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Smile Reanimation after Unilateral Facial Palsy by Lengthening Temporalis Myoplasty: Objective and Subjective Evaluation on 25 Cases

Foirest, Claire M.D.; Granger, Benjamin M.D.; Gatignol, Peggy; Bernat, Isabelle M.D.; Nguyen, Yann M.D., Ph.D.; Lamas, Georges M.D.; Tankere, Frederic M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 984e–993e
doi: 10.1097/PRS.0000000000003217
Reconstructive: Head and Neck: Original Articles

Background: Comparison of functional results of lengthening temporalis myoplasty relies in current practice on subjective scales. The goal of this study was to define a simple, reproducible, objective scale validated through a comparison with a subjective scale for smile symmetrization results after temporal muscle myoplasty.

Methods: A retrospective study was conducted on 25 patients having a unilateral facial palsy and rehabilitated with lengthening temporalis myoplasty. Evaluation consisted of objective measures: smile horizontal symmetry between left and right sides, vertical symmetry, and smile width on healthy and paretic sides on preoperative and postoperative photographs. Subjective scales were also used (i.e., a numeric scale and the Terzis and Noah scale) by a jury (four professionals and four nonprofessionals) and the patient himself or herself. Each evaluation was performed in three conditions: at rest, at intermediary smile, and at maximum smile.

Results: Comparison of objective measures on the impaired side showed a postoperative improvement in the three conditions evaluation. Reproducibility of the numeric scale was weak for evaluation at rest and fair for maximum smile evaluation (intraclass correlation coefficient of 0.57). The Terzis and Noah scale was not reproducible from one observer to another. At maximum smile, a correlation between smile symmetry in the vertical plane, smile symmetry in the horizontal plane, and professional evaluation with the numeric scale on the one hand and global patient satisfaction on the other hand was observed.

Conclusion: Postoperative smile horizontal symmetry between left and right sides, and smile vertical symmetry, are good indicators with which to assess postoperative results of facial palsy rehabilitation.

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Paris, France

From the Otolaryngology Department, the Department of Biostatistics, Public Health and Medical Information, and the Federation of Clinical Neurophysiology, AP-HP, Pitié-Salpêtrière Hospital; the Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, University Pierre and Marie Curie; and Inserm, UMR S-1159.

Received for publication June 11, 2015; accepted July 26, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Claire Foirest, M.D., Academic Department of Otolaryngology–Head and Neck Surgery, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, 75013 Paris, France,

©2017American Society of Plastic Surgeons