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Outcome of a graduated minimally invasive facial reanimation in patients with facial paralysis

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Abstract

Peripheral paralysis of the facial nerve is the most frequent of all cranial nerve disorders. Despite advances in facial surgery, the functional and aesthetic reconstruction of a paralyzed face remains a challenge. Graduated minimally invasive facial reanimation is based on a modular principle. According to the patients’ needs, precondition, and expectations, the following modules can be performed: temporalis muscle transposition and facelift, nasal valve suspension, endoscopic brow lift, and eyelid reconstruction. Applying a concept of a graduated minimally invasive facial reanimation may help minimize surgical trauma and reduce morbidity. Twenty patients underwent a graduated minimally invasive facial reanimation. A retrospective chart review was performed with a follow-up examination between 1 and 8 months after surgery. The FACEgram software was used to calculate pre- and postoperative eyelid closure, the level of brows, nasal, and philtral symmetry as well as oral commissure position at rest and oral commissure excursion with smile. As a patient-oriented outcome parameter, the Glasgow Benefit Inventory questionnaire was applied. There was a statistically significant improvement in the postoperative score of eyelid closure, brow asymmetry, nasal asymmetry, philtral asymmetry as well as oral commissure symmetry at rest (p < 0.05). Smile evaluation revealed no significant change of oral commissure excursion. The mean Glasgow Benefit Inventory score indicated substantial improvement in patients’ overall quality of life. If a primary facial nerve repair or microneurovascular tissue transfer cannot be applied, graduated minimally invasive facial reanimation is a promising option to restore facial function and symmetry at rest.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Laura C. Holtmann, Kerstin Stähr, Stephan Lang & Stefan Mattheis

  2. Department Neuroophthalmology, Strabism and Oculoplastics, University Eye Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Anja Eckstein

  3. Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, P.O. Box 208042, New Haven, CT, 06510, USA

    Minzhi Xing

Authors
  1. Laura C. Holtmann
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  2. Anja Eckstein
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  3. Kerstin Stähr
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  4. Minzhi Xing
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  5. Stephan Lang
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  6. Stefan Mattheis
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Correspondence to Laura C. Holtmann.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable standards. For this type of study, formal consent is not required.

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Informed consent was obtained from all individual participants included in this study.

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Holtmann, L.C., Eckstein, A., Stähr, K. et al. Outcome of a graduated minimally invasive facial reanimation in patients with facial paralysis. Eur Arch Otorhinolaryngol 274, 3241–3249 (2017). https://doi.org/10.1007/s00405-017-4551-6

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  • DOI: https://doi.org/10.1007/s00405-017-4551-6

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