Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2020; 53(03): 344-348
DOI: 10.1055/s-0040-1721877
Original Article

Inveterated Facial Palsy Correction with Endoscopically Assisted Multiple Muscle Transposition and Lifts: The EMTL Procedure

Marco Borsetti
1   Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
,
Ezio Nicola Gangemi 
1   Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
,
Silvia Germano
1   Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
,
Alessandra Clemente
1   Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
,
Luca Devalle
1   Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
,
Claudia Cerato
1   Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
,
Giorgio Merlino
1   Division of Plastic Surgery, Hand Surgery and Microsurgery, Surgical Department of ASL Città di Torino, Maria Vittoria Hospital, Turin, Italy
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

Abstract

Introduction The aim of the present analysis was to study the safety and efficacy associated with reanimation in facial nerve palsy by the endoscopically assisted multiple muscle transposition and lifts (EMTL).

Patients and Methods The study sample included all patients who had undergone a facial reanimation by EMTL procedure from September 2015 to May 2019. The patients were analyzed retrospectively, with more than 1 year of follow-up, and were evaluated in terms of functional-aesthetic results and postoperative complications. The outcome was evaluated with the Sunnybrook scale.

Results Fourteen patients were included in the present study. They were all inveterate palsies with minimum 4 years from the initial injury. The preoperative Sunnybrook score ranged from 0 to 5 and the postoperative ranged from 30 to 65. Spontaneous smile achievement was obtained in 10 patients and only mild restoration in one patient. The scar and static correction were satisfactory in all patients. Eye protection was improved in all cases with some form of active blinking in six cases.

Conclusion This study showed that facial palsy correction with EMTL procedure offers a promising alternative treatment for patients with facial palsy not suitable for microsurgical muscle transposition.

Keywords

facial palsy - endoscopic - reanimation


Publication History

Article published online:
24 December 2020

© 2020. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Bos R, Reddy SG, Mommaerts MY. Lengthening temporalis myoplasty versus free muscle transfer with the gracilis flap for long-standing facial paralysis: a systematic review of outcomes. J Craniomaxillofac Surg 2016; 44 (08) 940-951
    CrossrefPubMedSearch in Google Scholar
  • 2 Panossian A. Lengthening temporalis tyoplasty for single-stage smile reconstruction in children with facial paralysis. Plast Reconstr Surg 2016; 137 (04) 1251-1261
    CrossrefPubMedSearch in Google Scholar
  • 3 Nduka C, Hallam MJ, Labbè D. Refinements in smile reanimation: 10-year experience with the lengthening temporalis myoplasty. J Plast Reconstr Aesthet Surg 2012; 65 (07) 851-856
    CrossrefPubMedSearch in Google Scholar
  • 4 Moubayed SP, Labbé D, Rahal A. Lengthening temporalis myoplasty for facial paralysis reanimation: an objective analysis of each surgical step. JAMA Facial Plast Surg 2015; 17 (03) 179-182
    CrossrefPubMedSearch in Google Scholar
  • 5 Nahai F, Saltz R. Endoscopic Plastic Surgery. 2nd ed. New York: Thieme Medical Publishers; 2008. chapter 4
    CrossrefSearch in Google Scholar
  • 6 Gupta AK, Jain S. Temporalis muscle sling revisited: a technique to restore ocular sphincter function. Ann Plast Surg 1994; 33 (05) 496-499
    CrossrefPubMedSearch in Google Scholar
  • 7 Boahene KD, Farrag TY, Ishii L, Byrne PJ. Minimally invasive temporalis tendon transposition. Arch Facial Plast Surg 2011; 13 (01) 8-13
    CrossrefPubMedSearch in Google Scholar
  • 8 Conley J, Baker DC, Selfe RW. Paralysis of the mandibular branch of the facial nerve. Plast Reconstr Surg 1982; 70 (05) 569-577
    CrossrefPubMedSearch in Google Scholar
  • 9 Fattah AY, Gurusinghe ADR, Gavilan J. et al. Sir Charles Bell Society. Facial nerve grading instruments: systematic review of the literature and suggestion for uniformity. Plast Reconstr Surg 2015; 135 (02) 569-579
    CrossrefPubMedSearch in Google Scholar
  • 10 Berner JE, Kamalathevan P, Kyriazidis I, Nduka C. Facial synkinesis outcome measures: A systematic review of the available grading systems and a Delphi study to identify the steps towards a consensus. J Plast Reconstr Aesthet Surg 2019; 72 (06) 946-963
    CrossrefPubMedSearch in Google Scholar
  • 11 Hontanilla B, Olivas J, Cabello Á, Marré D. Cross-face nerve grafting versus masseteric-to-facial nerve transposition for reanimation of incomplete facial paralysis: a comparative study using the FACIAL CLIMA evaluating system. Plast Reconstr Surg 2018; 142 (02) 179e-191e
    CrossrefPubMedSearch in Google Scholar
  • 12 Labbè D, Bussu F, Iodice A. A comprehensive approach to long-standing facial paralysis based on lengthening temporalis myoplasty. Acta Otorhinolaryngol Ital 2012; 32 (03) 145-153
    PubMedSearch in Google Scholar