title: Botulinum Toxin Therapy versus Anterior Belly of Digastric Transfer in the Management of Marginal Mandibular Branch of the Facial Nerve Palsy: A Patient Satisfaction Survey.
abstract: BACKGROUND
  Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy.
  
  
  METHODS
  Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant.
  
  
  RESULTS
  Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01).
  
  
  CONCLUSIONS
  BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Butler
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Jo I
authors.initials: JI
authors.lastname: Leckenby
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Ben H
authors.initials: BH
authors.lastname: Miranda
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK.
authors.forename: Adriaan O
authors.initials: AO
authors.lastname: Grobbelaar
keywords: Botulinum toxins; Facial asymmetry; Facial paralysis