Effect of Endoscopic Brow Lift on Contractures and Synkinesis of the Facial Muscles in Patients with a Regenerated Postparalytic Facial Nerve Syndrome

Johns Hopkins University, Baltimore, Maryland, United States
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 10/2013; 133(1). DOI: 10.1097/01.prs.0000436834.19066.7c
Source: PubMed


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.
Therapeutic, III.

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