Surgical Smile Restoration Improves Quality of Life After Facial Paralysis

By Will Boggs MD

October 10, 2014

NEW YORK (Reuters Health) - Smile restoration using free gracilis muscle transfer helps improve the quality of life in patients who lost their smiles after facial nerve insult, researchers say.

High surgical success rates have been reported for free gracilis muscle transfer (FGMT), but the effect on disease-specific quality of life of successful smile reanimation surgery has not been investigated thoroughly, they say.

Dr. Robin W. Lindsay and colleagues from Massachusetts Eye and Ear Infirmary and Harvard Medical School in Boston used the Facial Clinimetric Evaluation (FaCE) scale, a validated patient-based measure of facial impairment and disability, to determine whether FGMT improves quality of life in 148 patients with facial paralysis.

Of the 154 FGMTs performed on these patients, 127 FGMTs on 124 patients (including three bilateral procedures) were deemed to be a success, the authors reported online October 2 in JAMA Facial Plastic Surgery.

Fourteen flaps (13 patients) were failures, and the remaining patients were not included in the analysis for various reasons.

Successful FGMT was associated with significant improvements in smile symmetry and significant increases in quality of life (as measured by the FaCE score).

Average FaCE scores improved in patients with flaccid paralysis and in patients with nonflaccid facial paralysis, regardless of whether they underwent cross-face nerve graft or innervation by the masseteric branch of the trigeminal nerve.

Patients in the "failure" group did not experience significant changes in quality of life after FGMT.

"FGMT has become a mainstay in the management armamentarium for patients with severe reduction in oral commissure movement after facial nerve insult and recovery," the researchers say.

"This study demonstrates a quantitative improvement in quality of life after successful FGMT in patients who failed to recover a meaningful smile after facial nerve insult," the investigators conclude. "Quality-of-life improvement was not statistically different between donor nerve groups or between patients with flaccid and nonflaccid facial paralysis."

Dr. Shai Rozen directs the facial palsy program at UT Southwestern Medical Center, Dallas, Texas. He told Reuters Health, "Very satisfactory results may be obtained in these patients, and there is hope. They need to be seen in centers where experience has been gained over the years and the treatment plan is then tailored to them."

"It is available in very few centers as in Boston, UTSW in Dallas, Toronto, and a few more, where individual surgeons have set up a multidisciplinary team and dedicate themselves to treatment of such problems," Dr. Rozen said. "We get quite a few patients from over the country and outside, who had subpar results due to inexperience of their caretakers."

"Referring physicians need to be educated about the options that are available," Dr. Rozen said. "It may involve sending them out of state, but experienced centers with multidisciplinary teams can actually evaluate some patients within a few days."

"As for surgeons who are considering performing these surgeries, great, but . . . one should have conviction that this is what they want to dedicate a good portion of their career, since inexperience can often do more harm than good," he said.

Dr. Lindsay did not respond to a request for comments.


JAMA Facial Plast Surg 2014.


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