Analysis of Facial Reanimation Procedures Performed Concurrently With Total Parotidectomy and Facial Nerve Sacrifice

Lu, G. Nina; Villwock, Mark R.; Humphrey, Clinton D.; Kriet, J. David; Bur, Andrés M.

doi:10.1001/jamafacial.2018.1057

Cited by 17 publications

(12 citation statements)

References 22 publications

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“…For cases with facial nerve sacrifice, it is surprising that only 25.5% of patients have documented reinnervation procedures, and only 24% have documented reanimation procedures (Table 2). This low rate of facial reinnervation and reanimation following radical parotidectomy is also underscored in a recent review of NSQIP [30]. This leads to the question of whether these procedures fail to be coded and thus detected by the database or whether these procedures are truly not performed commonly in cases with facial nerve sacrifice.…”

Section: Discussionmentioning

confidence: 99%

Reconstructive trends and complications following parotidectomy: Incidence and predictors in 11,057 cases

Bovenzi

Ciolek

Crippen

et al. 2019

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundParotidectomy is a common treatment option for parotid neoplasms and the complications associated with this procedure can cause significant morbidity. Reconstruction following parotidectomy is utilized to address contour deformity and facial nerve paralysis. This study aims to demonstrate national trends in parotidectomy patients and identify factors associated with adverse postoperative outcomes. This study includes the largest patient database to date in determining epidemiologic trends, reconstructive trends, and prevalence of adverse events following parotidectomy.MethodsA retrospective review was performed for parotidectomies included in the ACS-NSQIP database between January 2012 and December 2017. CPT codes were used to identify the primary and secondary procedures performed. Univariate and multivariate analysis was utilized to determine associations between pre- and perioperative variables with patient outcomes. Preoperative demographics, surgical indications, and common medical comorbidities were collected. CPT codes were used to identify patients who underwent parotidectomy with or without reconstruction. These pre- and perioperative characteristics were compared with 30-day surgical complications, medical complications, reoperation, and readmission using uni- and multivariate analyses to determine predictors of adverse events.ResultsThere were 11,057 patients who underwent parotidectomy. Postoperative complications within 30 days were uncommon (1.7% medical, 3.8% surgical), with the majority of these being surgical site infection (2.7%). Free flap reconstruction, COPD, bleeding disorders, smoking, and presence of malignant tumor were the strongest independent predictors of surgical site infection. Readmission and reoperation were uncommon at an incidence of 2.1% each. The strongest factors predictive of readmission were malignant tumor and corticosteroid usage. The strongest factors predictive of reoperation were free flap reconstruction, malignant tumor, bleeding disorder, and disseminated cancer. Surgical volume/contour reconstruction was relatively uncommon (18%). Facial nerve sacrifice was uncommon (3.7%) and, of these cases, only 25.5% underwent facial nerve reinnervation and 24.0% underwent facial reanimation.ConclusionsThere are overall low rates of complications, readmissions, and reoperations following parotidectomy. However, certain factors are predictive of adverse postoperative events and this data may serve to guide management and counseling of patients undergoing parotidectomy. Concurrent reconstructive procedures are not commonly reported which may be due to underutilization or underreporting.

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Section: Discussionmentioning

confidence: 99%

Reconstructive trends and complications following parotidectomy: Incidence and predictors in 11,057 cases

Bovenzi

Ciolek

Crippen

et al. 2019

Journal of Otolaryngology - Head & Neck Surgery

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“…An estimated 11.3% of patients undergoing nerve‐preservation surgery for recurrent parotid pleomorphic adenoma are left with facial palsy graded higher than House Brackmann III at 1‐year follow‐up 8 . For parotid malignancies, the rate of facial nerve sacrifice approaches 30%, with only 25% of these patients undergoing nerve repair at the time of oncologic resection 9,10 . The morbidity of facial nerve injury is significant, and patients with facial palsy report poor quality of life 11‐13 .…”

Section: Discussionmentioning

confidence: 99%

Identification of Degenerated Murine Facial Nerves With Fluorescence Labeling After Transection Injury

Crawford

Lee

Hom

et al. 2023

Otolaryngol.--head neck surg.

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Objective Delayed peripheral nerve repair is complicated by nerve degeneration and atrophy that can prevent identification. We use a murine facial nerve transection model to demonstrate the efficacy of ALM‐488 (bevonescein) in labeling degenerated facial nerves with quantitative image analysis and qualitative survey data. Study Design Prospective cohort study. Setting Laboratory. Methods Ten wild‐type mice underwent transection of the lower facial nerve division with subsequent degeneration. Either 9 (n = 5 mice) or 12 (n = 5 mice) weeks later, mice underwent intravenous infusion of ALM‐488 with in vivo real‐time fluorescence imaging (FL) of the facial nerve. Using ImageJ, the mean gray value of each nerve segment under white light reflectance (WLR) and FL was compared to that of adjacent soft tissue to calculate the signal‐to‐background ratio (SBR). A survey was distributed to evaluate the perceived utility of ALM‐488 in surgeon identification of degenerated nerves. Results The mean SBR of degenerated nerves was 1.08 (standard deviation [SD]: 0.07) under WLR and 2.11 (SD: 0.31) under FL (p < 0.001). In mice with degenerated nerves, survey participants identified on average 3.01 (SD: 1.84) nerve branches under WLR and 5.73 (SD: 1.88) under FL (p < 0.0001). Under FL, 47 of 48 survey responses correctly identified isolated, degenerated nerves; in contrast, only 12 responses identified degenerated nerves under WLR (p < 0.0001). Conclusion Preoperative intravenous infusion of ALM‐488 with FL improves the identification of degenerated facial nerves. ALM‐488 also improves surgeon confidence in nerve identification, particularly in degenerated nerve branches that are not visible with WLR.

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“…The ACC NSQIP database was used to retrospectively identify patients who underwent surgery for facial paralysis between 2008 and 2019 in the United States. This was achieved by filtering for encounters with Current Procedural Terminology codes corresponding to facial‐nerve‐specific diagnoses and procedures 8 . Relevant CPT codes are listed in Table 1.…”

Section: Methodsmentioning

confidence: 99%

“…Per a prior NSQIP analysis performed by Lu et al, patients who underwent surgical correction of iatrogenic facial paralysis were divided into three categories: nerve‐type repairs, sling‐type repairs, and free tissue transfer 8 . Nerve‐type repairs included CPT codes 64716, 64864, 64868, 64885, 64886, 64910, and 64727.…”

Section: Methodsmentioning

confidence: 99%

Race and sex demographics in the surgical management of facial nerve palsy

Crawford

Ball

Kalavacherla

et al. 2023

Laryngoscope Investig Oto

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Objective: Facial palsy affects patients of all backgrounds, yet no existing studies describe differences in its treatment patterns between demographic groups.Methods: We used the National Surgical Quality Improvement Project database to investigate whether race and sex disparities exist in facial reanimation surgery.Patients were identified using CPT codes corresponding to facial-nerve procedures.Results: Seven hundred sixty-one patients met criteria; 681 self-identified as White (89.5%), 51 as Black (6.7%), 43 as Hispanic (5.6%), 23 as Asian (3.0%), and 5 patients as other (0.61%). White patients were more than twice as likely to undergo brow ptosis repair than Non-White patients (OR 2.49, 95% CI 1.16-6.15, p = .03). After controlling for malignancy, men had longer operative times than women (480.2 vs. 413.9 min, p = .04) and higher likelihood of free tissue transfer (OR 4.1, 95% CI 1.9-9.8), fascial free tissue transfer (OR 10.7, 95% CI 2.1-195), and ectropion repair (OR 1.8, 95% CI 1.2-2.8). Conclusion:Most patients undergoing facial reanimation surgery in the United States are White. Men have longer operative times and a higher likelihood of undergoing free fascial grafts and cutaneous and fascial free tissue transfer than women regardless of malignancy status.

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Analysis of Facial Reanimation Procedures Performed Concurrently With Total Parotidectomy and Facial Nerve Sacrifice

Cited by 17 publications

References 22 publications

Reconstructive trends and complications following parotidectomy: Incidence and predictors in 11,057 cases

Reconstructive trends and complications following parotidectomy: Incidence and predictors in 11,057 cases

Identification of Degenerated Murine Facial Nerves With Fluorescence Labeling After Transection Injury

Race and sex demographics in the surgical management of facial nerve palsy

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