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Experience with 60 Adult Patients with Facial Paralysis Secondary to Tumor Extirpation

Terzis, Julia K. M.D., Ph.D.; Konofaos, Petros M.D.

Plastic & Reconstructive Surgery: July 2012 - Volume 130 - Issue 1 - p 51e–66e
doi: 10.1097/PRS.0b013e318254b149
Reconstructive: Head and Neck: Original Article

Background: The aim of this study was to present the authors' experience with facial reanimation in adult patients following tumor extirpation and to analyze the functional outcomes.

Methods: From 1978 to 2006, 60 adult patients underwent facial reanimation for facial paralysis following tumor extirpation. There was one patient with bilateral facial paralysis. Thus, evaluation was carried out in 61 hemifaces. Three independent assessors evaluated the preoperative and postoperative videos using the Terzis grading scale for eye closure, smile, depressor, and overall aesthetic and functional outcomes. Preoperative and postoperative electromyographic interpretations and the effect of demographic variables were also evaluated.

Results: There was significant improvement regarding preoperative versus postoperative outcomes for overall aesthesis and function. Good and excellent results were observed in 72.14 percent of the hemifaces (n = 44). The difference between preoperative and postoperative electromyographic results was of statistical significance (p < 0.0001) for each target reinnervated. Better results were observed in younger patients (≤35 years) (p = 0.023) and in early cases (p = 0.019).

Conclusions: The results of this present series illustrate that age and denervation time correlate with the final functional outcome. Cross-facial nerve grafts should ideally be used in patients with denervation time less than 6 months or more than 2 years combined with muscle transfers. In patients with a denervation time between 6 months and 2 years, the use of the babysitter procedure can yield a superior outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Long Island City, N.Y.; and Norfolk, Va.

From the Department of Plastic Surgery, New York University Medical Center, and the International Institute of Reconstructive Microsurgery, and the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Microsurgical Research Center.

Received for publication August 5, 2011; accepted January 20, 2012.

Disclosure: Neither of the authors has received or will receive financial compensation in any form from a commercial party related directly or indirectly to the subject of this article.

Julia K. Terzis, M.D., Ph.D.; International Institute of Reconstructive Microsurgery, 27-28 Thompson Avenue, Suite 620, Long Island City, N.Y. 11101, jktmd1@aol.com

©2012American Society of Plastic Surgeons