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Dynamic smile reanimation in facial nerve palsy

Journal of the Korean Association of Oral and Maxillofacial Surgeons / Journal of the Korean Association of Oral and Maxillofacial Surgeons, (P)2234-7550; (E)2234-5930
2020, v.46 no.2, pp.143-149
https://doi.org/10.5125/jkaoms.2020.46.2.143
Krishnakumar Krishnan Santha (Aster MIMS Hospital)
Subin Joseph (Baby Memorial Hospital, Kozhikode)
Sameer Latheef (Baby Memorial Hospital, Kozhikode)
Saju Narayanan (Aster MIMS Hospital)
Santhy Mohanachandran Nair (Baby Memorial Hospital, Kozhikode)
Bibilash Babu (Aster MIMS Hospital)
Anand Sivadasan (Baby Memorial Hospital, Kozhikode)
Srivatsa Manjunath Shet (Baby Memorial Hospital, Kozhikode)
Rajesh Vardhan Pydi (Baby Memorial Hospital, Kozhikode)
Ajit Pati (Aster MIMS Hospital)
Srikant Aruna Samantaray (Baby Memorial Hospital, Kozhikode)

Abstract

Objectives: Long-term facial paralysis results in degeneration of the distal nerve segment and atrophy of the supplied muscles. Options for these patients include free muscle transfer, temporalis myoplasty, and botulinum toxin injections for smile reanimation. In this study we aimed to evaluate the subjective and objective outcomes of these procedures. Materials and Methods: In our study, we retrospectively analyzed smile symmetry in patients with facial palsy (n=8) who underwent facial reanimation procedures. Results: Subjective analysis showed high satisfaction in seven out of eight patients. Objective analysis showed statistically significant improvement postoperatively in both vertical and horizontal smile symmetry at rest and during maximum smile (P<0.001). Conclusion: Choosing the ideal procedure for the patients is the most critical aspect for facial reanimation. Though free muscle transfer is considered gold standard procedure, temporalis myoplasty also gives satisfactory results. Residual synkinesis which can lead to disturbing aesthetic deformity can be effectively treated with botulinum toxin.

keywords
Facial nerve, Free tissue flaps, Smiling, Temporal muscle, Botulinum toxins

Journal of the Korean Association of Oral and Maxillofacial Surgeons