Effect of Endoscopic Brow Lift on Contractures and Synkinesis of the Facial Muscles in Patients with a Regenerated Postparalytic Facial Nerve Syndrome
ABSTRACT Delayed recovery after facial palsy results in aberrant nerve regeneration with symptomatic movement disorders, summarized as the post-paralytic facial nerve syndrome (PFS). Until now, therapeutic management was based on mime therapy and administration of botulinum toxin A (Btx A). We present an alternative surgical approach for improvement of peri-ocular movement disorders in patients with PFS. As a working hypothesis, we proposed that endoscopic brow lift leads to an improvement of periocular movement disorders by reducing pathologically raised levels of afferent input.
Eleven patients (7 females and 4 males), mean age 54 years (range, 33-85 years), with PFS underwent endoscopic brow lift in general anaesthesia. Comparison between preoperative and postoperative condition was performed with a retrospective questionnaire. Additionally, subjects were asked to compare the therapeutic effectiveness of endoscopic brow lift and Btx A.
Mean follow up was 52 months (range, 22-83 months). No intraoperative or postoperative complications occurred. During follow-up patients and physicians observed an improvement of periorbital contractures and oculo-facial synkinesis. Scores on quality of life improved significantly after endoscopic brow lift. Best results were obtained when Btx A was adjoined after the endoscopic brow lift. Patients described a cumulative therapeutic effect.
These findings suggest endoscopic brow lift as a promising additional treatment modality in treatment of periocular PFS-related symptoms, leading to an improved quality of life. Even though further prospective investigation is needed, a combination of endoscopic brow lift and postsurgical Btx A administration could become a new therapeutic standard.
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ABSTRACT: Post-paralytic facial nerve syndrome (PFS) summarizes specific symptoms that result from an incomplete or poor recovery of the facial nerve after peripheral facial palsy. Selective chemodenervation using botulinum toxin A (Btx A) and mime therapy represent the therapeutic standard for treating PFS. We report on a 35-year-old male who was suffering greatly from unilateral PFS-specific movement disorders, including periorbital contractions and oculofacial synkinesis that did not respond to Btx A administration. We present a surgical alternative to overcome periorbital movement disorders by selective neurolysis and review therapeutic options for this rare syndrome. In conclusion, selective neurolysis appears to be an efficient alternative treatment method of PFS in which the quality of life is severely impacted due to movement disorders and there was no therapeutic benefit from Btx A.Aesthetic Plastic Surgery 06/2014; 38(4). DOI:10.1007/s00266-014-0346-y · 1.19 Impact Factor
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ABSTRACT: Background: Augmentation of an underdeveloped anterior nasal spine (ANS) occidentalizes the Oriental nasal shape. The objective of this study was to investigate the effect of ANS augmentation using an injectable filler, assessing volumetric changes with 3-dimensional images and measuring 2-dimensional images. Methods: Forty Japanese patients were treated and evaluated before and after the augmentation. Local anesthetic was injected on the ANS for analgesia. To augment the underdeveloped ANS, approximately 0.5–1.0 ml of calcium hydroxylapatite filler was injected between the medial crura footplates and the ANS. Two-dimensional measurements and superimposable 3-dimensional volumetric assessments were performed pretreatment and 7 days posttreatment. Patients rated their satisfaction using a 5-point scale. Results: A significant decrease in nasal width and nostril axis inclination and an increase in nasal tip projection and columellolabial angle were observed by 2-dimensional measurements. Superimposable 3-dimensional color images reinforced the results of the 2-dimensional measurements and showed volumetric soft-tissue changes in the nasal and perinasal areas and the lower cheeks. Ninety percent of the patients were either “satisfied” or “very satisfied” with the results. Posttreatment traction pain and edema resolved in 5 days. Side effects such as hematoma, nodules, and skin necrosis were not observed. Conclusions: Objective assessments showed significant effects of this treatment, with good patient satisfaction and minimal levels of discomfort and side effects. Together these results demonstrate that this treatment is safe and effective for Oriental nose occidentalization and perinasal shaping and is also useful for predicting rhinoplasty results.08/2014; 2(8):e197. DOI:10.1097/GOX.0000000000000161