title: Multivectored suture suspension: a minimally invasive technique for reanimation of the paralyzed face.
abstract: BACKGROUND
  Despite advanced techniques for reanimation of the lower face, many patients opt for static suspension procedures, which are less invasive and have a relatively short recovery period. However, even static suspension procedures require general anesthesia, overnight hospital stay, and significant soft tissue manipulation. We present a minimally invasive technique, the multivectored suture suspension, which addresses these drawbacks.
  
  
  OBJECTIVE
  To study the technical feasibility and efficacy of the multivectored suture suspension technique in the paralyzed face.
  
  
  METHODS
  The study was carried out prospectively in 12 patients with House-Brackmann grade 6 facial paralysis. Nine patients presented within 6 months of tumor resection and 3 patients presented more than 1 year after surgery.
  
  
  METHODS
  The parameters evaluated were (1). restoration of nasal breathing; (2). improvement of drooling; (3). restoration of normal speech; (4). cosmetic results; and (5). total surgical time.
  
  
  RESULTS
  With an average follow-up of 14 months, patient evaluation of the outcome parameters was as follows: (1). 10 patients (83%) reported significant and 2 (17%) reported moderate restoration of nasal breathing; (2). 10 patients (83%) reported significant improvement and 2 (17%) reported modest drooling improvement; (3). 8 patients (66%) reported significant improvement and 4 (34%) reported modest improvement of speech; (4). 9 patients (75%) reported complete satisfaction and 3 (25%) reported moderate satisfaction with cosmesis. The average surgical time was 46 minutes. Three revisions were required for suture failure.
  
  
  CONCLUSIONS
  The multivectored suture suspension technique is a minimally invasive, reversible method of lower facial reanimation that provides improved cosmesis with restoration of nasal breathing. It can be performed under local anesthesia in an outpatient setting, thereby reducing morbidity and cost.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA. james_c_alex@lahey.org
authors.forename: James C
authors.initials: JC
authors.lastname: Alex
authors.forename: Davis B
authors.initials: DB
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005153:Facial Neoplasms / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013536:Suture Techniques; D016896:Treatment Outcome