Secondary surgery in adult facial paralysis reanimation

The series presented constitutes the entire experience with adult facial paralysis reanimation by a single surgeon over three decades. This report discusses the different reconstructive strategies used in this sample, focusing on the incidence and outcomes of commonly used revisional and ancillary procedures.

Since 1979, 175 adult cases of facial paralysis underwent facial reanimation surgery performed by the senior author (J.K.T.). The reconstructive strategies varied in accordance with denervation time, cause, and whether the paralysis was complete or partial and unilateral or bilateral. Irrespective of these variables, the number of patients who required secondary surgery totaled 141 of 175 (81 percent). Postrevision videos were available in 122 patients, who constituted the sample evaluated. Four independent observers rated the outcomes of secondary surgery using a five-category scale ranging from poor to excellent.

Interrater reliability testing showed Cronbach's alpha values above acceptable limits (alpha > 0.80). The effect of diverse revisional and ancillary interventions was measured computing a mean gain percentage score. Secondary surgery yielded a significant upgrade in symmetry and function, with appreciable improvements in all three facial regions (upper face, 28 to 166 percent gain; midface, 33 to 72 percent gain; and lower face, 20 to 127 percent gain).

This comprehensive analysis of the entire series of adult reanimation in the authors' center evidences the beneficial effects of revisional and ancillary interventions to augment function and overall symmetry. Inherent in all methods of dynamic reanimation is the need for secondary adjustments, which should be considered in most cases, as they can transform an adequate result into a gratifying outcome.