Paralyzing The Face To Make It More Normal
Mark D. DeLacure, MD
Institute of Reconstructive Plastic Surgery, New York University, New York, NY
In the course of the surgical treatment of head & neck malignancies, or of certain potentially threatening benign tumors, the need to intentionally transect or attenuate identifiable major nerves commonly presents itself. Along with this is the attendant acceptance of expected, predictable and often significant sacrifice of function and/or aesthetics. Most commonly, such issues involve the facial nerve or its branches. Head & neck oncologic surgeons often become desensitized to such decisions, and their sequelae and impact, over many years of practice.
Chemodenervation techniques are not a routine part of training at either the resident, or more importantly, subspecialty head & neck fellowship levels. As such, botulinum toxin injection remains largely relegated to the offices of facial plastic, aesthetic, or laryngology specialists within departments of otolaryngology and plastic surgery, and it is very rarely utilized among head & neck surgeons in dedicated oncology practices.
Advanced reconstructive techniques are not appropriate to all such patients, for a variety of reasons, some oncologic, some chronologic, and for reasons other. Despite the completion of formal additional training in plastic & reconstructive surgery, the author, only in recent years, has begin to actively integrate chemodenervation into the postoperative care of head & neck patients after over 2 decades of active full-time academic oncology practice.
This paper studies the experiences of the first 17 patients treated over the past 5 years, including injections within the first few weeks postoperative. Lessons learned, and the willingness and desire of such patients to seek follow-up injections, in the case of real or apparent permanent loss of function, underlines the importance of the issues raised above, and for a strong potential need in the truly comprehensive treatment and rehabilitation of head & neck patients. Implications for training the compleat head and neck and oncoplastic surgeons of the future are also explored.
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