Dual Innervation of Free Functional Muscle Flaps in Facial Paralysis

Klebuc, Michael; Xue, Amy S.; Doval, Andres F.

doi:10.1016/j.fsc.2021.03.006

Cited by 13 publications

(23 citation statements)

References 18 publications

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“…The outcomes of free functional muscle transfers in the setting of facial paralysis depend on multiple factors, such as muscle inset, coaptation techniques, and more 9,12,[30][31][32] but assuming other factors are optimized the donor nerve has perhaps the most impact on the postoperative muscle behavior. 9,12,32 As there is a paucity of studies comparing the outcomes of one-versus two-stage dual-innervated gracilis FFMTs, 9,12,13 the impetus for this study was to objectively assess the outcomes of the two approaches over time in repose, closed-mouth smile, and open-mouth smile with reliably-recorded long-term follow-ups.…”

Section: Discussionmentioning

confidence: 99%

“…These outcomes support the hypothesis that two-stage reconstruction would demonstrate superior longterm resting tone as the CFNG would have a relatively greater head start in the innervation of the FFMT's neuromuscular junctions compared to one-staged reconstruction. 12 Similarly, comparisons of FFMTs solely innervated by CFNGs have shown superior resting tone with twostage reconstructions than with one-stage reconstructions. 33 Furthermore, we found that photographs in closed-and open-mouth smile had significant and sustained improvements with the majority of paralyzed-side and symmetry measurements in the one and two-stage groups.…”

Section: Accepted Manuscriptmentioning

confidence: 97%

“…9,12,13 Ephaptic signaling (i.e., the activation of a nearby nerve after being excited by a primary nerve) 12,25,26 may explain the similarly synergistic outcomes seen with different configurations of dual innervation, 10,12 suggesting that the CFNG may act as a trigger of the NTM's fibers in dual innervation. 12,15,17,24 Yet, evidence is lacking on the ideal staging of dually-innervated FFMTs in facial reanimation. 9,12,13 Due to NTM's high axonal load (1542-2775 axons) 27,28 versus the low axonal input from a CFNG at its distal end (100-200 axons) 28 and due to the time it takes for axons to reach the FFMT via a CFNG, it has been hypothesized that dual innervation should be performed in two stages.…”

mentioning

confidence: 99%

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Dual-Innervated Gracilis Free Functional Muscle Transfers in Facial Palsy Patients: Comparing Long-Term Outcomes between One- versus Two-Stage Procedures

Wen,

Thachil,

Madrazo

et al. 2024

J Reconstr Microsurg

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Background: In facial reanimation, dual-innervated gracilis free functional muscle transfers (FFMTs) may have amalgamated increases in tone, excursion, synchroneity, and potentially spontaneity when compared to single innervation. The ideal staging of dual-innervated gracilis FFMTs has not been investigated. We aim to compare objective long-term outcomes following one- and two-stage dual-innervated gracilis FFMTs. Methods: Included were adult patients with facial paralysis who underwent either one- (one-stage group) or two-stage (two-stage group) dual-innervated gracilis FFMT with ≥1 year of postoperative follow-up. Facial measurements were obtained from standardized photographs of patients in repose, closed-mouth smile, and open-mouth smile taken preoperatively, 1-year postoperatively, and 3-year postoperatively. Symmetry was calculated from the absolute difference between the paralyzed and healthy hemiface; a lower value indicates greater symmetry. Results: Of 553 facial paralysis patients, 14 were included. Respectively, 5 and 9 patients were in the one and two-stage groups, with mean follow-up time respectively being 2.5 and 2.6 years. Within-group analysis of both groups, most paralyzed-side and symmetry measurements significantly improved over time with maintained significance at 3-year postoperatively in closed and open-mouth smile (all p≤0.05). However, only the two-stage group had maintained significance in improvements at 3-year postoperatively in paralyzed-side and symmetry measurements in repose with commissure position (median change [IQR], 7.62 [6.00 to 10.56] mm), commissure angle (median change [IQR], 8.92 [6.18 to 13.69] degrees), commissure position symmetry (median change [IQR], -5.18 [-10.48 to -1.80] mm), and commissure angle symmetry (median change [IQR], -9.78 [-11.73 to -7.32] degrees), commissure height deviation (median change [IQR], -5.70 [-7.19 to -1.64] mm) (all p≤0.05). In the between-group analysis, all measurements were comparable in repose, closed-mouth smile, and open-mouth smile (all p>0.05). Conclusion: Long-term outcomes demonstrate that both one- and two-stage dual-innervated gracilis FFMTs significantly improve excursion but only two-stage reconstruction significantly improves resting tone.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 97%

mentioning

confidence: 99%

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Dual-Innervated Gracilis Free Functional Muscle Transfers in Facial Palsy Patients: Comparing Long-Term Outcomes between One- versus Two-Stage Procedures

Wen,

Thachil,

Madrazo

et al. 2024

J Reconstr Microsurg

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“…Accordingly, varying (and extreme) complication rates and treatment recommendations have been documented (Supplemental Digital Content 1, Table 1, http://links.lww.com/SCS/F487). It is important to highlight that these reports of different surgical approaches have substantially advanced FP research and broadened the therapeutic armamentarium, thereby improving the quality of care for FP patients 11,14–27 . Yet, analyses of multicenter databases may help overcome the inherent limitations of such studies and mitigate bias by pooling patient data with geographical, institutional, and demographic variance.…”

Section: Introductionmentioning

confidence: 99%

“…It is important to highlight that these reports of different surgical approaches have substantially advanced FP research and broadened the therapeutic armamentarium, thereby improving the quality of care for FP patients. 11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] Yet, analyses of multicenter databases may help overcome the inherent limitations of such studies and mitigate bias by pooling patient data with geographical, institutional, and demographic variance. Thus, based on a diverse patient population, robust data on the occurrence of postoperative complications following different surgical BP techniques can be identified.…”

Section: Introductionmentioning

confidence: 99%

An ACS-NSQIP Data Analysis of 30-Day Outcomes Following Surgery for Bell’s Palsy

Knoedler,

Hoch

et al. 2023

Journal of Craniofacial Surgery

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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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Motor Nerve Reconstruction of the Facial Nerve

Krane

Loyo

et al. 2023

Advancements and Innovations in OMFS, ENT, and Facial Plastic Surgery

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Dual Innervation of Free Functional Muscle Flaps in Facial Paralysis

Cited by 13 publications

References 18 publications

Dual-Innervated Gracilis Free Functional Muscle Transfers in Facial Palsy Patients: Comparing Long-Term Outcomes between One- versus Two-Stage Procedures

Dual-Innervated Gracilis Free Functional Muscle Transfers in Facial Palsy Patients: Comparing Long-Term Outcomes between One- versus Two-Stage Procedures

An ACS-NSQIP Data Analysis of 30-Day Outcomes Following Surgery for Bell’s Palsy

Motor Nerve Reconstruction of the Facial Nerve

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