title: Lengthening temporalis myoplasty versus hypoglossal-facial nerve coaptation in the surgical rehabilitation of facial palsy: evaluation by medical and nonmedical juries and patient-assessed quality of life.
abstract: BACKGROUND
  To compare the results of 2 techniques of facial rehabilitation, lengthening temporalis myoplasty and 2 types of hypoglossal-facial (XII-VII) coaptation as evaluated by medical and nonmedical teams and patient self-assessment of quality of life (QOL).
  
  
  METHODS
  Videos of 42 consecutive patients with complete facial palsy who underwent surgery from 1998 to 2005 were reviewed. Facial rehabilitation was by temporalis myoplasty (n = 10) or by XII-VII coaptation (n = 32) either end-to-end (n = 16) or end-to-side with a jump interpositional graft (n = 16). Evaluation was by (i) a medical jury using 4 facial nerve grading systems and 3 other measurements for the face at rest and during voluntary and emotional motions, (ii) a nonmedical jury using the 3 measures described above, and (iii) patient self-assessment of QOL by questionnaires.
  
  
  RESULTS
  Whatever the grading systems used, the medical jury rated facial rehabilitation with XII-VII coaptation better than myoplasty. Scores did not differ between the 2 types of coaptation: synkinesis was severe with end-to-end and almost absent with end-to-side coaptation. However, muscle tone was stronger in the end-to-end than end-to-side coaptation. The nonmedical jury considered that XII-VII coaptation, whatever the type, led to better results than myoplasty. Patients in all groups considered their QOL improved by surgery, whatever the format, with no significant differences between the groups.
  
  
  CONCLUSIONS
  This study revealed XII-VII coaptation with better results than myoplasty. End-to-end coaptation should be restricted to patients with a strong emotional expression or those with a long-standing facial palsy because it provides a strong muscle tone but significant synkinesis.
authors.affiliation: Department of Oto-Rhino-Laryngology, Lariboisiere Hospital, Paris, France.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Kecskes
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.forename: Romain
authors.initials: R
authors.lastname: Kania
authors.forename: Didier
authors.initials: D
authors.lastname: Salvan
authors.forename: Wissame
authors.initials: W
authors.lastname: El Bakkouri
authors.forename: Patrice Tran Ba
authors.initials: PT
authors.lastname: Huy
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sauvaget
mesh_terms: D000328:Adult; D000368:Aged; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D013506:Otologic Surgical Procedures; D011379:Prognosis; D011788:Quality of Life; D013701:Temporal Bone / Q000601:surgery*