The Gold Standard: It's Time to Shun the Term

Static reanimation of the paralyzed face using non-absorbable polypropylene mesh

<br><b>Introduction:</b> There are 2 methods for correcting facial deformities resulting from facial nerve paralysis - dynamic and static. Although dynamic methods are the standard approach in selected patient groups, static facial suspension using synthetic material provides a minimally invasive alternative for those who do not qualify for them.</br> <br><b>Aim:<b> Presenting experiences with the use of non-absorbable polypropylene mesh in the Department of Plastic Surgery in Polanica-Zdrój and reviewing the literature related to static facial reanimation methods.</br> <br><b>Materials and methods:</b> Fourteen patients underwent static facial tissue suspension using non-absorbable polypropylene mesh and 12 patients underwent surgery using classical autologous tissue techniques between 2019 and 2023. Indications for surgical treatment were analyzed, and preliminary results of treatment using both methods were compared.</br> <br><b>Results:</b> Compared to autologous tissue methods, surgeries using synthetic mesh were associated with shorter hospitalization times. No long-term postoperative complications were observed in any patient. There were no differences in treatment outcomes between autologous tissue and synthetic mesh techniques, and all patients assessed the outcome as favorable.</br> <br><b>Discussion:</b> Treatment of facial nerve paralysis sequelae using static techniques should be considered for patients not qualifying for surgery with dynamic methods and/or not consenting to such procedures. Using synthetic material as an alternative to autologous material reduces surgical time and avoids donor-site injuries and prolonged recovery.</br> <br><b>Conclusions:</b> Facial suspension with synthetic material is an effective, low-risk procedure for static correction of facial nerve paralysis sequelae.</br> <br><b>Study significance:</b> Emphasizing the importance of static methods in facial reanimation.</br>.

Evidence-Based Surgery: What Can Intra-Operative Images Contribute?

Evidence-based medicine integrates results from randomized controlled trials (RCTs) and meta-analyses, combining the best external evidence with individual clinical expertise and patients' preferences. However, RCTs of surgery differ from those of medicine in that surgical performance is often assumed to be consistent. Yet, evaluating whether each surgery is performed to the same standard is quite challenging. As a primary issue, the novelty of this review is to emphasize-with a focus on orthopedic trauma-the advantage of having complete intra-operative image documentation, allowing the direct evaluation of the quality of the intra-operative technical performance. The absence of complete intra-operative image documentation leads to the inhomogeneity of case series, yielding inconsistent results due to the impossibility of a secondary analysis. Thus, comparisons and the reproduction of studies are difficult. Access to complete intra-operative image data in surgical RCTs allows not only secondary analysis but also comparisons with similar cases. Such complete data can be included in electronic papers. Offering these data to peers-in an accessible link-when presenting papers facilitates the selection process and improves publications for readers. Additionally, having access to the full set of image data for all presented cases serves as a rich resource for learning. It enables the reader to sift through the information and pinpoint the details that are most relevant to their individual needs, allowing them to potentially incorporate this knowledge into daily practice. A broad use of the concept of complete intra-operative image documentation is pivotal for bridging the gap between clinical research findings and real-world applications. Enhancing the quality of surgical RCTs would facilitate the equalization of evidence acquisition in both internal medicine and surgery. Joint effort by surgeons, scientific societies, publishers, and healthcare authorities is needed to support the ideas, implement economic requirements, and overcome the mental obstacles to its realization.

Suprazygomatic Aponeurotic McLaughlin Myoplasty for Facial Reanimation

BACKGROUND

Suprazygomatic aponeurotic McLaughlin (SAM) myoplasty technique for facial reanimation is based on the classical McLauglin's lengthening temporalis myoplasty with a series of new modifications. A comprehensive review of previously described other orthodromic temporalis myoplasty techniques is also included to give a succinct comparison.

METHODS

Twelve adult patients of facial palsy underwent SAM myoplasty for a period of 4 years. Three had congenital facial palsy, 4 patients had facial palsy secondary to acoustic neuromas, 3 were posttraumatic, and 2 patients had Bell's palsy.

RESULTS

Range of modiolus excursion achieved as measured at 3 months postoperatively on reanimation in our patients was 5 mm to 20 mm with an average of 12.6 mm. With SAM myoplasty technique, we were able to achieve excellent result in 4 patients and good results in 8 patients as evaluated with May and Druker scoring system.

CONCLUSIONS

Suprazygomatic aponeurotic McLaughlin myoplasty for facial reanimation demonstrates a successful modification of the classical McLaughlin lengthening temporalis myoplasty, making it more customizable, simple, and predictable by taking the level of transection to the temporalis aponeurosis without the need for zygomatic osteotomy. A new classification of orthodromic temporalis myoplasty based on level of transections is also proposed for the first time. Good to excellent outcomes coupled with high patient satisfaction and low morbidity should make this technique popular among the facial reanimation surgeons.