Recent Advances in the Surgical Management of Facial Paralysis: A systematic review
Anusha Patil*1, Brandon Dexter1, Ariel Harsinay3, Richa Patel1, Timothy Olsen1, Safi Ali-Khan2, Jonathan Leckenby2
1University of Rochester School of Medicine and Dentistry, Rochester, NY; 2Department of Plastic Surgery, University of Rochester Medical Center, Rochester, NY; 3Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
Background: Facial palsy poses a challenge for the reconstructive surgeon. There is currently no conceivable method of restoring all 17 muscles of facial expression, nor can one reliably predict the outcome of available surgical procedures even when the same procedure is performed by the same surgeon. Unique craniofacial anatomy and the spectrum of possible functional and cosmetic deficits further complicate cases. This review serves to update reconstructive surgeons on the shifting landscape of surgical management of facial paralysis, and to elucidate the gaps that remain in the current literature to direct future research goals
Methods: The Pubmed database was reviewed according to PRISMA guidelines. Articles published between 2008-2022 were included. Publications not written in English, case reports, publications from nonscientific journals, cadaveric studies, and animal studies were excluded. A full-text review was performed on articles fulfilling selection criteria.
Results: The last 15 years have introduced us to novel surgical concepts and modifications to gold-standard techniques that improve both resting and dynamic symmetry but minimize donor-site morbidity. Less invasive surgical procedures and strategic placement minimize and conceal scarring that would otherwise disrupt movement and aesthetics. Multivector free flaps and vascularized nerve flaps offer dimensional movement while adding minimal bulk to the face. "˜Modified' selective neurectomy preserves a patient's natural spontaneous smile while reducing synkinetic phenomena. Extraoperative factors like biological sex and muscle volume transferred"”relative to donor nerve selection"”have been found to impact surgical outcomes. Lastly, ultrasound imaging allows for postoperative monitoring of buried free flaps.
Conclusion: While shared decision-making largely guides surgical approach, the current literature demonstrates the important role timing, donor nerve selection, and chosen muscle transposition play in surgical planning.
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