title: Outcome of a graduated minimally invasive facial reanimation in patients with facial paralysis.
abstract: Peripheral paralysis of the facial nerve is the most frequent of all cranial nerve disorders. Despite advances in facial surgery, the functional and aesthetic reconstruction of a paralyzed face remains a challenge. Graduated minimally invasive facial reanimation is based on a modular principle. According to the patients' needs, precondition, and expectations, the following modules can be performed: temporalis muscle transposition and facelift, nasal valve suspension, endoscopic brow lift, and eyelid reconstruction. Applying a concept of a graduated minimally invasive facial reanimation may help minimize surgical trauma and reduce morbidity. Twenty patients underwent a graduated minimally invasive facial reanimation. A retrospective chart review was performed with a follow-up examination between 1 and 8 months after surgery. The FACEgram software was used to calculate pre- and postoperative eyelid closure, the level of brows, nasal, and philtral symmetry as well as oral commissure position at rest and oral commissure excursion with smile. As a patient-oriented outcome parameter, the Glasgow Benefit Inventory questionnaire was applied. There was a statistically significant improvement in the postoperative score of eyelid closure, brow asymmetry, nasal asymmetry, philtral asymmetry as well as oral commissure symmetry at rest (p < 0.05). Smile evaluation revealed no significant change of oral commissure excursion. The mean Glasgow Benefit Inventory score indicated substantial improvement in patients' overall quality of life. If a primary facial nerve repair or microneurovascular tissue transfer cannot be applied, graduated minimally invasive facial reanimation is a promising option to restore facial function and symmetry at rest.
authors.affiliation: Department of Otorhinolaryngology, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany. laura.holtmann@uk-essen.de.
authors.forename: Laura C
authors.identifier: http://orcid.org/0000-0003-0908-4119
authors.initials: LC
authors.lastname: Holtmann
authors.affiliation: Department Neuroophthalmology, Strabism and Oculoplastics, University Eye Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Eckstein
authors.affiliation: Department of Otorhinolaryngology, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Stähr
authors.affiliation: Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, P.O. Box 208042, New Haven, CT, 06510, USA.
authors.forename: Minzhi
authors.initials: M
authors.lastname: Xing
authors.affiliation: Department of Otorhinolaryngology, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Lang
authors.affiliation: Department of Otorhinolaryngology, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Mattheis
mesh_terms: D000328:Adult; D005145:Face / Q000503:physiopathology / Q000601:surgery; D005149:Facial Expression; D005158:Facial Paralysis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013703:Temporal Muscle / Q000601:surgery
keywords: Facial paralysis; Facial reanimation; Smile restoration; Temporalis muscle transfer