Long-term results of facial animation surgery in patients with Moebius syndrome

Bianchi, Bernardo; Zito, Francesca; Perlangeli, Giuseppe; Pedrazzi, Giuseppe; Ferrari, Pier Francesco; Stefani, Elisa De; Sesenna, Enrico; Tano, Andrea Di; Ferri, Andrea

doi:10.1016/j.jcms.2020.10.005

Cited by 7 publications

(9 citation statements)

References 30 publications

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“…The treatment of facial paralysis is determined by the ethiology and by what portions of the face are affected. In patients presenting congenital or acquired long term facial paralysis, facial reanimation surgery (smile surgery, SS) is the optimal option in order to restore a dynamic smile ( 2 – 6 ). During SS, also known as functional muscle transfer ( 2 , 7 ), a new muscle is inserted into the paralyzed face to shape a smile.…”

Section: Introductionmentioning

confidence: 99%

“…During SS, also known as functional muscle transfer ( 2 , 7 ), a new muscle is inserted into the paralyzed face to shape a smile. Free muscle transfer allows the maxillo surgeon to create a dynamic reanimation of the paralyzed face and the creation of a voluntary smile ( 2 , 3 , 5 , 6 ). Depending on the type of paralysis (unilateral or bilateral), patients undergo one or two muscle transplants at least 6 months apart.…”

Section: Introductionmentioning

confidence: 99%

“…The most common muscle used for SS is the gracilis muscle: a portion of this muscle is taken from the patients' leg with its own nerve and blood vessels and transferred into the face. Here it is connected to the masseteric nerve (derived from a branch of the trigeminal nerve) which is responsible for activating the bite via the masseter muscle ( 2 , 4 , 6 ). After surgery, the recovery of the aesthetic smile is the main aspect to be taken into consideration to improve the patients' quality of life and substantial effort is made by clinicians to improve rehabilitation protocols for obtaining spontaneous and symmetrical activation of the smile ( 1 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

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Post-surgery Rehabilitative Intervention Based on Imitation Therapy and Mouth-Hand Motor Synergies Provides Better Outcomes in Smile Production in Children and Adults With Long Term Facial Paralysis

et al. 2022

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Rehabilitation after free gracilis muscle transfer (smile surgery, SS) is crucial for a functional recovery of the smiling skill, mitigating social and psychological problems resulting from facial paralysis. We compared two post-SS rehabilitation treatments: the traditional based on teeth clenching exercises and the FIT-SAT (facial imitation and synergistic activity treatment). FIT-SAT, based on observation/imitation therapy and on hand-mouth motor synergies would facilitate neuronal activity in the facial motor cortex avoiding unwanted contractions of the jaw, implementing muscle control. We measured the smile symmetry on 30 patients, half of whom after SS underwent traditional treatment (control group, CG meanage = 20 ± 9) while the other half FIT-SAT (experimental group, EG meanage= 21 ± 14). We compared pictures of participants while holding two postures: maximum and gentle smile. The former corresponds to the maximal muscle contraction, whereas the latter is strongly linked to the control of muscle strength during voluntary movements. No differences were observed between the two groups in the maximum smile, whereas in the gentle smile the EG obtained a better symmetry than the CG. These results support the efficacy of FIT-SAT in modulating the smile allowing patients to adapt their smile to the various social contexts, aspect which is crucial during reciprocal interactions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-surgery Rehabilitative Intervention Based on Imitation Therapy and Mouth-Hand Motor Synergies Provides Better Outcomes in Smile Production in Children and Adults With Long Term Facial Paralysis

et al. 2022

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“…This is achieved by presenting clips of an actor smiling bilat-erally and by giving instruction about the coactivation of the hands. Bilateral exercises include modulation tasks in which the patient is asked to perform maximum and small (gentle) smiles 8 in order to train and control the contraction force of the transplanted muscle/s. One of the most complex aspects of home training is ensuring that patients perform the exercises correctly.…”

Section: Synergistic Activity Treatment (Sat): Theoreticalmentioning

confidence: 99%

“…Depending on the origin of the facial palsy and on its evolution over time, patients may require a muscle transfer (free functional muscle transfer, FFMT) [3]. For patients with bilateral paralysis such as MBS, FFMT is the standard procedure aimed at restoring facial animation [8,9] (for further details on FFMT, see supplementary online material). Rehabilitation requires a prolonged period after surgery, with the patient spending many months exercising facial movements under the guidance of a speech therapist [10].…”

Section: Introductionmentioning

confidence: 99%

A New Neurorehabilitative Postsurgery Intervention for Facial Palsy Based on Smile Observation and Hand-Mouth Motor Synergies

et al. 2021

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Objective. To perform a preliminary test of a new rehabilitation treatment (FIT-SAT), based on mirror mechanisms, for gracile muscles after smile surgery. Method. A pre- and postsurgery longitudinal design was adopted to study the efficacy of FIT-SAT. Four patients with bilateral facial nerve paralysis (Moebius syndrome) were included. They underwent two surgeries with free muscle transfers, one year apart from each other. The side of the face first operated on was rehabilitated with the traditional treatment, while the second side was rehabilitated with FIT-SAT. The FIT-SAT treatment includes video clips of an actor performing a unilateral or a bilateral smile to be imitated (FIT condition). In addition to this, while smiling, the participants close their hand in order to exploit the overlapped cortical motor representation of the hand and the mouth, which may facilitate the synergistic activity of the two effectors during the early phases of recruitment of the transplanted muscles (SAT). The treatment was also aimed at avoiding undesired movements such as teeth grinding. Discussion. Results support FIT-SAT as a viable alternative for smile rehabilitation after free muscle transfer. We propose that the treatment potentiates the effect of smile observation by activating the same neural structures responsible for the execution of the smile and therefore by facilitating its production. Closing of the hand induces cortical recruitment of hand motor neurons, recruiting the transplanted muscles, and reducing the risk of associating other unwanted movements such as teeth clenching to the smile movements.

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Optimizing the results of facial animation surgery: Botulinum toxin injection into free functional gracilis flap transfer

Ferri¹,

Zito²,

Menapace³

et al. 2023

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Long-term results of facial animation surgery in patients with Moebius syndrome

Cited by 7 publications

References 30 publications

Post-surgery Rehabilitative Intervention Based on Imitation Therapy and Mouth-Hand Motor Synergies Provides Better Outcomes in Smile Production in Children and Adults With Long Term Facial Paralysis

Post-surgery Rehabilitative Intervention Based on Imitation Therapy and Mouth-Hand Motor Synergies Provides Better Outcomes in Smile Production in Children and Adults With Long Term Facial Paralysis

A New Neurorehabilitative Postsurgery Intervention for Facial Palsy Based on Smile Observation and Hand-Mouth Motor Synergies

Optimizing the results of facial animation surgery: Botulinum toxin injection into free functional gracilis flap transfer

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