Dynamic smile reanimation in facial nerve palsy

Abstract

Objectives: Long-term facial paralysis results in degeneration of the distal nerve segment and atrophy of the supplied muscles. Options for these patients include free muscle transfer, temporalis myoplasty, and botulinum toxin injections for smile reanimation. In this study we aimed to evaluate the subjective and objective outcomes of these procedures. Materials and Methods: In our study, we retrospectively analyzed smile symmetry in patients with facial palsy (n=8) who underwent facial reanimation procedures. Results: Subjective analysis showed high satisfaction in seven out of eight patients. Objective analysis showed statistically significant improvement postoperatively in both vertical and horizontal smile symmetry at rest and during maximum smile (P<0.001). Conclusion: Choosing the ideal procedure for the patients is the most critical aspect for facial reanimation. Though free muscle transfer is considered gold standard procedure, temporalis myoplasty also gives satisfactory results. Residual synkinesis which can lead to disturbing aesthetic deformity can be effectively treated with botulinum toxin.

Evaluation of the Patient with Facial Palsy: A Multidisciplinary Approach

“…Early access to specialist FP services may also be necessary in cases that require time critical management, such as facial nerve decompression following trauma/infection, 6 or in planning reinnervation surgery within an 18-to 24-month window from FP onset. 4 Better coordination of primary and secondary care pathways are required to ensure best patient care and outcomes is achieved by minimizing unnecessary delays to treatment. 7 individual disciplines.…”

“…This need is ever greater, when we account for the relatively high (>25%) misdiagnosis rate of Bell's palsy within this patient population. 4,5 Timely access is imperative for patients that present acutely, such as stroke or mastoiditis, where emergency intervention may be required. Early access to specialist FP services may also be necessary in cases that require time critical management, such as facial nerve decompression following trauma/infection, 6 or in planning reinnervation surgery within an 18-to 24-month window from FP onset.…”

“…36,37 Multiple studies have shown that facial function can significantly be improved by using tailored stretches and facial exercises. 2,4,5,38 At the authors center, facial assessment and treatment therapy is performed by a physiotherapists and speech and language therapists who have specialized in facial rehabilitation. Facial palpation is also performed to identify specific areas of stiffness and weakness, which feeds into an individualized stretching and exercise program for the patient.…”