Qualitative and Quantitative Analysis of Smile Excursion in Facial Reanimation: A Systematic Review and Meta-analysis of 1- Versus 2-stage Procedures

Overview

Journal Plast Reconstr Surg Glob Open

Specialty General Surgery

Date 2018 Apr 11

PMID 29632792

Citations 4

Authors

Hamidreza Natghian

Jian Fransen

Shai M Rozen

Andres Rodriguez-Lorenzo

Affiliations

Soon will be listed here.

Abstract

Background: Free functional muscle transfer has become a common treatment modality for smile restoration in long-lasting facial paralysis, but the selection of surgical strategy between a 1-stage and a 2-stage procedure has remained a matter of debate. The aim of this study was to compare the quantitative and qualitative outcomes of smile excursion between 1-stage and 2-stage free muscle transfers in the literature.

Methods: A comprehensive review of the published literature between 1975 and end of January 2017 was conducted.

Results: The abstracts or titles of 2,743 articles were screened. A total of 24 articles met our inclusion criteria of performing a quantitative or qualitative evaluation of a free-functioning muscle transfer for smile restoration. For the purpose of meta-analysis, 7 articles providing quantitative data on a total of 254 patients were included. When comparing muscle excursion between 1-stage and 2-stage procedures, the average range of smile excursion was 11.5 mm versus 6.6 mm, respectively. For the purpose of systematic review, 17 articles were included. The result of the systematic review suggested a tendency toward superior functional results for the 1-stage procedure when comparing the quality of smile.

Conclusions: The results of this review must be interpreted with great caution. Quantitative analysis suggests that 1-stage procedures produce better excursion than 2-stage procedures. Qualitative analysis suggests that 1-stage procedures might also produce superior results when based on excursion and symmetry alone, but these comparisons do not include one important variable dictating the quality of a smile-the spontaneity of the smile. The difficulty in comparing published results calls for a consensus classification system for facial palsy.

Citing Articles

Novel Method of Dual-innervated Free Gracilis Muscle Transfer for Facial Reanimation: A Case Series.

Hebel N, Boonipat T, Robertson C, Asaad M, Meaike J, Gibreel W Plast Reconstr Surg Glob Open. 2023; 11(12):e5388.

PMID: 38074495 PMC: 10703116. DOI: 10.1097/GOX.0000000000005388.

A Ready-to-Use Grading Tool for Facial Palsy Examiners-Automated Grading System in Facial Palsy Patients Made Easy.

Knoedler L, Miragall M, Kauke-Navarro M, Obed D, Bauer M, Tissler P J Pers Med. 2022; 12(10).

PMID: 36294878 PMC: 9605133. DOI: 10.3390/jpm12101739.

Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature.

Kim S, Lee H J Korean Med Sci. 2020; 35(30):e245.

PMID: 32743989 PMC: 7402921. DOI: 10.3346/jkms.2020.35.e245.

A Rapid Protocol for Intraoperative Assessment of Peripheral Nerve Myelinated Axon Count and Its Application to Cross-Facial Nerve Grafting.

Wang W, Kang S, Hernandez I, Jowett N Plast Reconstr Surg. 2019; 143(3):771-778.

PMID: 30601328 PMC: 7147971. DOI: 10.1097/PRS.0000000000005338.

References

Wei W, Zuoliang Q, Xiaoxi L, Jiasheng D, Chuan Y, Hussain K . Free split and segmental latissimus dorsi muscle transfer in one stage for facial reanimation. Plast Reconstr Surg. 1999; 103(2):473-80; discussion 481-2. DOI: 10.1097/00006534-199902000-00016. View

Manktelow R, Tomat L, Zuker R, Chang M . Smile reconstruction in adults with free muscle transfer innervated by the masseter motor nerve: effectiveness and cerebral adaptation. Plast Reconstr Surg. 2006; 118(4):885-899. DOI: 10.1097/01.prs.0000232195.20293.bd. View

Snyder-Warwick A, Fattah A, Zive L, Halliday W, Borschel G, Zuker R . The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density. Plast Reconstr Surg. 2015; 135(2):370e-381e. DOI: 10.1097/PRS.0000000000000860. View

OBrien B, Pederson W, Khazanchi R, Morrison W, MacLeod A, Kumar V . Results of management of facial palsy with microvascular free-muscle transfer. Plast Reconstr Surg. 1990; 86(1):12-22; discussion 23-4. View

Hontanilla B, Auba C . Automatic three-dimensional quantitative analysis for evaluation of facial movement. J Plast Reconstr Aesthet Surg. 2007; 61(1):18-30. DOI: 10.1016/j.bjps.2007.03.037. View

Momeni A, Chang J, Khosla R . Microsurgical reconstruction of the smile--contemporary trends. Microsurgery. 2012; 33(1):69-76. DOI: 10.1002/micr.22042. View

Hayashi A, Maruyama Y . Neurovascularized free short head of the biceps femoris muscle transfer for one-stage reanimation of facial paralysis. Plast Reconstr Surg. 2005; 115(2):394-405. DOI: 10.1097/01.prs.0000149405.89201.9e. View

Hontanilla B, Marre D, Cabello A . Facial reanimation with gracilis muscle transfer neurotized to cross-facial nerve graft versus masseteric nerve: a comparative study using the FACIAL CLIMA evaluating system. Plast Reconstr Surg. 2013; 131(6):1241-1252. DOI: 10.1097/PRS.0b013e31828bd4da. View

OBrien B, Franklin J, Morrison W . Cross-facial nerve grafts and microneurovascular free muscle transfer for long established facial palsy. Br J Plast Surg. 1980; 33(2):202-15. DOI: 10.1016/0007-1226(80)90013-2. View

10.

Bae Y, Zuker R, Manktelow R, Wade S . 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. Plast Reconstr Surg. 2006; 117(7):2407-13. DOI: 10.1097/01.prs.0000218798.95027.21. View

11.

Bray D, Henstrom D, Cheney M, Hadlock T . Assessing outcomes in facial reanimation: evaluation and validation of the SMILE system for measuring lip excursion during smiling. Arch Facial Plast Surg. 2010; 12(5):352-4. DOI: 10.1001/archfacial.2010.69. View

12.

Koshima I, Tsuda K, Hamanaka T, Moriguchi T . One-stage reconstruction of established facial paralysis using a rectus abdominis muscle transfer. Plast Reconstr Surg. 1997; 99(1):234-8. DOI: 10.1097/00006534-199701000-00036. View

13.

Tzou C, Chuang D, Chen H . Facial paralysis grading system: a new and simple smile excursion score for evaluating facial reanimation surgery. Ann Plast Surg. 2013; 74(2):210-3. DOI: 10.1097/SAP.0b013e318295dec2. View

14.

Faria J, Scopel G, Busnardo F, Ferreira M . Nerve sources for facial reanimation with muscle transplant in patients with unilateral facial palsy: clinical analysis of 3 techniques. Ann Plast Surg. 2007; 59(1):87-91. DOI: 10.1097/01.sap.0000252042.58200.c3. View

15.

IJpma F, Nicolai J, Meek M . Sural nerve donor-site morbidity: thirty-four years of follow-up. Ann Plast Surg. 2006; 57(4):391-5. DOI: 10.1097/01.sap.0000221963.66229.b6. View

16.

Manktelow R, Zuker R, Tomat L . Facial paralysis measurement with a handheld ruler. Plast Reconstr Surg. 2008; 121(2):435-442. DOI: 10.1097/01.prs.0000297648.90717.bd. View

17.

Harii K, Ohmori K, Torii S . Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg. 1976; 57(2):133-43. DOI: 10.1097/00006534-197602000-00001. View

18.

Gousheh J, Arasteh E . Treatment of facial paralysis: dynamic reanimation of spontaneous facial expression-apropos of 655 patients. Plast Reconstr Surg. 2011; 128(6):693e-703e. DOI: 10.1097/PRS.0b013e318230c58f. View

19.

Terzis J, Noah M . Analysis of 100 cases of free-muscle transplantation for facial paralysis. Plast Reconstr Surg. 1997; 99(7):1905-21. DOI: 10.1097/00006534-199706000-00016. View

20.

Vinod Kumar P, Hassan K . Cross-face nerve graft with free-muscle transfer for reanimation of the paralyzed face: a comparative study of the single-stage and two-stage procedures. Plast Reconstr Surg. 2002; 109(2):451-62; discussion 463-4. DOI: 10.1097/00006534-200202000-00006. View