Impact of increasing age on functioning free muscle transplantation for facial palsy reconstruction

Lu, Johnny Chuieng Yi; Fang, Frank; Lin, Jerry Tsung-Kai; Chang, Tommy Nai-Jen; Chuang, David Chwei‐Chin

doi:10.1002/micr.30481

Cited by 6 publications

(9 citation statements)

References 27 publications

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“…As one would anticipate, immediate HB grade was found to significantly influence the ultimate recovery potential for a patient, with worse HB grade leading to worse outcomes. However, after controlling for this variable, age was found to independently affect the potential for complete recovery, which parallels other literature pertaining to peripheral nerve recovery (11)(12)(13)(14)(15)(16)(17) and supports the hypothesis of the present study. Of note, no statistically significant associations of tumor size, extent of resection, or surgical approach with complete facial nerve recovery were identified.…”

Section: Discussionsupporting

confidence: 91%

“…A natural correlate is idiopathic facial nerve paralysis, a condition in which complete recovery has been identified to occur less frequently with older aged patients (11,12). Although it involves the extratemporal facial nerve, a similar influence of age has been identified in facial nerve reanimation procedures, especially with cross-face cable grafting where robust axonal regrowth is needed (13)(14)(15)(16)(17). Evaluating other reinnervation procedures within the head and neck, the negative influence of advanced age has been well studied in ansa cervicalis to recurrent laryngeal nerve reanimation procedures and has remained a relative contraindication for this procedure (20,21).…”

Section: Discussionmentioning

confidence: 99%

“…Data have shown that, in general, peripheral nerve recovery after injury worsens with age (10), a finding that holds true for other facial nerve disorders, including idiopathic facial nerve paralysis (Bell's palsy) (11,12). Furthermore, literature within the field of facial reanimation has shown that overall outcomes for reinnervation procedures and the axonal count of requisite peripheral nerves worsen with age (13–17). Yet, few studies have focused on the potential impact of age on the recovery of facial nerve function after injury resulting from VS microsurgery.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Age on Facial Nerve Recovery After Vestibular Schwannoma Resection

Macielak¹,

Lohse

Wallerius³

et al. 2023

Otol Neurotol

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Objective The objective of this study is to assess the influence of age on facial nerve recovery after microsurgical resection of sporadic vestibular schwannoma. Study Design A historical cohort study was performed. Setting The study was performed at a tertiary referral center. Patients The studied cohort included patients with a House–Brackmann (HB) Grade III or worse in the immediate postoperative period. Interventions The studied intervention was microsurgical resection. Main Outcome Measures The main outcome measure was complete recovery of facial nerve function to HB Grade I at least 12 months postoperatively. Results There were six patients with intracanalicular tumors and 100 with cerebellopontine angle (CPA) tumors eligible for study. Given the few patients with intracanalicular tumors, no further analysis was pursued in this subset. For patients with CPA tumors, a multivariable analysis of several patient and tumor characteristics demonstrated age at surgery (odds ratio for 10-year increase of 0.68; 95% confidence interval [CI], 0.47–0.98; p = 0.04) and immediate postoperative HB grade (odds ratio for one-grade increase of 0.27; 95% CI, 0.15–0.50; p < 0.001) to be jointly significantly associated with complete recovery to HB Grade I, indicating that the likelihood of complete facial nerve recovery was higher for younger patients and for those with better immediate postoperative HB grades. For example, the predicted probability of complete facial nerve recovery for a 30-year-old with immediate postoperative HB Grade III was 0.76 (or 76% when expressed as a percentage), whereas the predicted probability for a 50-year-old with immediate postoperative HB Grade V was only 0.10. Conclusions After considering immediate postoperative HB grade, younger age at surgery was independently significantly associated with complete facial nerve recovery, which can assist in intraoperative decision-making regarding extent of resection and postoperative counseling.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Age on Facial Nerve Recovery After Vestibular Schwannoma Resection

Macielak¹,

Lohse

Wallerius³

et al. 2023

Otol Neurotol

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“…However, no CFNG‐driven FFMT was used in the senior population. Lu et al (2020) demonstrated that the smile excursion in CFNG‐driven FFMT in patients ≤55 years of age was superior to >55 years. In this study, no pediatric patients were included.…”

Section: Discussionmentioning

confidence: 99%

Age‐related outcome of facial reanimation surgery using cross face nerve graft and gracilis free functional muscle transfer—A retrospective cohort study

et al. 2022

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Background Free functional muscle transfer has become the criterion standard for the treatment of long‐standing flaccid facial paralysis. Clinical experience suggests that a two‐stage approach using a cross‐face nerve graft (CFNG) as a donor nerve for free functional muscle transfers (FFMT) is less successful in older patients when compared to the pediatric population. However, clear data and scientific evidence are still rare. This study examines the age‐related outcome of CFNG‐driven FFMT. Methods Twenty‐eight patients with a mean age of 20.73 years (ranging 5–51 years) who received two‐stage facial reanimation with CFNG‐driven gracilis FFMT at our institution from 1998 to 2019 were included. The ipsilateral sural nerve was used as CFNG. After 12 months, the ipsilateral gracilis muscle was used as FFMT. Patients were distributed equally into three cohorts according to their age. We assessed facial symmetry before and after facial reanimation measuring the angle between the interpupillary and the intermodiolar line (pupillo‐modiolar angle). Additionally, the commissure height was measured using the Emotrics software. Results The mean follow‐up of the pediatric, young adults and the middle‐aged cohort was 29.5 ± 7.3, 24.9 ± 6.3, and 25.5 ± 12.4 months, respectively. One patient suffered flap loss due to flap ischemia. Four patients suffered insufficient innervation of the FFMT. Otherwise no major complication occurred. The likelihood of successful innervation of the FFMT was significantly higher in patients younger than 31 years (100% vs. 50%; p = .003). Smiling facial symmetry (pupillo‐modiolar angle) significantly improved in the pediatric cohort (5–16 years; 8.68° ± 0.69° to 1.48° ± 0.67°; p < .001) and the young adults' cohort (17–30 years; 11.55° ± 1.95° to 4.62° ± 1.08°; p = .005), but improved only slightly in the middle‐aged cohort (31–51 years; 11.77° ± 1.16° to 9.4° ± 1.8° p = .27). The postoperative smiling symmetry showed a significant correlation with increasing age (r = .62, p < .001). The smiling commissure height deviation significantly improved in the pediatric cohort (5–16 years; 6.5–2.3 mm; p = .006) and the postoperative result was significantly better than the middle‐aged group (31–51 years; 2.3 vs. 7.5 mm; p = .02). Conclusions The outcome of CFNG‐driven gracilis FFMT is age‐related. Static as well as dynamic facial symmetry after two‐stage facial reanimation was best in the pediatric and young adult population. For older patients, other approaches like the nerve‐to‐masseter‐driven FFMT should be considered.

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“…Free Functional Muscle Transfer is considered to be the gold standard treatment for long-standing facial paralysis, which can obtain the symmetry of facial expression dynamic. 1 There are many muscles for us to choose from, such as the latissimus dorsi, 2 pectoralis minor 3 and rectus abdominis. 4 The gracilis, however, is a valuable donor muscle used in microsurgery and has gradually become the preferred muscle for facial reanimation.…”

mentioning

confidence: 99%

Facial Animation With Free Functional Gracilis Transfer Innervated by the Cross-Facial Nerve Graft

Liang

Chen

Yang

et al. 2020

Journal of Craniofacial Surgery

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Background: The treatment of long-standing facial paralysis has always been a challenge for plastic surgery. The purpose of this study was to demonstrate that the free functional gracilis transfer innervated by the cross-facial nerve graft (CFNG) is still an ideal option, even though there are many new surgical options available. Methods: A retrospective survey was made on 12 patients who received free functional gracilis transfer innervated by the CFNG. A modified version of the House-Brackmann scale was used to evaluate the movement of the corners of mouth after surgery. Patients were also asked about their satisfaction with the operation. In addition, an objective test was performed to assess the postoperative angle improvement by measuring the angle formed between the horizontal line of both corners of the lips and the vertical midline. Results: All grafts survived well. No severe complication occurred. Three patients received further surgical operations for aesthetic reasons. The movement of the corners of mouth was classified as excellent in 8 cases, good in three cases, and fair in one cases. The static angle and dynamic angle of postoperation improved and the range of dynamic angle improvement was larger than that of static angle. Conclusion: Free functional gracilis transfer innervated by the CFNG is an ideal technique for facial paralysis. It can effectively improve the facial dynamic of the affected side.

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Impact of increasing age on functioning free muscle transplantation for facial palsy reconstruction

Cited by 6 publications

References 27 publications

The Effect of Age on Facial Nerve Recovery After Vestibular Schwannoma Resection

The Effect of Age on Facial Nerve Recovery After Vestibular Schwannoma Resection

Age‐related outcome of facial reanimation surgery using cross face nerve graft and gracilis free functional muscle transfer—A retrospective cohort study

Facial Animation With Free Functional Gracilis Transfer Innervated by the Cross-Facial Nerve Graft

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