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Spontaneity Assessment In Dually Innervated Gracilis Smile Reanimation Surgery.

J. Dusseldorp, Martinus M. van Veen, D. L. Guarín, Olivia E Quatela, Nate Jowett, T. Hadlock
Published 2019 · Medicine

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Importance Surgeons have sought to optimize outcomes of smile reanimation surgery by combining inputs from nerve-to-masseter and cross-face nerve grafts. An objective assessment tool could help surgeons evaluate outcomes to determine the optimal neural sources for smile reanimation. Objective To evaluate the use of a novel video time-stamping method and standard outcome measurement tools to assess outcomes of facial reanimation surgery using various innervation strategies. Design, Setting, and Participants Cohort study assessing the outcomes of dually innervated gracilis free muscle transfers vs single-source innervated gracilis transfer performed at a tertiary care facial nerve center between 2007 and 2017 using a novel, video time-stamping spontaneity assessment method. The statistical analyses were performed in 2018. Interventions Dually innervated gracilis free muscle transfers or single-source innervated gracilis transfer. Main Outcomes and Measures Spontaneous smiling was assessed by clinicians and quantified using blinded time-stamped video recordings of smiling elicited while viewing humorous video clips. Results This retrospective cohort study included 25 patients (12 men and 13 women; median [range] age, 38.4 [29.3-46.0] years) treated with dually innervated gracilis free functional muscle graft for unilateral facial palsy between 2007 and 2017. Smile spontaneity assessment was performed in 17 patients and was compared with assessment performed in 24 patients treated with single-source innervated gracilis transfer (ie, nerve-to-masseter-driven or cross-face nerve graft-driven gracilis [n = 13]) (demographic data not available for NTM and CFNG cohorts). The use of time-stamped video assessment revealed that spontaneous synchronous oral commissure movement in a median percentage of smiles was 33% in patients with dually innervated gracilis (interquartile range [IQR], 0%-71%), 20% of smiles in patients with nerve-to-masseter-driven gracilis (IQR, 0%-50%), and 75% of smiles in patients with cross-face nerve graft-driven gracilis (IQR, 0%-100%). Clinicians graded smile spontaneity in dually innervated cases as absent in 40% (n = 6 of 15), trace in 33% (n = 5 of 15) and present in 27% (n = 4 of 15). No association was demonstrated between clinician-reported spontaneity and objectively measured synchronicity. Conclusions and Relevance Dually innervated gracilis free muscle transfers may improve smile spontaneity compared with masseteric nerve-driven transfers but not to the level of cross-face nerve graft-driven gracilis transfers. Quantifying spontaneity is notoriously difficult, and most authors rely on clinical assessment. Our results suggest that clinicians may rate presence of spontaneity higher than objective measures, highlighting the importance of standardized assessment techniques. Level of Evidence 4.
This paper references
Facial Reanimation with Gracilis Muscle Transfer Neurotized to Cross-Facial Nerve Graft versus Masseteric Nerve: A Comparative Study Using the FACIAL CLIMA Evaluating System
B. Hontanilla (2013)
A Comparison of Commissure Excursion following Gracilis Muscle Transplantation for Facial Paralysis Using a Cross-Face Nerve Graft versus the Motor Nerve to the Masseter Nerve
Yong-Chan Bae (2006)
Photographic Standards for Patients With Facial Palsy and Recommendations by Members of the Sir Charles Bell Society
Katherine B Santosa (2017)
Development and validation of a spontaneous smile assay.
Carlo Iacolucci (2015)
Latero-terminal neurorrhaphy without removal of the epineural sheath. Experimental study in rats.
F. Viterbo (1992)
Pre-operative masseter muscle EMG activation during smile predicts synchronicity of smile development in facial palsy patients undergoing reanimation with the masseter nerve: A prospective cohort study✰.
Y. Lenz (2019)
One-stage dual latissimus dorsi muscle flap transfer with a pair of vascular anastomoses and double nerve suturing for long-standing facial paralysis.
M. Okazaki (2015)
Reversing the Outcome of Synapse Elimination at Developing Neuromuscular Junctions In Vivo: Evidence for Synaptic Competition and Its Mechanism
S. G. Turney (2012)
A Machine Learning Approach for Automated Facial Measurements in Facial Palsy.
D. L. Guarín (2018)
Double innervation in free-flap surgery for long-standing facial paralysis.
F. Biglioli (2012)
Clinician-Graded Electronic Facial Paralysis Assessment: The eFACE
C. Banks (2015)
Double-powered free gracilis muscle transfer for smile reanimation: A longitudinal optoelectronic study.
C. Sforza (2015)
Double innervated free functional muscle transfer for facial reanimation
A. Cárdenas-Mejía (2015)
Activation of the masseter muscle during normal smile production and the implications for dynamic reanimation surgery for facial paralysis.
M. Schaverien (2011)
Reverse end-to-side neurotization.
J. Isaacs (2005)
Validation of a Patient‐Graded Instrument for Facial Nerve Paralysis: The FaCE Scale
J. B. Kahn (2001)
Involuntary Movement during Mastication in Patients with Long-Term Facial Paralysis Reanimated with a Partial Gracilis Free Neuromuscular Flap Innervated by the Masseteric Nerve
S. Rozen (2013)
Spasticity after stroke: Physiology, assessment and treatment
A. Thibaut (2013)
Analysis of 100 Cases of Free‐Muscle Transplantation for Facial Paralysis
J. Terzis (1997)
Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation.
J. Barbour (2012)
The Success of Free Gracilis Muscle Transfer to Restore Smile in Patients With Nonflaccid Facial Paralysis
R. Lindsay (2014)
The Supercharge End-to-Side Anterior Interosseous–to–Ulnar Motor Nerve Transfer for Restoring Intrinsic Function: Clinical Experience
K. Davidge (2015)
Patient experience in nerve-to-masseter-driven smile reanimation.
Martinus M. van Veen (2019)
Spontaneity of smile after facial paralysis rehabilitation when using a non-facial donor nerve.
B. Hontanilla (2016)
End‐to‐Side Neurorrhaphy with Removal of the Epineurial Sheath: An Experimental Study in Rats
F. Viterbo (1994)
Objective outcomes analysis following microvascular gracilis transfer for facial reanimation: a review of 10 years' experience.
P. Bhama (2014)
Double innervation (facial/masseter) sur le lambeau gracile dans les réanimations du tiers moyen de la face lors de la prise en charge des paralysies faciales : nouveau concept
F. Biglioli (2013)
[Double innervation (facial/masseter) on the gracilis flap, in the middle face reanimation in the management of facial paralysis: a new concept].
F. Biglioli (2013)
Dual innervation method using one-stage reconstruction with free latissimus dorsi muscle transfer for re-animation of established facial paralysis: simultaneous reinnervation of the ipsilateral masseter motor nerve and the contralateral facial nerve to improve the quality of smile and emotional faci
Y. Watanabe (2009)
A technicolour approach to the connectome
J. Lichtman (2008)
The Degree of Facial Movement following Microvascular Muscle Transfer in Pediatric Facial Reanimation Depends on Donor Motor Nerve Axonal Density
Alison K Snyder-Warwick (2015)

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