Twenty-Five-Year Outcomes of Treatment of Irreversible Facial Paralysis with Gillies and McLaughlin Techniques

Abstract

Introduction: Data on treatment outcomes of surgical correction of irreversible facial paralysis is rare and long-term outcomes are scarce in the literature, making treatment choices difficult for operating surgeons. Objective: This study evaluated 25-year outcomes of treatment of irreversible facial paralysis with Gillies and McLaughlin techniques with a focus on general functional and age-related functional outcomes. Methods: Data of all patients who underwent surgical correction of facial paralysis using either Gillies or McLaughlin procedure between 1994 and 2018 were included in the analysis of this retrospective, single-centre study (n = 154). Results: Gillies surgery was performed on 12 and McLaughlin technique on 33 patients. Gillies and McLaughlin surgeries were associated with high patient satisfaction (75-86%), low complication rates (8-24%), and achievement of full or partial eyelid closure in 75% as well as smile reanimation in 97% of patients operated. Achievement of resting facial symmetry was low for both techniques and ranged from 27 to 46%. Age-related functional outcomes were generally superior in middle-aged patients (21-59 years) with fewer complications and reoperations compared to younger and older patients. Conclusions: Surgical correction with Gillies or McLaughlin dynamic muscle support techniques yielded good clinical results with high patient satisfaction and should, therefore, be included as a treatment option for facial reanimation of irreversible facial paralysis. Patient age may play a role in treatment outcomes and reoperation and complication rates and should be taken into careful consideration during treatment planning.

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

“…Infection rates after surgical treatment of BP range from 1.1% reported by Murphey et al (masseteric nerve transfers) to 3.9% by Leckenby et al (tensor fascia lata intervention) and to 9.1% in the McLaughlin procedure reported by Schlosshauer et al 11,18,19 With an infection rate of 3.5% for SSI and DII, the incidence we found is approximately in the middle field of previously reported percentages.…”

“…Notably, our analysis included a variety of BP procedures, whereas Garcia et al focused on gracilis free muscle transfers 16 . The rate of reoperation is also significantly higher in other studies, with 17% for modified selective neurectomy and with 50% and 71.9% for Gillies surgery and McLaughlin surgery, respectively 15,19 (Supplemental Digital Content 1, Table 1, http://links.lww.com/SCS/F487). As a rule of thumb in BP surgery, more invasive approaches, such as muscle transfer, are associated with a higher incidence of adverse events.…”

“…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.…”

“…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.…”

Modified McLaughlin’s Dynamic Muscle Support in the 21st Century? A Retrospective Study With a Prospective Follow-Up Analysis for Patients With Long Standing Facial Paralysis

“…Thus, the patient can be spared an additional intraoral wound with the corresponding risk of infection. 16…”