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Bernardo Hontanilla - One of the best experts on this subject based on the ideXlab platform.
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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
Plastic and Reconstructive Surgery, 2018Co-Authors: Bernardo Hontanilla, Alvaro Cabello, Jesus Olivas, Diego MarreAbstract:Background Incomplete facial paralysis is still a challenge because we must restore what is missing without causing damage to what has recovered. The current literature is insufficient, with a small number of cases. The use of Nerve transfers has gained recent popularity for reanimating facial palsy. The authors present a comparative study between cross-face Nerve grafting and Masseteric-to-facial Nerve transposition for incomplete facial paralysis. Methods Twenty-eight patients with incomplete unilateral facial paralysis were reanimated with either cross-face Nerve grafting (group I, n = 10) or Masseteric Nerve transfer (group II, n = 18). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA dystem. Spontaneity of the movement and satisfaction were also assessed. Results When comparing the reconstructed and the healthy sides, statistical differences were found in group I but not in group II, suggesting that the resulting movement was symmetrical in group II but not in group I. Intergroup comparison showed that both commissural displacement and commissural contraction velocity were higher in group II. Spontaneity in group I was higher than in group II, but patients in group II showed more satisfaction, both without being statistically significant. Conclusions Reanimation of incomplete facial paralysis can be satisfactorily achieved with both cross-face Nerve grafting and direct Masseteric-to-facial Nerve transposition. However, with the Masseteric Nerve, better symmetry, a higher degree of recovery, and an increased level of satisfaction are achieved in a one-stage operation. Furthermore, both Nerve sources are able to restore spontaneity in more than 50 percent of the patient's daily life, with no significant differences between them. Clinical question/level of evidence Therapeutic, III.
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spontaneity of smile after facial paralysis rehabilitation when using a non facial donor Nerve
Journal of Cranio-maxillofacial Surgery, 2016Co-Authors: Bernardo Hontanilla, Alvaro CabelloAbstract:Abstract Introduction The current focus in dynamic reanimation of facial paralysis lies not only in restoring movement but also regaining smile spontaneity. It has been argued that a spontaneous smile can only be achieved using the contralateral facial Nerve as donor via cross-face Nerve grafting. Techniques based on the motor Nerve to the masseter, however, have shown good rates of spontaneity as well. Patients and methods Patients with complete facial paralysis reanimated using free gracilis to Masseteric Nerve or Masseteric-to-facial Nerve transfer were included. Patients were grouped according to gender comparing the rates of spontaneous smile. Results Thirty-six patients (17 women and 19 men) underwent gracilis innervated by the Masseteric Nerve whereas Masseteric-to-facial Nerve transfer was performed in 30 cases (14 women and 16 men). For both techniques, women showed significantly higher rates of spontaneity. Additionally, women recovered spontaneity earlier than men. Conclusions Along with providing a strong and reliable commissural pull, the motor Nerve to the masseter is able to restore spontaneity as well. Women seem more prone to achieving it. Brain plasticity and the close relationship between the cortical areas of the Masseteric and facial Nerves are most likely the mechanisms underlying smile spontaneity.
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Masseteric facial Nerve transposition for reanimation of the smile in incomplete facial paralysis
British Journal of Oral & Maxillofacial Surgery, 2015Co-Authors: Bernardo Hontanilla, Diego MarreAbstract:Abstract Incomplete facial paralysis occurs in about a third of patients with Bell's palsy. Although their faces are symmetrical at rest, when they smile they have varying degrees of disfigurement. Currently, cross-face Nerve grafting is one of the most useful techniques for reanimation. Transfer of the Masseteric Nerve, although widely used for complete paralysis, has not to our knowledge been reported for incomplete palsy. Between December 2008 and November 2013, we reanimated the faces of 9 patients (2 men and 7 women) with incomplete unilateral facial paralysis with transposition of the Masseteric Nerve. Sex, age at operation, cause of paralysis, duration of denervation, recipient Nerves used, and duration of follow-up were recorded. Commissural excursion, velocity, and patients’ satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. The mean (SD) age at operation was 39 (±6) years and the duration of denervation was 29 (±19) months. There were no complications that required further intervention. Duration of follow-up ranged from 6-26 months. FACIAL CLIMA showed improvement in both commissural excursion and velocity of more than two thirds in 6 patients, more than one half in 2 patients and less than one half in one. Qualitative evaluation showed a slight or pronounced improvement in 7/9 patients. The Masseteric Nerve is a reliable alternative for reanimation of the smile in patients with incomplete facial paralysis. Its main advantages include its consistent anatomy, a one-stage operation, and low morbidity at the donor site.
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differences between sexes in dissociation and spontaneity of smile in facial paralysis reanimation with the Masseteric Nerve
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Bernardo Hontanilla, Diego MarreAbstract:Background A patient's sex is likely to play an important role in facial paralysis reanimation, with women being superior in terms of development of brain plasticity after reanimation. The purpose of this study was to compare the rate of movement dissociation and spontaneity of men versus women reanimated with gracilis transfer neurotized to the Masseteric Nerve. Methods We conducted a retrospective chart review of 27 patients who underwent facial paralysis reanimation with microvascular gracilis transplants neurotized to the ipsilateral Masseteric Nerve. Patients were classified by sex, comparing age at surgery, denervation time, and follow-up, as well as the rates of movement dissociation and smile spontaneity. Results After reanimation with gracilis to Masseteric Nerve, movement dissociation and spontaneity were higher in women during the first year after onset of facial movement (p = .02 and p = .01, respectively). Conclusion After reanimation with Masseteric Nerve, women seem to be able to smile spontaneously and independently from teeth clenching earlier than men. © 2013 Wiley Periodicals, Inc. Head Neck 36: 1176–1180, 2014
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Masseteric Nerve for reanimation of the smile in short term facial paralysis
British Journal of Oral & Maxillofacial Surgery, 2014Co-Authors: Bernardo Hontanilla, Diego Marre, Alvaro CabelloAbstract:Our aim was to describe our experience with the Masseteric Nerve in the reanimation of short term facial paralysis. We present our outcomes using a quantitative measurement system and discuss its advantages and disadvantages. Between 2000 and 2012, 23 patients had their facial paralysis reanimated by Masseteric-facial coaptation. All patients are presented with complete unilateral paralysis. Their background, the aetiology of the paralysis, and the surgical details were recorded. A retrospective study of movement analysis was made using an automatic optical system (Facial Clima). Commissural excursion and commissural contraction velocity were also recorded. The mean age at reanimation was 43(8) years. The aetiology of the facial paralysis included acoustic neurinoma, fracture of the skull base, schwannoma of the facial Nerve, resection of a cholesteatoma, and varicella zoster infection. The mean time duration of facial paralysis was 16(5) months. Follow-up was more than 2 years in all patients except 1 in whom it was 12 months. The mean duration to recovery of tone (as reported by the patient) was 67(11) days. Postoperative commissural excursion was 8(4)mm for the reanimated side and 8(3)mm for the healthy side (p=0.4). Likewise, commissural contraction velocity was 38(10)mm/s for the reanimated side and 43(12)mm/s for the healthy side (p=0.23). Mean percentage of recovery was 92(5)mm for commissural excursion and 79(15)mm/s for commissural contraction velocity. Masseteric Nerve transposition is a reliable and reproducible option for the reanimation of short term facial paralysis with reduced donor site morbidity and good symmetry with the opposite healthy side.
Diego Marre - One of the best experts on this subject based on the ideXlab platform.
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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
Plastic and Reconstructive Surgery, 2018Co-Authors: Bernardo Hontanilla, Alvaro Cabello, Jesus Olivas, Diego MarreAbstract:Background Incomplete facial paralysis is still a challenge because we must restore what is missing without causing damage to what has recovered. The current literature is insufficient, with a small number of cases. The use of Nerve transfers has gained recent popularity for reanimating facial palsy. The authors present a comparative study between cross-face Nerve grafting and Masseteric-to-facial Nerve transposition for incomplete facial paralysis. Methods Twenty-eight patients with incomplete unilateral facial paralysis were reanimated with either cross-face Nerve grafting (group I, n = 10) or Masseteric Nerve transfer (group II, n = 18). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA dystem. Spontaneity of the movement and satisfaction were also assessed. Results When comparing the reconstructed and the healthy sides, statistical differences were found in group I but not in group II, suggesting that the resulting movement was symmetrical in group II but not in group I. Intergroup comparison showed that both commissural displacement and commissural contraction velocity were higher in group II. Spontaneity in group I was higher than in group II, but patients in group II showed more satisfaction, both without being statistically significant. Conclusions Reanimation of incomplete facial paralysis can be satisfactorily achieved with both cross-face Nerve grafting and direct Masseteric-to-facial Nerve transposition. However, with the Masseteric Nerve, better symmetry, a higher degree of recovery, and an increased level of satisfaction are achieved in a one-stage operation. Furthermore, both Nerve sources are able to restore spontaneity in more than 50 percent of the patient's daily life, with no significant differences between them. Clinical question/level of evidence Therapeutic, III.
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Masseteric facial Nerve transposition for reanimation of the smile in incomplete facial paralysis
British Journal of Oral & Maxillofacial Surgery, 2015Co-Authors: Bernardo Hontanilla, Diego MarreAbstract:Abstract Incomplete facial paralysis occurs in about a third of patients with Bell's palsy. Although their faces are symmetrical at rest, when they smile they have varying degrees of disfigurement. Currently, cross-face Nerve grafting is one of the most useful techniques for reanimation. Transfer of the Masseteric Nerve, although widely used for complete paralysis, has not to our knowledge been reported for incomplete palsy. Between December 2008 and November 2013, we reanimated the faces of 9 patients (2 men and 7 women) with incomplete unilateral facial paralysis with transposition of the Masseteric Nerve. Sex, age at operation, cause of paralysis, duration of denervation, recipient Nerves used, and duration of follow-up were recorded. Commissural excursion, velocity, and patients’ satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. The mean (SD) age at operation was 39 (±6) years and the duration of denervation was 29 (±19) months. There were no complications that required further intervention. Duration of follow-up ranged from 6-26 months. FACIAL CLIMA showed improvement in both commissural excursion and velocity of more than two thirds in 6 patients, more than one half in 2 patients and less than one half in one. Qualitative evaluation showed a slight or pronounced improvement in 7/9 patients. The Masseteric Nerve is a reliable alternative for reanimation of the smile in patients with incomplete facial paralysis. Its main advantages include its consistent anatomy, a one-stage operation, and low morbidity at the donor site.
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differences between sexes in dissociation and spontaneity of smile in facial paralysis reanimation with the Masseteric Nerve
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Bernardo Hontanilla, Diego MarreAbstract:Background A patient's sex is likely to play an important role in facial paralysis reanimation, with women being superior in terms of development of brain plasticity after reanimation. The purpose of this study was to compare the rate of movement dissociation and spontaneity of men versus women reanimated with gracilis transfer neurotized to the Masseteric Nerve. Methods We conducted a retrospective chart review of 27 patients who underwent facial paralysis reanimation with microvascular gracilis transplants neurotized to the ipsilateral Masseteric Nerve. Patients were classified by sex, comparing age at surgery, denervation time, and follow-up, as well as the rates of movement dissociation and smile spontaneity. Results After reanimation with gracilis to Masseteric Nerve, movement dissociation and spontaneity were higher in women during the first year after onset of facial movement (p = .02 and p = .01, respectively). Conclusion After reanimation with Masseteric Nerve, women seem to be able to smile spontaneously and independently from teeth clenching earlier than men. © 2013 Wiley Periodicals, Inc. Head Neck 36: 1176–1180, 2014
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Masseteric Nerve for reanimation of the smile in short term facial paralysis
British Journal of Oral & Maxillofacial Surgery, 2014Co-Authors: Bernardo Hontanilla, Diego Marre, Alvaro CabelloAbstract:Our aim was to describe our experience with the Masseteric Nerve in the reanimation of short term facial paralysis. We present our outcomes using a quantitative measurement system and discuss its advantages and disadvantages. Between 2000 and 2012, 23 patients had their facial paralysis reanimated by Masseteric-facial coaptation. All patients are presented with complete unilateral paralysis. Their background, the aetiology of the paralysis, and the surgical details were recorded. A retrospective study of movement analysis was made using an automatic optical system (Facial Clima). Commissural excursion and commissural contraction velocity were also recorded. The mean age at reanimation was 43(8) years. The aetiology of the facial paralysis included acoustic neurinoma, fracture of the skull base, schwannoma of the facial Nerve, resection of a cholesteatoma, and varicella zoster infection. The mean time duration of facial paralysis was 16(5) months. Follow-up was more than 2 years in all patients except 1 in whom it was 12 months. The mean duration to recovery of tone (as reported by the patient) was 67(11) days. Postoperative commissural excursion was 8(4)mm for the reanimated side and 8(3)mm for the healthy side (p=0.4). Likewise, commissural contraction velocity was 38(10)mm/s for the reanimated side and 43(12)mm/s for the healthy side (p=0.23). Mean percentage of recovery was 92(5)mm for commissural excursion and 79(15)mm/s for commissural contraction velocity. Masseteric Nerve transposition is a reliable and reproducible option for the reanimation of short term facial paralysis with reduced donor site morbidity and good symmetry with the opposite healthy side.
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facial reanimation with gracilis muscle transfer neurotized to cross facial Nerve graft versus Masseteric Nerve a comparative study using the facial clima evaluating system
Plastic and Reconstructive Surgery, 2013Co-Authors: Bernardo Hontanilla, Diego Marre, Alvaro CabelloAbstract:Background Longstanding unilateral facial paralysis is best addressed with microneurovascular muscle transplantation. Neurotization can be obtained from the cross-facial or the masseter Nerve. The authors present a quantitative comparison of both procedures using the FACIAL CLIMA system. Methods Forty-seven patients with complete unilateral facial paralysis underwent reanimation with a free gracilis transplant neurotized to either a cross-facial Nerve graft (group I, n=20) or to the ipsilateral Masseteric Nerve (group II, n=27). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using the independent samples t test. Mean percentage of recovery of both parameters were compared between the groups using the independent samples t test. Results Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I (p=0.001 and p=0.014, respectively) but not in group II. Intergroup comparisons showed that both commissural displacement and commissural contraction velocity were higher in group II, with significant differences for commissural displacement (p=0.048). Mean percentage of recovery of both parameters was higher in group II, with significant differences for commissural displacement (p=0.042). Conclusions Free gracilis muscle transfer neurotized by the Masseteric Nerve is a reliable technique for reanimation of longstanding facial paralysis. Compared with cross-facial Nerve graft neurotization, this technique provides better symmetry and a higher degree of recovery. Clinical question/level of evidence Therapeutic, III.
Alvaro Cabello - One of the best experts on this subject based on the ideXlab platform.
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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
Plastic and Reconstructive Surgery, 2018Co-Authors: Bernardo Hontanilla, Alvaro Cabello, Jesus Olivas, Diego MarreAbstract:Background Incomplete facial paralysis is still a challenge because we must restore what is missing without causing damage to what has recovered. The current literature is insufficient, with a small number of cases. The use of Nerve transfers has gained recent popularity for reanimating facial palsy. The authors present a comparative study between cross-face Nerve grafting and Masseteric-to-facial Nerve transposition for incomplete facial paralysis. Methods Twenty-eight patients with incomplete unilateral facial paralysis were reanimated with either cross-face Nerve grafting (group I, n = 10) or Masseteric Nerve transfer (group II, n = 18). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA dystem. Spontaneity of the movement and satisfaction were also assessed. Results When comparing the reconstructed and the healthy sides, statistical differences were found in group I but not in group II, suggesting that the resulting movement was symmetrical in group II but not in group I. Intergroup comparison showed that both commissural displacement and commissural contraction velocity were higher in group II. Spontaneity in group I was higher than in group II, but patients in group II showed more satisfaction, both without being statistically significant. Conclusions Reanimation of incomplete facial paralysis can be satisfactorily achieved with both cross-face Nerve grafting and direct Masseteric-to-facial Nerve transposition. However, with the Masseteric Nerve, better symmetry, a higher degree of recovery, and an increased level of satisfaction are achieved in a one-stage operation. Furthermore, both Nerve sources are able to restore spontaneity in more than 50 percent of the patient's daily life, with no significant differences between them. Clinical question/level of evidence Therapeutic, III.
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spontaneity of smile after facial paralysis rehabilitation when using a non facial donor Nerve
Journal of Cranio-maxillofacial Surgery, 2016Co-Authors: Bernardo Hontanilla, Alvaro CabelloAbstract:Abstract Introduction The current focus in dynamic reanimation of facial paralysis lies not only in restoring movement but also regaining smile spontaneity. It has been argued that a spontaneous smile can only be achieved using the contralateral facial Nerve as donor via cross-face Nerve grafting. Techniques based on the motor Nerve to the masseter, however, have shown good rates of spontaneity as well. Patients and methods Patients with complete facial paralysis reanimated using free gracilis to Masseteric Nerve or Masseteric-to-facial Nerve transfer were included. Patients were grouped according to gender comparing the rates of spontaneous smile. Results Thirty-six patients (17 women and 19 men) underwent gracilis innervated by the Masseteric Nerve whereas Masseteric-to-facial Nerve transfer was performed in 30 cases (14 women and 16 men). For both techniques, women showed significantly higher rates of spontaneity. Additionally, women recovered spontaneity earlier than men. Conclusions Along with providing a strong and reliable commissural pull, the motor Nerve to the masseter is able to restore spontaneity as well. Women seem more prone to achieving it. Brain plasticity and the close relationship between the cortical areas of the Masseteric and facial Nerves are most likely the mechanisms underlying smile spontaneity.
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Masseteric Nerve for reanimation of the smile in short term facial paralysis
British Journal of Oral & Maxillofacial Surgery, 2014Co-Authors: Bernardo Hontanilla, Diego Marre, Alvaro CabelloAbstract:Our aim was to describe our experience with the Masseteric Nerve in the reanimation of short term facial paralysis. We present our outcomes using a quantitative measurement system and discuss its advantages and disadvantages. Between 2000 and 2012, 23 patients had their facial paralysis reanimated by Masseteric-facial coaptation. All patients are presented with complete unilateral paralysis. Their background, the aetiology of the paralysis, and the surgical details were recorded. A retrospective study of movement analysis was made using an automatic optical system (Facial Clima). Commissural excursion and commissural contraction velocity were also recorded. The mean age at reanimation was 43(8) years. The aetiology of the facial paralysis included acoustic neurinoma, fracture of the skull base, schwannoma of the facial Nerve, resection of a cholesteatoma, and varicella zoster infection. The mean time duration of facial paralysis was 16(5) months. Follow-up was more than 2 years in all patients except 1 in whom it was 12 months. The mean duration to recovery of tone (as reported by the patient) was 67(11) days. Postoperative commissural excursion was 8(4)mm for the reanimated side and 8(3)mm for the healthy side (p=0.4). Likewise, commissural contraction velocity was 38(10)mm/s for the reanimated side and 43(12)mm/s for the healthy side (p=0.23). Mean percentage of recovery was 92(5)mm for commissural excursion and 79(15)mm/s for commissural contraction velocity. Masseteric Nerve transposition is a reliable and reproducible option for the reanimation of short term facial paralysis with reduced donor site morbidity and good symmetry with the opposite healthy side.
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facial reanimation with gracilis muscle transfer neurotized to cross facial Nerve graft versus Masseteric Nerve a comparative study using the facial clima evaluating system
Plastic and Reconstructive Surgery, 2013Co-Authors: Bernardo Hontanilla, Diego Marre, Alvaro CabelloAbstract:Background Longstanding unilateral facial paralysis is best addressed with microneurovascular muscle transplantation. Neurotization can be obtained from the cross-facial or the masseter Nerve. The authors present a quantitative comparison of both procedures using the FACIAL CLIMA system. Methods Forty-seven patients with complete unilateral facial paralysis underwent reanimation with a free gracilis transplant neurotized to either a cross-facial Nerve graft (group I, n=20) or to the ipsilateral Masseteric Nerve (group II, n=27). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using the independent samples t test. Mean percentage of recovery of both parameters were compared between the groups using the independent samples t test. Results Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I (p=0.001 and p=0.014, respectively) but not in group II. Intergroup comparisons showed that both commissural displacement and commissural contraction velocity were higher in group II, with significant differences for commissural displacement (p=0.048). Mean percentage of recovery of both parameters was higher in group II, with significant differences for commissural displacement (p=0.042). Conclusions Free gracilis muscle transfer neurotized by the Masseteric Nerve is a reliable technique for reanimation of longstanding facial paralysis. Compared with cross-facial Nerve graft neurotization, this technique provides better symmetry and a higher degree of recovery. Clinical question/level of evidence Therapeutic, III.
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facial reanimation with gracilis muscle transfer neurotized to cross facial Nerve graft versus Masseteric Nerve a comparative study using the facial clima evaluating system
Plastic and Reconstructive Surgery, 2013Co-Authors: Bernardo Hontanilla, Diego Marre, Alvaro CabelloAbstract:BACKGROUND: Longstanding unilateral facial paralysis is best addressed with microneurovascular muscle transplantation. Neurotization can be obtained from the cross-facial or the masseter Nerve. The authors present a quantitative comparison of both procedures using the FACIAL CLIMA system. METHODS: Forty-seven patients with complete unilateral facial paralysis underwent reanimation with a free gracilis transplant neurotized to either a cross-facial Nerve graft (group I, n=20) or to the ipsilateral Masseteric Nerve (group II, n=27). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using the independent samples t test. Mean percentage of recovery of both parameters were compared between the groups using the independent samples t test. RESULTS: Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I (p=0.001 and p=0.014, respectively) but not in group II. Intergroup comparisons showed that both commissural displacement and commissural contraction velocity were higher in group II, with significant differences for commissural displacement (p=0.048). Mean percentage of recovery of both parameters was higher in group II, with significant differences for commissural displacement (p=0.042). CONCLUSIONS: Free gracilis muscle transfer neurotized by the Masseteric Nerve is a reliable technique for reanimation of longstanding facial paralysis. Compared with cross-facial Nerve graft neurotization, this technique provides better symmetry and a higher degree of recovery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Federico Biglioli - One of the best experts on this subject based on the ideXlab platform.
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Use of the Masseteric Nerve to treat segmental midface paresis
'Elsevier BV', 2018Co-Authors: Federico Biglioli, Filippo Tarabbia, Dimitri Rabbiosi, Alessandro Lozza, Fabiana Allevi, M. Soliman, M. El-shazly, W. Saadeldeen, E.a. Abda, Silvia CupelloAbstract:Segmental midface paresis with or without synkinesis reflects incomplete recovery from Bell's palsy, operations on the cranial base or parotid, or trauma, in 25%–30% of cases. To correct the deficit, the Masseteric Nerve was used to deliver a powerful stimulus to the zygomatic muscle complex, with the addition of a cross-face sural Nerve graft to ensure more spontaneous smiling. By doing this, the orbicularis oculi muscle continues to have an appropriate stimulus from the facial Nerve, and the zygomatic muscle complex is separately innervated, which considerably reduces synkinesis between the two muscle compartments. For those patients with muscular contractures of the midface, the new healthy neural stimulus relaxes muscles at rest. From January 2011 to March 2017, 20 patients presented with segmental facial paresis of the midface and were operated on using this new technique. All patients were evaluated before and after operation using Clinician-Graded Electronic Facial Paralysis Assessment (eFACE), and they showed considerable postoperative improvements in static, dynamic, and synkinetic variables. Our proposed use of the Masseteric Nerve to treat segmental facial paresis produces favourable results, but our initial data require confirmation by further studies
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triple innervation for re animation of recent facial paralysis
Journal of Cranio-maxillofacial Surgery, 2018Co-Authors: Federico Biglioli, Dimitri Rabbiosi, Alberto Maria Saibene, Silvia Cupello, Valeria Marinella Augusta Battista, Fabiana Allevi, Giacomo CollettiAbstract:Abstract Recent facial palsies are those in which fibrillations of the mimetic musculature remain detectable by electromyography (EMG). Such fibrillations generally cease 18–24 months after palsy onset. During this period, facial re-animation surgery seeks to supply new neural inputs to the facial Nerve. Neural usable sources were divided into qualitative (contralateral facial Nerve) and quantitative (hypoglossus and Masseteric Nerve), depending on the type of stimulus provided. To further improve the extent and quality of facial re-animation, we here describe a new surgical technique featuring triple neural inputs: the use of the Masseteric Nerve and 30% of the hypoglossus Nerve fibres as quantitative sources was associated with the contralateral facial Nerve (incorporated via two cross-face Nerve grafts) as a qualitative source in order to restore facial movements in 24 consecutive patients. The use of two quantitative motor Nerve sources together with a qualitative neural source appears to improve re-animation after facial paralysis, despite earlier doubts as to whether patients could use different Nerves to produce facial movements. In fact, movement was much improved. Smiling according to emotions and blinking seem to be better assured if cross-face Nerve grafting is performed in two steps rather than one.
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Mixed facial reanimation technique to treat paralysis in medium-term cases
'Elsevier BV', 2018Co-Authors: Federico Biglioli, Silvia Cupello, Alessandro Lozza, Fabiana Allevi, D. Rabbiosi, F. Bolognesi, A. Previtera, V.m.a. Battista, C. MarchettiAbstract:Recent facial paralyses, in which fibrillations of the mimetic muscles are still detectable by electromyography (EMG), allow facial reanimation based on giving new neural stimuli to musculature. However, if more time has elapsed, mimetic muscles can undergo irreversible atrophy, and providing a new neural stimulus is simply not effective. In these cases function is provided by transferring free flaps into the face or transposing masticatory muscles to reinstitute major movements, such as eyelid closure and smiling. In a small number of cases, patients affected by paralysis are referred late — more than 18 months after onset. In these cases, reinnervating the musculature carries a high risk of failure because some or all of the mimetic muscles may atrophy irreversibly while axonal ingrowth is taking place. A mixed reanimation technique to address this involves a neurorrhaphy between the Masseteric Nerve and a facial Nerve branch for the orbicularis oculi, to ensure a stronger innervation to that muscle, associated with the transposition of the temporalis muscle to the nasiolabial sulcus. This gives good symmetry in the rest of the midface, while smiling movement is achievable, but not guaranteed. This one-time facial reanimation is particularly indicated for those who refuse major free-flap surgery or when that may be risky, as in previously operated and irradiated fields. More extensive procedures based on utilizing a free flap to recover smiling, while adding a cross-face Nerve graft to restore blinking, may be proposed for motivated patients. Between 2010 and 2015, five patients affected by complete unilateral facial palsy underwent this technique in the Maxillofacial Surgery Department, San Paolo Hospital (Milan, Italy). Symmetry of the middle-third of the face at rest and recovery of smiling was quite good. Complete voluntary eyelid closure was obtained in all cases. Combining temporalis flap rotation and a Masseteric-to-orbicularis-oculi-facial-Nerve branch neurorrhaphy seems to be a valid solution for those medium-term referred patients
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Surgical treatment of synkinesis between smiling and eyelid closure.
Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2017Co-Authors: Federico Biglioli, Otilija Kutanovaite, Dimitri Rabbiosi, Giacomo Colletti, M.a.s. Mohammed, Alberto Maria Saibene, Silvia Cupello, Antonino Privitera, Valeria Marinella Augusta Battista, Alessandro LozzaAbstract:Abstract Synkinetic movements are common among patients with incomplete recovery from facial palsy, with reported rates ranging from 9.1% to almost 100%. The authors propose the separation of the neural stimulus of the orbicularis oculi from that of the zygomatic muscular complex to treat eyelid closure/smiling synkinesis. This technique, associated with an anastomosis between the Masseteric Nerve and a central branch of the facial Nerve, as well as with the use of a cross-facial Nerve graft, resolves most of the spasms of the midface musculature, leading to a more relaxed tone when the mimic muscle is at rest and enhancing muscle excursion during voluntary and spontaneous smiling. Between 2011 and 2016, 18 patients affected by segmental paresis of the middle of the face underwent surgical treatment at the Maxillofacial Surgery Department of the San Paolo Hospital (Milan, Italy). Of these patients, 72.22% of cases with hypertone obtained partial to complete relaxation. Synkinesis was completely resolved in 83.33% of cases, and a significant improvement in facial movement was achieved in all patients. Neurorrhaphy of the Masseteric Nerve and the central branch of the facial Nerve appears to produce favorable results. These initial data should be confirmed by further studies.
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Masseteric-facial Nerve neurorrhaphy: Results of a case series
'Journal of Neurosurgery Publishing Group (JNSPG)', 2017Co-Authors: Federico Biglioli, Filippo Tarabbia, Silvia Cupello, Alessandro Lozza, Federica Giovanditto, V. Colombo, D. Rabbiosi, Pietro MortiniAbstract:OBJECTIVE: Facial palsy is a well-known functional and esthetic problem that bothers most patients and affects their social relationships. When the time between the onset of paralysis and patient presentation is less than 18 months and the proximal stump of the injured facial Nerve is not available, another Nerve must be anastomosed to the facial Nerve to reactivate its function. The Masseteric Nerve has recently gained popularity over the classic hypoglossus Nerve as a new motor source because of its lower associated morbidity rate and the relative ease with which the patient can activate it. The aim of this work was to evaluate the effectiveness of Masseteric-facial Nerve neurorrhaphy for early facial reanimation. METHODS: Thirty-four consecutive patients (21 females, 13 males) with early unilateral facial paralysis underwent Masseteric-facial Nerve neurorrhaphy in which an interpositional Nerve graft of the great auricular or sural Nerve was placed. The time between the onset of paralysis and surgery ranged from 2 to 18 months (mean 13.3 months). Electromyography revealed mimetic muscle fibrillations in all the patients. Before surgery, all patients had House-Brackmann Grade VI facial Nerve dysfunction. Twelve months after the onset of postoperative facial Nerve reactivation, each patient underwent a clinical examination using the modified House-Brackmann grading scale as a guide. RESULTS: Overall, 91.2% of the patients experienced facial Nerve function reactivation. Facial recovery began within 2-12 months (mean 6.3 months) with the restoration of facial symmetry at rest. According to the modified House-Brackmann grading scale, 5.9% of the patients had Grade I function, 61.8% Grade II, 20.6% Grade III, 2.9% Grade V, and 8.8% Grade VI. The morbidity rate was low; none of the patients could feel the loss of Masseteric Nerve function. There were only a few complications, including 1 case of postoperative bleeding (2.9%) and 2 local infections (5.9%), and a few patients complained about partial loss of sensitivity of the earlobe or a small area of the ankle and foot, depending on whether great auricular or sural Nerves were harvested. CONCLUSIONS: The surgical technique described here seems to be efficient for the early treatment of facial paralysis and results in very little morbidity
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the Masseteric Nerve a versatile power source in facial animation techniques
British Journal of Oral & Maxillofacial Surgery, 2014Co-Authors: Bernardo Bianchi, Andrea Ferri, Silvano Ferrari, Chiara Copelli, L Salvagni, Enrico SesennaAbstract:The Masseteric Nerve has many advantages including low morbidity, its proximity to the facial Nerve, the strong motor impulse, its reliability, and the fast reinnervation that is achievable in most patients. Reinnervation of a neuromuscular transplant is the main indication for its use, but it has been used for the treatment of recent facial palsies with satisfactory results. We have retrospectively evaluated 60 patients who had facial animation procedures using the Masseteric Nerve during the last 10 years. The patients included those with recent, and established or congenital, unilateral and bilateral palsies. The Masseteric Nerve was used for coaptation of the facial Nerve either alone or in association with crossfacial Nerve grafting, or for the reinnervation of gracilis neuromuscular transplants. Reinnervation was successful in all cases, the mean (range) time being 4 (2-5) months for facial Nerve coaptation and 4 (3-7) months for neuromuscular transplants. Cosmesis was evaluated (moderate, n=10, good, n=30, and excellent, n=20) as was functional outcome (no case of impairment of masticatory function, all patients able to smile, and achievement of a smile independent from biting). The Masseteric Nerve has many uses, including in both recent, and established or congenital, cases. In some conditions it is the first line of treatment. The combination of combined techniques gives excellent results in unilateral palsies and should therefore be considered a valid option.
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cross facial Nerve graft and Masseteric Nerve cooptation for one stage facial reanimation principles indications and surgical procedure
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Bernardo Bianchi, Andrea Ferri, Silvano Ferrari, Chiara Copelli, Alice Sara Magri, Teore Ferri, Enrico SesennaAbstract:Background The use of facial cross-grafting in acquired recent unilateral facial palsy provides spontaneity and emotional activation. Masseteric Nerve for facial animation has mainly been described for reinnervation of neuromuscular transplants, babysitter procedures, or direct facial Nerve cooptation. The simultaneous use in a single procedure of cross-facial Nerve grafting and Masseteric cooptation has not been described. Methods Eight patients underwent facial animation using single stage cross-facial Nerve grafting and Masseteric Nerve cooptation. The mean duration of facial palsy was 10.2 months (range, 1–23 months). Results Voluntary contraction in response to Masseteric Nerve activation was observed after 2 to 4 months. All patients underwent postoperative rehabilitation and spontaneous contraction was achieved in 7 to 13 months postoperatively. Cosmetic outcomes were evaluated as moderate in 1 patient, good in 5 patients, and excellent in the remaining 2 patients. Conclusion This new technique could provide good results with fast, reliable, and powerful reinnervation, spontaneity, and low morbidity. © 2013 Wiley Periodicals, Inc. Head Neck 36: 235–240, 2014
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successful salvage surgery after treatment failures with cross graft and free muscle transplant in facial reanimation
Journal of Cranio-maxillofacial Surgery, 2012Co-Authors: Bernardo Bianchi, Andrea Ferri, Silvano Ferrari, Chiara Copelli, Enrico SesennaAbstract:Abstract Background The microneurovascular transfer of a free-muscle transplant is the procedure of choice for facial animation, It is characterized by low morbidity in both adult and paediatric patients. In spite of the improvements in microsurgical techniques, failures due to absent revascularization or reinnervation of the transplanted muscle or infections causing flap necrosis are observed. We propose a second surgical procedure based on the gracilis muscle transplant reinnervated by the Masseteric Nerve as a solution for these cases. Methods We analyzed and report on two patients treated in our department after the failure of a previous cross-facial Nerve graft and free muscle transplant. They were treated with a new facial reanimation using the contralateral gracilis muscle and the Masseteric Nerve as the donor Nerve. Results and discussion We did not observe any postoperative complications, and all of the flaps survived. Reinnervation and contraction of the muscle appeared 3–4 months postoperatively, with good functional and aesthetic results. Conclusions This technique is a one-step procedure characterized by reliable flap harvesting, low donor site morbidity and good activity of the Masseteric Nerve. We consider it as a good option for treatment of facial animation failures.