American Society for Peripheral Nerve

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Facial Reanimation in the Seventh and Eighth Decades of Life
Bridget Harrison, MD; Gangadasu Reddy, MD, MS;
Shai Rozen University of Texas Southwestern Medical Center, Dallas, TX, USA

Introduction: Patients in their later years of life suffering from facial palsy are often denied the option of dynamic facial reanimation on the basis of their age alone and are often offered inferior reconstructive static techniques. Several studies strongly indicate that a two stage reanimation with cross facial nerve grafting in the older population reveal inferior results explained by poor reinnervation. We present a series of 5 patients over the age of 60 who were successfully reanimated for their facial palsy with a partial gracilis muscle innervated by the nerve to masseter as measured by smile excursion, improved symmetry in repose and animation, and satisfaction from surgery. Methods: A retrospective review was completed of 5 patients over the age of sixty who had undergone dynamic facial reanimation in a one-stage procedure with a partial gracilis muscle innervated by the masseter nerve. Demographics include age, sex, etiology, time interval from palsy to surgery, and time interval from surgery to motion. Additionally each patient was analyzed pre and post operatively for changes in philtral deviation, and smile angle with the FaceGram software. Results: Average age of the study population was 64.4 years (Range 60-71). All patients were female. Mean follow up was 23.4 months (Range 11-44 months). Time interval from palsy to surgery was 14.1 years (Range 1.5 27 years), average time interval from surgery to motion was 4 months. Based on measurements with the FACE program average change in degree of the modiolus on the paralyzed side from the horizontal were 3.6 degrees in repose and 8.8 degrees in animation, and average change in philtral deviation on the paralyzed side was 2.96 mm in repose and 6.88 mm in animation. A satisfaction questionnaire revealed that all patients would have repeated the surgery. Conclusion: Old age alone should not be exclusion for dynamic reanimation in the patient with facial palsy. If the patient can medically undergo a free tissue transfer for dynamic animation of the face, a one-stage technique with a partial gracilis muscle to the masseter nerve yields excellent excursion and improved facial symmetry.


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