative and postoperative data from validated PROMs. After conducting the quality assessment, data were subtracted from the articles. Meta-analyses of subgroups were performed when study outcomes where compatible. RESULTS Incorporating 24 studies (522 patients), our systematic review revealed consistent and significant QoL improvements following diverse reconstructive surgical procedures. CONCLUSIONS Our systematic review and meta-analysis showed the positive effects of different reconstructive surgical procedures on QoL of patients with facial palsy. These results support clinicians to better inform patients about their potential outcomes, optimizing informed and shared decision-making and ultimately improving overall QoL in patients with facial palsy.
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Affiliation(s)
- Johannes N van der Lely
- Department of Plastic & Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Niek J Nieuwdorp
- Department of Plastic & Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ineke C A W Smits
- Department of Otorhinolaryngology - Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Floris V W J van Zijl
- Department of Otorhinolaryngology - Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline M L Corten
- Department of Plastic & Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic & Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Kim MG, Bae CR, Oh TS, Park SJ, Jeong JM, Kim DY. Reliability and Validity of Emotrics in the Assessment of Facial Palsy. J Pers Med 2023; 13:1135. [PMID: 37511748 PMCID: PMC10381242 DOI: 10.3390/jpm13071135] [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: 05/12/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
The globally accepted evaluation method for facial palsy is the House-Brackmann facial grading system; however, it does not reflect minute changes. Several methods have been attempted, but there is no universally accepted evaluation method that is non-time-consuming and quantitative. Recently, Emotrics, a two-dimensional analysis that incorporates machine-learning techniques, has been used in various clinical fields. However, its reliability and validity have not yet been determined. Therefore, this study aimed to examine and establish the reliability and validity of Emotrics. All patients had previously received speech therapy for facial palsy at our hospital between January and November 2022. In speech therapy at our hospital, Emotrics was routinely used to measure the state of the patient's facial palsy. A frame was created to standardize and overcome the limitation of the two-dimensional analysis. Interrater, intrarater, and intrasubject reliability were evaluated with intraclass correlation coefficients (ICC) by measuring the indicators that reflect eye and mouth functions. Validity was evaluated using Spearman's correlation for each Emotrics parameter and the House-Brackmann facial grading system. A total of 23 patients were included in this study. For all parameters, there was significant interrater and intrarater reliability (ICC, 0.61 to 0.99). Intrasubject reliability showed significant reliability in most parameters (ICC, 0.68 to 0.88). Validity showed a significant correlation in two parameters (p-value < 0.001). This single-center study suggests that Emotrics could be a quantitative and efficient facial-palsy evaluation method with good reliability. Therefore, Emotrics is expected to play a key role in assessing facial palsy and in monitoring treatment effects more accurately and precisely.
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Affiliation(s)
- Min Gi Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Cho Rong Bae
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Tae Suk Oh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Sung Jong Park
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jae Mok Jeong
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Kimura KS, Kfoury P, Pepper JP. Evidence-Based Medicine: Facial Reanimation. Facial Plast Surg 2023; 39:266-272. [PMID: 36720255 DOI: 10.1055/a-2023-9051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This article provides a brief historical overview of the assessment instruments that have been developed to categorize the severity of disease in patients with facial palsy. Important advances in the quality of these instruments are discussed. The modern-day instruments that are commonly required for evidence-based patient assessment are then presented, with emphasis on the level of evidence of the studies that describe these instruments.
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Affiliation(s)
- Kyle S Kimura
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Peter Kfoury
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Jon-Paul Pepper
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Zhao J, Zeng W, Qiu C, Liu J, Li K, Huang J, Tong MCF, Zhang X. Protection of the marginal mandibular branches of the facial nerves by different surgical procedures in comprehensive cervical lymphadenectomy for locally advanced oral and oropharyngeal cancer: a multicenter experience. World J Surg Oncol 2023; 21:30. [PMID: 36721264 PMCID: PMC9887872 DOI: 10.1186/s12957-023-02913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE According to the different characteristics of patients and cervical lymph node metastasis of oral and oropharyngeal cancer, the marginal mandibular branches of facial nerves were treated by different surgical procedures, and the safety and protective effects of different surgical procedures were investigated. METHODS One hundred ninety-seven patients with oral and oropharyngeal cancer satisfying the inclusion criteria were selected. According to the different characteristics of patients and cervical metastatic lymph nodes, three different surgical procedures were used to treat the marginal mandibular branches of the facial nerve: finding and exposing the marginal mandibular branches of the facial nerves at the mandibular angles of the platysma flaps, finding and exposing the marginal mandibular branches of facial nerves at the intersections of the distal ends of facial arteries and veins with the mandible, and not exposing the marginal mandibular branches of the facial nerves. The anatomical position, injury, and complications of the marginal mandibular branches of the facial nerves were observed. RESULTS The marginal mandibular branches of the facial nerves were found and exposed at the mandibular angles of the platysma flaps in 102 patients; the marginal mandibular branches of facial nerves were found and exposed at the intersections of the distal ends of the facial arteries and veins with the mandibles in 64 patients; the marginal mandibular branches of facial nerves were not exposed in 31 patients; among them, four patients had permanent injury of the marginal mandibular branches of the facial nerves, and temporary injury occurred in seven patients. There were statistically significant differences in the protection of the mandibular marginal branch of the facial nerve among the three different surgical methods (P = 0.0184). The best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap, and the injury rate was only 2.94%. CONCLUSION The three different surgical procedures were all safe and effective in treating the marginal mandibular branches of the facial nerves, the best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap.
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Affiliation(s)
- Jiuzhou Zhao
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| | - Wen Zeng
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi Province People’s Republic of China
| | - Chengyu Qiu
- Department of Oral and Maxillofacial Surgery, First Hospital of Qiqihaer City, Heilongjiang Province, Qiqihaer, People’s Republic of China
| | - Jiafeng Liu
- grid.452437.3Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province People’s Republic of China
| | - Ke Li
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| | - Jing Huang
- Department of Institute of Cancer Research, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi Province People’s Republic of China
| | - Michael C. F. Tong
- grid.10784.3a0000 0004 1937 0482Department of Otorhinolaryngology, Head & Neck Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China
| | - Xiangmin Zhang
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
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Pinkiewicz M, Dorobisz K, Zatoński T. A Comprehensive Approach to Facial Reanimation: A Systematic Review. J Clin Med 2022; 11:jcm11102890. [PMID: 35629016 PMCID: PMC9143601 DOI: 10.3390/jcm11102890] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection. Methodological approach: A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles. Conclusions: A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.
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Effect of Penetration Electroacupuncture Combined with Intermediate Frequency Electrotherapy, Facial Acupoint Massage, and Cervical Reduction on Facial Nerve Function and Curative Effect of Senile Refractory Facial Paralysis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:3776006. [PMID: 34630985 PMCID: PMC8500759 DOI: 10.1155/2021/3776006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Objective This study aimed to explore the curative effects on senile refractory facial paralysis treated by penetration electroacupuncture combined with intermediate frequency electrotherapy, facial acupoint massage, and cervical reduction on facial nerve. Methods 106 elderly patients with intractable facial paralysis that were retrospectively analyzed were all admitted from January 2019 to June 2020. The 106 patients were evenly divided into 2 groups according to the treatment method. The control group was treated with penetration electroacupuncture, while the observation group was treated with penetration electroacupuncture plus intermediate frequency electrotherapy + facial acupoint massage + cervical reduction treatment. Then, House–Brackmann (H-B) facial nerve function evaluation, RPA score, TCM syndrome score, disease remission rate, and incidence of adverse events were evaluated and compared between the two groups. Results After 4 weeks of treatment, the H-B facial nerve function grading in the observation group was better than that in the control group (P < 0.05). And the disease remission rate after 1 week, 2 weeks, and 4 weeks of treatment was higher than that in the control group (P < 0.05). Meanwhile, the TCM syndrome score and RPA score after 2 weeks and 4 weeks of treatment were better than that in the control group (P < 0.05). Conclusion For the elderly patients with refractory facial paralysis, the application of the combined treatment that penetration electroacupuncture + medium frequency electrotherapy + facial acupoint massage + cervical adjustment can significantly improve the facial nerve function and reduce various diseases, and the effect of this combined treatment plan is more significant than that of penetration electroacupuncture treatment.
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