Multivectored Superficial Muscular Aponeurotic System Suspension for Facial Paralysis

Leach, Garrison A; Kurnik, Nicole M.; Joganic, Jessica L.; Joganic, Edward F.

doi:10.1097/scs.0000000000003501

Cited by 4 publications

(10 citation statements)

References 14 publications

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“…For the patients that were most bothered by the facial asymmetry, suture suspension was also the best initial choice of static reanimation, since it allowed addressing the upper, middle and lower face simultaneously, and therefore ensured better cosmetic results. Good outcomes regarding the restoration of facial symmetry using suspension techniques have also been reported by other studies (19,20). Refinements of particular areas can always be made using barbed sutures, due to the minimally invasive character of the procedure, even when plain suture suspension was initially performed (18).…”

Section: Discussionsupporting

confidence: 63%

Management of facial paralysis following treatment of neurosurgical tumours

Costan¹,

Ciofu²,

Sava³

et al. 2019

roneuro

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The purpose of this study is to present our experience on improving the quality of life of patients with facial paralysis due to an operated intracranial tumour, by performing minimally invasive static reanimation procedures. We reviewed the clinical information pertaining to neurosurgical patients with facial paralysis that underwent static reanimation. The study included 11 patients with complete facial nerve paralysis of all nerve branches, that reported different primary complaints upon presentation. The performed procedures consisted of gold plate insertion into the superior eyelid, inferior eyelid ectropion correction or suture suspension. The functional results were favourable in all cases and the resulting appearance was acceptable. The choice of the different techniques used is discussed. Good outcomes are possible using static reanimation with an adequate adaptation of the techniques to the main patient complaint.

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Section: Discussionsupporting

confidence: 63%

Management of facial paralysis following treatment of neurosurgical tumours

Costan¹,

Ciofu²,

Sava³

et al. 2019

roneuro

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“…Leach et al looked at the use of suspension sutures placed in the SMAS for facial reanimation in patients with facial nerve paralysis and found statistically significant improvement in restoring symmetry and improving function, with low morbidity and reliable results. 30 Compared with simple layered closure, which may have inconsistent results on long-term follow-up, suspension sutures can distribute tension with the possibility of longer lasting results. 31 Use of multiple anchor points in an arcade fashion with our technique with long-lasting dissolvable sutures distributes the tension over multiple points until healing is completed in the corrected, lifted position.…”

Section: Discussionmentioning

confidence: 99%

Arcade Sutures to Minimize Ear Displacement in Rhytidectomy

et al. 2022

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Ear deformities after rhytidectomy are not uncommon and have a significant impact on cosmetic success. We postulate the use of horizontal mattress suspension sutures in the anterior face anchored to the deep temporalis fascia (DTF) during rhytidectomy allows for a vertical lift while minimizing the risk to the frontal branch of the facial nerve and decreasing forward rotation of the ear. To compare auricular displacement during rhytidectomy using an arcade of horizontal mattress suspension sutures anchored to the DTF instead of the preauricular pre-parotid fascia, and evaluate outcomes with this modification at 1 year. This was a proof of concept prospective cohort study of 20 patients (40 sides) undergoing rhytidectomy by a single plastic surgeon (level of evidence 4). Intraoperative measurements were taken to determine the amount of auricular displacement with suspension sutures placed in the preauricular fascia compared with the DTF. To confirm longevity, we compared ear position preoperatively and at 1 year after rhytidectomy with our technique. There was significantly less auricular displacement when superficial musculoaponeurotic system (SMAS) suspension sutures were placed in the DTF 0.75 ± 0.69 mm compared with the preauricular fascia 9.71 ± 2.57 mm (p < 0.00001). With our technique at an average follow-up of 370.3 days, there was no significant change in auricular rotation compared with preoperative photos (p = 0.125).Our simple rhytidectomy modification allows for vertical resuspension of the SMAS in the anterior face in a safe manner while minimizing displacement of the auricle.

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“…Additionally, generalized Procrustes superimposition optimally translates, scales, and rotates landmarks from all samples into a common shape space, controlling for variability in image acquisition such as head tilt and angulation. 9 Potential applications of this tool in clinical practice include further characterizing complex morphologic processes, identifying phenotypic subpopulations within larger disease categories, and optimizing surgical planning of craniofacial reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…While more commonly used for skeletal disorders, the ability of GM to accurately quantify anatomical proportions also makes the technique well-suited for studying the soft tissues of the face. [8][9][10][11]15,17,[29][30][31] Leach et al employed GM to study facial symmetry following superficial muscular aponeurotic system (SMAS) suspension to treat facial paralysis, reporting a significant postoperative difference between contralateral distances from soft tissue landmarks off midline compared with preoperative measurements. 9 This finding indicates contralateral neural overcompensation is mitigated following restoration of facial symmetry.…”

Section: Soft Tissue Applicationsmentioning

confidence: 99%

“…[8][9][10][11]15,17,[29][30][31] Leach et al employed GM to study facial symmetry following superficial muscular aponeurotic system (SMAS) suspension to treat facial paralysis, reporting a significant postoperative difference between contralateral distances from soft tissue landmarks off midline compared with preoperative measurements. 9 This finding indicates contralateral neural overcompensation is mitigated following restoration of facial symmetry. 9 The greatest increase in facial symmetry was observed in the regions of the mouth and lower nose.…”

Section: Soft Tissue Applicationsmentioning

confidence: 99%

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The Expanding Role of Geometric Morphometrics in Craniofacial Surgery

Rutland

Bellaire

Yao

et al. 2021

Journal of Craniofacial Surgery

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Introduction: Geometric morphometrics (GM) is an advanced landmark-based quantitative method used to study biological shape and form. Historically, GM has been limited to non-biomedical fields such as comparative biology; however, this technique confers advantages over traditional cephalometric methods, warranting a review of current applications of GM to human craniofacial disorders. Methods: The RISmed package was used to extract metadata associated with PubMed publications referencing GM analysis techniques in craniofacial and reconstructive surgery. PubMed search terms included ''geometric AND morphometric AND craniofacial;'' and ''geometric AND morphometric AND reconstructive surgery.'' Duplicate search results were eliminated. Results: Search yielded 139 studies between 2005 and 2020, of which 27 met inclusion criteria. Human craniofacial studies constituted 2% of all queried GM studies. Among these, cleft lip and palate were the most commonly studied craniofacial conditions (7 studies, 26%), followed by sagittal craniosynostosis (4 studies, 15%). Seventeen studies (63%) used GM to assess skeletal structures, seven studies (26%) examined both skeletal and soft tissues, and three studies (11%) analyzed soft tissues only. Eleven studies (40.1%) employed a GM approach to evaluate postoperative changes in craniofacial morphology. Two studies (7%) systematically compared GM analysis with conventional shape measurements. Conclusion:The ability to study shape while controlling for variability in structure size and imaging technique make GM a promising tool for understanding growth patterns in complex craniofacial diseases. Furthermore, GM overcomes many limitations of traditional cephalometric techniques, and hence may claim an expanded role in the study of human craniofacial disorders in clinical and research settings.

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Multivectored Superficial Muscular Aponeurotic System Suspension for Facial Paralysis

Abstract: In conclusion, multivectored SMAS suture suspension is an effective method for restoring static suspension of the face after facial paralysis. This method has the benefit of producing quick, reliable results with improved function, low cost, and low morbidity.

Cited by 4 publications

References 14 publications

Management of facial paralysis following treatment of neurosurgical tumours

Management of facial paralysis following treatment of neurosurgical tumours

Arcade Sutures to Minimize Ear Displacement in Rhytidectomy

The Expanding Role of Geometric Morphometrics in Craniofacial Surgery

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