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Favorable Outcome Perception in Facial Selective Neurectomy.

Tal Kaufman Goldberg1, John P Flynn1, Roy Xiao1

  • 1Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
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PubMed
Summary
This summary is machine-generated.

Facial selective neurectomy (SN) success in nonflaccid facial paralysis (NFFP) depends on specific smile metrics. Improved oral commissure excursion and lower lip movement, alongside reduced interlabial distance, significantly predict favorable outcomes perceived by facial nerve practitioners.

Keywords:
nonflaccid facial paralysisoutcome perceptionselective neurectomysynkinesis

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Area of Science:

  • Plastic Surgery
  • Neurology
  • Otolaryngology

Background:

  • Facial selective neurectomy (SN) is a surgical technique to improve facial function in nonflaccid facial paralysis (NFFP).
  • SN denervates muscles that oppose the smile, aiming to enhance symmetry and movement.
  • Objective assessment of factors influencing SN outcomes is crucial for patient counseling and surgical planning.

Purpose of the Study:

  • To determine which objective facial function metrics correlate with favorable outcomes after SN in NFFP patients.
  • To understand how facial nerve (FN) practitioners perceive SN success based on quantifiable facial movements.
  • To identify key indicators for successful facial reanimation surgery.

Main Methods:

  • Retrospective cohort study of NFFP patients undergoing SN.
  • Analysis of standardized preoperative and postoperative facial photographs using clinician-graded (eFACE) and automated (Emotrics) measurements.
  • Subjective ranking of favorable outcomes by three independent facial nerve practitioners.

Main Results:

  • Fifty-eight SN cases were analyzed.
  • Oral commissure excursion with smile, interlabial distance, and lower lip movement were significant predictors of favorable outcome.
  • Increased smile excursion (OR: 1.754) and lower lip movement (OR: 1.027) improved odds of favorable outcome, while increased interlabial distance asymmetry decreased them (OR: 0.753).

Conclusions:

  • Objective smile metrics, including smile excursion, interlabial distance, and lower lip movement, significantly influence the perception of successful SN outcomes by facial nerve practitioners.
  • These findings can aid surgeons and patients in managing expectations and planning surgical interventions for facial reanimation.
  • The identified metrics may be applicable to other facial reanimation procedures.