Neurotization Preferences in Smile Reanimation: A Discrete Choice Experiment

Area of Science:

• Plastic Surgery
• Neurosurgery
• Decision Science

Background:

• Smile reanimation surgery aims to restore facial symmetry and function in patients with facial paralysis.
• Common donor nerve options include the ipsilateral trigeminal motor nerve and contralateral facial nerve branches.
• Patient preference for neurotization strategies is influenced by various factors, but their relative importance is unclear.

Purpose of the Study:

• To assess decision-making factors in smile reanimation surgery using a stated preference model.
• To determine the relative importance of different attributes influencing patient choice between trigeminal and cross-facial neurotization.

Main Methods:

• Qualitative interviews identified key attributes: smile type, number of operations, success rates, complication rates, and side effects.
• A discrete-choice experiment was conducted with 250 community volunteers evaluating simulated free muscle transfer scenarios.
• Hierarchical Bayes estimation modeled attribute importance based on participant choices.

Main Results:

• The chance of success (37.3%) was the most critical factor, followed by smile type (21.4%).
• Most participants (67.6%) preferred cross-facial neurotization over trigeminal neurotization, assuming an 80% success rate for cross-facial.
• Trigeminal neurotization was preferred when the cross-facial success rate dropped below 67%.

Conclusions:

• A majority of respondents favored cross-facial neurotization for smile reanimation, even with a higher perceived failure risk.
• Decision-making in smile reanimation is complex, involving a trade-off between different surgical outcomes and risks.
• Individualized assessment of risk tolerance is crucial for guiding treatment choices in facial reanimation.