American Society for Peripheral Nerve

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Smile reconstruction in flaccid facial paralysis optimization of oral symmetry by combining static and dynamic techniques
Jurij Kiefer, M.D.1, G. Bjoern Stark, M.D.2 and Steffen U. Eisenhardt, M.D.2
1Department of Hand-, Plastic- and Reconstructive Surgery, Burn/Trauma Center, Plastic-and Hand Surgery University of Heidelberg, Medical Center, University of Freiburg, Freiburg, Germany, 2Medical Center, University of Freiburg, Freiburg, Germany

Background
With increasing skin laxity and soft tissue ptosis, the functionality and aesthetics of the oral region worsen notably in patients with long-standing facial paralysis. Thus, reanimation of the smile in these cases is technically challenging. The purpose of the study was to improve facial symmetry and outcome in this patient clientele by combining dynamic reanimation with fascia lata grafts for static suspension compared to functional gracilis transfer alone.

Methods
We evaluated six patients (mean age 57.8 ? 65.2, group A) who were treated using both dynamic reconstruction and fascial strips for static support, and compared their results to 6 patients with flaccid facial paralysis who received a functional gracilis transfer alone (mean age 52.5 ? 67.5, group B). To test the efficacy of the techniques, we retrospectively analyzed the correction of the oral asymmetry as well as nasal and philtral deviation by computer- assisted photograph analysis six months postoperatively.

Results
The comparative analysis revealed a significant postoperative improvement of the oral asymmetry (A: 90.065.0% relative correction at rest vs. B: 62.6617.2%, P<.05), nasal (A: 0.46 0.2 vs. B: 0.760.4 mm, P<.05), and philtral deviation (A: 0.560.6 vs. B: 2.861.8 mm, P<.05) in group A. Furthermore, patients of Group tended to need fewer secondary procedures to achieve a pleasing oral symmetry (average number of procedures: 1.7 0.5 vs. 3.2 1.7; p = 0.07).

Conclusion
The combined procedure for dynamic facial reanimation allows for immediate correction of the oral asymmetry and improves overall outcome in patients with advanced soft tissue ptosis and oral asymmetry at rest.


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