Early Outcomes in an Emerging Facial Nerve Center: The Oregon Health and Science University (OHSU) Experience

Abstract

Objectives: Nerve transfer (NT) and free gracilis muscle transfer (FGMT) are procedures for reanimation of the paralyzed face. Assessing the surgical outcomes of these procedures is imperative when evaluating the effectiveness of these interventions, especially when establishing a new center focused on the treatment of patients with facial paralysis. We desired to discuss the factors to consider when implementing a facial nerve center and the means by which the specialist can assess and analyze outcomes. Methods: Patients with facial palsy secondary to multiple etiologies, including cerebellopontine angle tumors, head and neck carcinoma, and trauma, who underwent NT or FGMT between 2014 and 2019 were included. Primary outcomes were facial symmetry and smile excursion, calculated using FACE-gram and Emotrics software. Subjective quality of life outcomes, including the Facial Clinimetric Evaluation (FaCE) Scale and Synkinesis Assessment Questionnaire (SAQ), were also assessed. Results: 14/22 NT and 6/6 FGMT patients met inclusion criteria having both pre-and postoperative photo documentation. NT increased oral commissure excursion from 0.4 mm (SD 5.3) to 2.9 mm (SD 6.8) ( P = 0.05), and improved symmetry of excursion ( P < 0.001) and angle ( P < 0.001). FGMT increased oral commissure excursion from −1.4 mm (SD 3.9) to 2.1 mm (SD 3.7), ( P = 0.02), and improved symmetry of excursion ( P < 0.001). FaCE scores improved in NT patients postoperatively ( P < 0.001). Conclusions: Measuring outcomes, critical analyses, and a multidisciplinary approach are necessary components when building a facial nerve center. At our emerging facial nerve center, we found NT and FGMT procedures improved smile excursion and symmetry, and improved QOL following NT in patients with facial palsy secondary to multiple etiologies.

Supercharged massetric‐facial cross‐graft for gracilis reinnervation in unilateral facial palsy treatment

“…Despite these initial considerations, which inevitably affected this report, some attempts have been made to reduce biases by introducing software that provides an objective evaluation of surgical results. Emotrics, similarly to eFace, is a tool that provide and compare facial measures through specific reference points on pictures of patients (Dusseldorp et al, 2018; Krane et al, 2020).…”

Evidence-Based Medicine: Facial Reanimation

“…Emotrics has been used to compare the outcomes of multiple surgical techniques. [42][43][44] However, the accuracy of these measurements is contingent upon the familiarity of the user to the interface as it is not available on all commonly used software platforms. Also, the clinician selects which still-frame images or photos to use for analysis, which introduces some potential for bias.…”

Use of Self-Sustaining Aptos Caprolactone Pla Thread for Correction Of Hemiface Deviation Presenting as Late Result of Facial Paralysis. Case Series Report

“…These techniques Procedures are usually included multi-stage operations, hospitalization and not always the desired result. In addition to these methods are used, other methods, such as blepharoplasty, correction [16][17][18][19][20][21][22] . Applicable techniques for restoring facial symmetry after facial paralysis such as masseter or temporalis muscle transplantation, transverse facial nerve transplantation and free muscle transplantation; although it can improve facial symmetry, it is associated with more downtime and several complications.…”