title: Multimodality approach to management of the paralyzed face.
abstract: OBJECTIVE
  Despite the ability of facial reanimation techniques to introduce meaningful movement to the paralyzed face, dynamic methods do not address all zones of the face. Our objective was to retrospectively review outcomes after multimodality management of the patient with facial paralysis, to describe several novel surgical methods that introduce subtle improvements in static facial balance, and to present an algorithm for comprehensive management of the paralyzed face.
  
  
  RESULTS
  Three hundred thirty-seven patients with facial paralysis were seen and treated in a busy facial nerve center setting over a 3-year period using a range of standard muscle transfers, physical therapy, chemodenervation with botulinum toxin, and static surgical techniques. Three adjunct techniques emerged as novel and useful procedures that more fully addressed facial balance issues than existing techniques. Of patients proceeding with physical therapy, greater than 80% of patients experienced a benefit, and 97% of those who proceeded with botulinum toxin therapy experienced a benefit.
  
  
  CONCLUSIONS
  Facial paralysis is best managed using a multimodality approach that includes surgical interventions, physical therapy, and chemodeneveration. We describe three adjunctive surgical techniques for management of the paralyzed face and present a comprehensive algorithm for management of the paralyzed face. That may provide improved function and cosmesis in all zones of the paralyzed face.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. tessa_hadlock@meei.harvard.edu
authors.forename: Tessa A
authors.initials: TA
authors.lastname: Hadlock
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Greenfield
authors.forename: Mara
authors.initials: M
authors.lastname: Wernick-Robinson
authors.forename: Mack L
authors.initials: ML
authors.lastname: Cheney
mesh_terms: D000465:Algorithms; D001905:Botulinum Toxins / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005158:Facial Paralysis / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins