Early masseter to facial nerve transfer may improve smile excursion in facial paralysis

Shuhao Zhang, Austin Hembd, Christina W. Ching, Philip Tolley, Shai Rozen

Research output: Contribution to journalArticle

Abstract

Background: Masseter-to-facial nerve transfer has been shown to be an effective and safe treatment option in patients with acute and subacute facial palsy. The present article aims to characterize whether there is a benefit in early nerve transfers while minimizing other confounding variables; we present a study that consist of only patients with complete facial nerve paralysis resulting from intratemporal facial nerve resections. Methods: Between 2012 and 2016, 7 masseter-to-facial nerve transfers were performed for complete facial nerve palsy after intratemporal proximal nerve resections. Pre- and postoperative photographic and video evaluations were performed using both the Sunnybrook facial grading scale and the MEEI FACE-gram software for more objective metric measurements. Statistical analysis was performed to determine which patient and surgical variables had significant effects on outcome. Results: Mean 14-month follow-up revealed that patients who underwent nerve transfer prior to 6 months' denervation achieved postoperative oral commissural excursion of 11.1mm versus 6.5mm in patients who underwent nerve transfer after 6 months (P = 0.003). Performing masseter-to-facial nerve transfer to the main facial nerve trunk resulted in a significantly higher improvement in the modiolus-philtral ratio (31.6% versus 6.1%) than selective transfer in patients (P = 0.01) at the latest follow-up. Conclusions: Early masseter-to-facial nerve transfers, before 6 months of palsy duration, can potentially improve smile excursion and symmetry of open mouth smile. Additionally, truncal coaptations may provide improved tone over coapting to selective facial nerve branches. These findings necessitate larger studies regarding the importance of denervation time with fifth-to-seventh nerve transfers.

Original languageEnglish (US)
Article numbere2023
JournalPlastic and Reconstructive Surgery - Global Open
Volume6
Issue number11
DOIs
StatePublished - Jan 1 2018

Fingerprint

Nerve Transfer
Facial Paralysis
Facial Nerve
Denervation
Patient Transfer
Confounding Factors (Epidemiology)
Paralysis
Mouth
Software

ASJC Scopus subject areas

  • Surgery

Cite this

Early masseter to facial nerve transfer may improve smile excursion in facial paralysis. / Zhang, Shuhao; Hembd, Austin; Ching, Christina W.; Tolley, Philip; Rozen, Shai.

In: Plastic and Reconstructive Surgery - Global Open, Vol. 6, No. 11, e2023, 01.01.2018.

Research output: Contribution to journalArticle

Zhang, Shuhao ; Hembd, Austin ; Ching, Christina W. ; Tolley, Philip ; Rozen, Shai. / Early masseter to facial nerve transfer may improve smile excursion in facial paralysis. In: Plastic and Reconstructive Surgery - Global Open. 2018 ; Vol. 6, No. 11.
@article{35c2c1094bed460383fb7327af2c4d1c,
title = "Early masseter to facial nerve transfer may improve smile excursion in facial paralysis",
abstract = "Background: Masseter-to-facial nerve transfer has been shown to be an effective and safe treatment option in patients with acute and subacute facial palsy. The present article aims to characterize whether there is a benefit in early nerve transfers while minimizing other confounding variables; we present a study that consist of only patients with complete facial nerve paralysis resulting from intratemporal facial nerve resections. Methods: Between 2012 and 2016, 7 masseter-to-facial nerve transfers were performed for complete facial nerve palsy after intratemporal proximal nerve resections. Pre- and postoperative photographic and video evaluations were performed using both the Sunnybrook facial grading scale and the MEEI FACE-gram software for more objective metric measurements. Statistical analysis was performed to determine which patient and surgical variables had significant effects on outcome. Results: Mean 14-month follow-up revealed that patients who underwent nerve transfer prior to 6 months' denervation achieved postoperative oral commissural excursion of 11.1mm versus 6.5mm in patients who underwent nerve transfer after 6 months (P = 0.003). Performing masseter-to-facial nerve transfer to the main facial nerve trunk resulted in a significantly higher improvement in the modiolus-philtral ratio (31.6{\%} versus 6.1{\%}) than selective transfer in patients (P = 0.01) at the latest follow-up. Conclusions: Early masseter-to-facial nerve transfers, before 6 months of palsy duration, can potentially improve smile excursion and symmetry of open mouth smile. Additionally, truncal coaptations may provide improved tone over coapting to selective facial nerve branches. These findings necessitate larger studies regarding the importance of denervation time with fifth-to-seventh nerve transfers.",
author = "Shuhao Zhang and Austin Hembd and Ching, {Christina W.} and Philip Tolley and Shai Rozen",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/GOX.0000000000002023",
language = "English (US)",
volume = "6",
journal = "Plastic and Reconstructive Surgery - Global Open",
issn = "2169-7574",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "11",

}

TY - JOUR

T1 - Early masseter to facial nerve transfer may improve smile excursion in facial paralysis

AU - Zhang, Shuhao

AU - Hembd, Austin

AU - Ching, Christina W.

AU - Tolley, Philip

AU - Rozen, Shai

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Masseter-to-facial nerve transfer has been shown to be an effective and safe treatment option in patients with acute and subacute facial palsy. The present article aims to characterize whether there is a benefit in early nerve transfers while minimizing other confounding variables; we present a study that consist of only patients with complete facial nerve paralysis resulting from intratemporal facial nerve resections. Methods: Between 2012 and 2016, 7 masseter-to-facial nerve transfers were performed for complete facial nerve palsy after intratemporal proximal nerve resections. Pre- and postoperative photographic and video evaluations were performed using both the Sunnybrook facial grading scale and the MEEI FACE-gram software for more objective metric measurements. Statistical analysis was performed to determine which patient and surgical variables had significant effects on outcome. Results: Mean 14-month follow-up revealed that patients who underwent nerve transfer prior to 6 months' denervation achieved postoperative oral commissural excursion of 11.1mm versus 6.5mm in patients who underwent nerve transfer after 6 months (P = 0.003). Performing masseter-to-facial nerve transfer to the main facial nerve trunk resulted in a significantly higher improvement in the modiolus-philtral ratio (31.6% versus 6.1%) than selective transfer in patients (P = 0.01) at the latest follow-up. Conclusions: Early masseter-to-facial nerve transfers, before 6 months of palsy duration, can potentially improve smile excursion and symmetry of open mouth smile. Additionally, truncal coaptations may provide improved tone over coapting to selective facial nerve branches. These findings necessitate larger studies regarding the importance of denervation time with fifth-to-seventh nerve transfers.

AB - Background: Masseter-to-facial nerve transfer has been shown to be an effective and safe treatment option in patients with acute and subacute facial palsy. The present article aims to characterize whether there is a benefit in early nerve transfers while minimizing other confounding variables; we present a study that consist of only patients with complete facial nerve paralysis resulting from intratemporal facial nerve resections. Methods: Between 2012 and 2016, 7 masseter-to-facial nerve transfers were performed for complete facial nerve palsy after intratemporal proximal nerve resections. Pre- and postoperative photographic and video evaluations were performed using both the Sunnybrook facial grading scale and the MEEI FACE-gram software for more objective metric measurements. Statistical analysis was performed to determine which patient and surgical variables had significant effects on outcome. Results: Mean 14-month follow-up revealed that patients who underwent nerve transfer prior to 6 months' denervation achieved postoperative oral commissural excursion of 11.1mm versus 6.5mm in patients who underwent nerve transfer after 6 months (P = 0.003). Performing masseter-to-facial nerve transfer to the main facial nerve trunk resulted in a significantly higher improvement in the modiolus-philtral ratio (31.6% versus 6.1%) than selective transfer in patients (P = 0.01) at the latest follow-up. Conclusions: Early masseter-to-facial nerve transfers, before 6 months of palsy duration, can potentially improve smile excursion and symmetry of open mouth smile. Additionally, truncal coaptations may provide improved tone over coapting to selective facial nerve branches. These findings necessitate larger studies regarding the importance of denervation time with fifth-to-seventh nerve transfers.

UR - http://www.scopus.com/inward/record.url?scp=85065145885&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065145885&partnerID=8YFLogxK

U2 - 10.1097/GOX.0000000000002023

DO - 10.1097/GOX.0000000000002023

M3 - Article

VL - 6

JO - Plastic and Reconstructive Surgery - Global Open

JF - Plastic and Reconstructive Surgery - Global Open

SN - 2169-7574

IS - 11

M1 - e2023

ER -