Myectomy and botulinum toxin for paralysis of the marginal mandibular branch of the facial nerve: a series of 76 cases.
BACKGROUND
Paralysis of the marginal mandibular branch of the facial nerve is frequently seen in patients with oromandibular reconstructions or facial palsy. However, deformities caused by overpulling of the depressor muscles of the contralateral lower lip without being antagonized by the diseased counterpart is often quite conspicuous. Depressor myectomy of the contralateral lower lip therefore provides a method for correcting the dynamic deformity.


METHODS
Seventy-six patients with paralysis of the marginal mandibular branch of the facial nerve were treated with either surgical depressor myectomy of the lower lip (25 patients), depressor myectomy with subsequent botulinum toxin injection (eight patients), or only chemical depressor myectomy with botulinum toxin injections (43 patients).


RESULTS
Good to fair results were always achieved, with near balance of the lower lip during mouth opening and in facial expressions. Surgical myectomy may still result in recurrence in eight patients (24 percent), which will necessitate further treatment with botulinum toxin injections.


CONCLUSIONS
Using myectomy for paralysis of the marginal mandibular branch of the facial nerve can be an effective treatment for this significant deformity. Chemical myectomy with botulinum toxin injection is a safe and convenient mode of treatment; however, the disadvantage is that it needs repeated injections and costs more.
Chen
Chen-Kun
CK
Taipei, Taiwan From the Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital.
Tang
Yueh-Bih
YB
D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005149:Facial Expression; D005152:Facial Muscles / Q000294:innervation / Q000601:surgery*; D005155:Facial Nerve Diseases / Q000151:congenital / Q000188:drug therapy* / Q000209:etiology; D020220:Facial Nerve Injuries / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D008046:Lip / Q000294:innervation; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects* / Q000503:physiopathology; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000601:surgery; D011832:Radiation Injuries / Q000188:drug therapy; D012008:Recurrence; D012189:Retrospective Studies
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A