Assessing Outcomes in Facial Reanimation: Evaluation and Validation of
                        the SMILE System for Measuring Lip Excursion During Smiling

Bray, Dominic; Henstrom, Douglas K.; Cheney, Mack L.; Hadlock, Tessa A.

doi:10.1001/archfaci.2010.69

Cited by 51 publications

(12 citation statements)

References 9 publications

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“…These measures were recorded with the Scaled Measurements of Improvement in Lip Excursion (SMILE technique). 12 With use of Photoshop (Adobe Systems Inc, San Jose, California), the iris white-to-white diameter was measured and divided by the standardized human average (11.7 mm) to produce a photograph-specific scaled vector, which was then applied to additional measurements in the same photograph to calculate facial dimension as follows. Commissure excursion (z-line), the distance from the lower vermilion midpoint to the oral commissure, and the smile angle (a-value), the angle between the z-line and the vertical midline (Figure 1), were measured for both sides at rest and when smiling.…”

Section: Outcome Analysismentioning

confidence: 99%

Lengthening Temporalis Myoplasty: Objective Outcomes and Site‐Specific Quality‐of‐Life Assessment

Panciera¹,

Sampieri

Deganello

et al. 2017

Otolaryngol.--head neck surg.

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Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes.

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Section: Outcome Analysismentioning

confidence: 99%

Lengthening Temporalis Myoplasty: Objective Outcomes and Site‐Specific Quality‐of‐Life Assessment

Panciera¹,

Sampieri

Deganello

et al. 2017

Otolaryngol.--head neck surg.

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“…Hadlock Smile Measurement of Improvement in Lip Excursion Scale 24 to quantitatively measure paralyzed lip excursion.…”

Section: Methodsmentioning

confidence: 99%

Surgical Treatment for Postparalytic Facial Synkinesis — A 35 Year Experience

Chuang

Chang

et al. 2022

Plastic &Amp; Reconstructive Surgery

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ostparalytic facial synkinesis is a sequela after recovery of facial paralysis, resulting in involuntary and unwanted facial muscle movements during facial animation. There are various clinical presentations, such as synkinesis between mouth and eye, synkinesis between mouth and neck, and many others. [1][2][3][4] With advanced microneurovascular surgery, nerve transfer and functioning free muscle transplantation has become the primary operation for the reconstruction of longstanding facial paralysis. [5][6][7][8][9][10][11][12][13] However, the treatment of postparalytic facial synkinesis remains challenging and controversial. The mechanism of postparalytic facial synkinesis is extensively studied, but not well understood. [1][2][3][4] Recommended surgical treatments for postparalytic facial synkinesis in the literature include trunk neurectomy, 14 selective neurectomy, 15,16 highly selective neurectomy, 17 modified midface selective neurectomy, 18 selective myotomy or myectomy, 19,20 and extensive neurectomy and myectomy in the cheek and neck regions followed by functioning free muscle transplantation. 21 Each method has its advantages and disadvantages. The aim of this article is to give a comprehensive review of type II and III postparalytic facial synkinesis patients who underwent extensive reconstructive surgery at a single institution.

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“…FACE-Gram is a user-friendly, freely available, often used, and clinically validated computer software program that provides quantitative objective analysis of facial features from a single high-resolution frontal view of the patient’s face. 16–22 Facial features are scaled in reference to the iris diameter (corneal white-to-white diameter), which is conserved at 11.71 ± 0.42 mm in humans from ages 5 to 80 years. 23 After manual annotation of specific surface anatomical landmarks, the software calculates the scaled distances between facial landmarks of interest.…”

Section: Methodsmentioning

confidence: 99%

Dynamic Reconstruction of Facial Paralysis in Craniofacial Microsomia

Zuo¹,

Heinelt²,

Ho³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Craniofacial microsomia is associated with maxillomandibular hypoplasia, microtia, soft-tissue deficiency, and variable severity of cranial nerve dysfunction, most often of the facial nerve. This study evaluated the incidence of facial paralysis in patients with craniofacial microsomia and outcomes after free functioning muscle transfer for dynamic smile reconstruction. Methods: A single-center, retrospective, cross-sectional study was performed from 1985 to 2018 to identify pediatric patients with craniofacial microsomia and severe facial nerve dysfunction who underwent dynamic smile reconstruction with free functioning muscle transfer. Preoperative and postoperative facial symmetry and oral commissure excursion during maximal smile were measured using photogrammetric facial analysis software. Results: This study included 186 patients with craniofacial microsomia; 41 patients (21 male patients, 20 female patients) had documented facial nerve dysfunction (22 percent) affecting all branches (51 percent) or the mandibular branch only (24 percent). Patients with severe facial paralysis (n = 8) underwent smile reconstruction with a free functioning muscle transfer neurotized either with a cross-face nerve graft (n = 7) or with the ipsilateral motor nerve to masseter (n =1). All patients achieved volitional muscle contraction with improvement in lip symmetry and oral commissure excursion (median, 8 mm; interquartile range, 3 to 10 mm). The timing of orthognathic surgery and facial paralysis reconstruction was an important consideration in optimizing patient outcomes. Conclusions: The authors’ institution’s incidence of facial nerve dysfunction in children with craniofacial microsomia is 22 percent. Free functioning muscle transfer is a reliable option for smile reconstruction in children with craniofacial microsomia. To optimize outcomes, a novel treatment algorithm is proposed for craniofacial microsomia patients likely to require both orthognathic surgery and facial paralysis reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Assessing Outcomes in Facial Reanimation: Evaluation and Validation of the SMILE System for Measuring Lip Excursion During Smiling

Cited by 51 publications

References 9 publications

Lengthening Temporalis Myoplasty: Objective Outcomes and Site‐Specific Quality‐of‐Life Assessment

Lengthening Temporalis Myoplasty: Objective Outcomes and Site‐Specific Quality‐of‐Life Assessment

Surgical Treatment for Postparalytic Facial Synkinesis — A 35 Year Experience

Dynamic Reconstruction of Facial Paralysis in Craniofacial Microsomia

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