Facial Plastic Surgery & Aesthetic Medicine最新文献

Background: Nerve transfers can restore lost motor function in cases of facial palsy, with recovery reliant on brain plasticity enabling volitional control. Objective: To quantify clinical and treatment factors influencing independent facial motor recovery after hypoglossal-to-facial nerve transfer. Methods: Patients with complete unilateral facial palsy who underwent hypoglossal (resultsXII) to facial (CNVII) nerve transfer were analyzed. Brain plasticity was graded using a 4-point Plasticity Grading Scale (PGS). Patient variables, including age, sex, surgical timing, follow-up duration, and rehabilitation quality, were recorded and analyzed for their relationship with PGS scores. Results: Sixty-six patients were included, with a median age of 45 years, of which 62% were male. Plasticity was classified as poor in 53% and absent in 41% of patients. No patient achieved complete independence of facial muscles from tongue movements. Higher PGS scores were associated with earlier surgical intervention (≤6 months post-trauma; p = 0.008), younger age (p = 0.001), and adherence to rehabilitation at a specialized neurorehabilitation center (p = 0.002). Conclusions: Brain plasticity after hypoglossal-to-facial nerve transfer is often limited, failing to achieve independence of facial muscles from the donor nerve. Early intervention, younger age, and specialized rehabilitation enhanced functional recovery.

Introduction: Depressor anguli oris (DAO) myectomy improves smile symmetry and emotions conveyed with a smile in synkinesis patients. However, no long-term follow-up studies have been reported. Objective: To evaluate long-term changes in smile symmetry and emotions conveyed with smile in synkinesis patients after DAO myectomy. Methods: Synkinesis patients who underwent DAO myectomy between August 2021 and December 2023 with at least 12-months of follow-up were retrospectively reviewed. Patient-reported, clinician-graded, and objective outcomes were compared. Results: Fifty patients (84% female, median age 45.00 years old [16-79], median follow-up 21.57 months [12.10-37.10]) were included. Patients reported improved quality of life and smile symmetry on the facial clinimetric survey (p < 0.001). Blinded electronic facial paralysis assessments revealed improved oral commissure excursion with smile (p = 0.01). Emotrics+ analysis revealed improved upper lip (p = 0.014), oral commissure (p < 0.001), and dental display (p < 0.001) symmetry with smile. FaceReader analysis demonstrated patients conveyed 13% more happiness with smile after surgery (p < 0.001) and fewer negative emotions (p = 0.05). While further improvements were seen after 3 months, these changes were not statistically significant. Conclusions: DAO myectomy likely results in long-term improvements in smile symmetry and happiness conveyed with smile in synkinesis patients. Postoperative outcomes at 3 months appear to be predictive of long-term results.

Background: Facial synkinesis can lead to unintended activation of perinasal muscles, contributing to dynamic nasal obstruction. Objective: To determine whether targeted botulinum toxin injections, compared to no treatment, reduce new ipsilateral nasal obstruction symptoms in patients with facial synkinesis, as measured by patient-reported outcomes and the Nasal Obstruction Symptom Evaluation (NOSE) scale. Methods: A retrospective review was conducted of patients presenting with ipsilateral nasal obstruction and synkinesis at a multidisciplinary facial nerve clinic. Botulinum toxin (2-2.5 units) was injected into the supra-alar nasalis and depressor septi muscles. Symptom improvement was assessed at 4 weeks using patient-reported outcomes and the NOSE scale. Results: Of 99 treated synkinetic patients, 23 (23.5%) reported new-onset nasal obstruction. Following chemodenervation, 74% experienced symptom relief, 4% had no improvement, and 22% were indeterminate. NOSE scores significantly improved from a mean of 44.86 to 28.93, with a mean difference of 15.93 (95% confidence interval: 2.86-29.00). Conclusion: Botulinum toxin injections targeting the perinasal musculature significantly improved nasal obstruction symptoms in patients with facial synkinesis.

Background: The masseteric nerve is one of the most commonly utilized in facial reanimation nerve transfer surgery, though reported methods of intraoperative identification are variable. Objective: To systematically review techniques for identifying the masseteric nerve and meta-analyze pooled distances from important landmarks for facial reanimation. Methods: This was a systematic review and meta-analysis of entries on PubMed and EMBASE/Ovid, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Eleven studies with 291 nerve identification procedures were recorded. Anatomical landmarks, including the tragus, zygomatic arch (ZA), lateral canthus, temporomandibular joint, and alar, were referenced to locate the masseteric nerve. Geometric areas, including the "masseteric area" and "subzygomatic triangle," were reported. Random-effects meta-analysis revealed a pooled mean distance from the ZA to the masseteric nerve of 10.26 mm (95% confidence interval [CI]: 7.72-12.80 mm) and 33.61 mm (95% CI: 10.37-56.86 mm) from the tragus. Conclusion: Distances to the masseteric nerve from static anatomical landmarks may vary due to gender, weight, height, and ethnicity. The most reliable method to localize the masseteric nerve is to measure its distance from the ZA to define the two-dimensional area of interest and triangulate this with depth measurements from the parotidomasseteric fascia for higher accuracy in surgical dissection.

Background: There is a paucity of evidence to support body mass index (BMI) cutoffs for facial feminization surgery (FFS). Objective: To assess the relationship between BMI and adverse events (AEs) after FFS. Methods: Records of patients at a single institution were reviewed for AEs occurring within 90 days after FFS. Patients were categorized into BMI subclasses via the World Health Organization criteria, and multivariate logistic regressions were used to assess relationships between variables. Results: A total of 984 transfeminine patients underwent 4,394 procedures, with a mean (SD) age of 35 (11.8) years old and a mean (range) BMI of 26.78 (15-83.9). Wound dehiscence (58, 5.9%) and emergency room (ER) visits (53, 5.4%) were the most frequent AEs 90 days postoperatively. Patients with BMI >40 demonstrated the highest rates of wound dehiscence, bleeding, ER visits, and having at least one AE, despite no significant relationship between BMI and any AE on multivariate analysis. Independent of BMI, older age was associated with extended hospitalization (OR = 1.03, p = 0.044) and the development of at least one AE (OR = 1.02, p = 0.007). Conclusion: Though BMI cutoffs do not appear useful in predicting AEs after FFS, counseling specific to factors associated with high BMI poses greater utility.

Background: Septal perforation repair is variably successful, and its impact on nasal breathing remains underexplored. Objective: To evaluate the effectiveness of bipedicled mucosal advancement flap repair in septal perforation surgery, using closure rates and patient-reported breathing outcomes. Methods: A retrospective review was conducted on patients who underwent septal perforation repair using bipedicled mucosal flaps between 2014 and 2023. Closure rates and Nasal Obstruction Symptom Evaluation scores were analyzed using multivariable logistic and linear regression to assess associations with perforation size, flap type, etiology, age, and gender. Results: Seventy-four patients were included (63% female; mean age = 43.3 years). Most perforations were due to prior nasal surgery (42%). Repairs were performed via external rhinoplasty with cadaveric dermis interposition in 97% of cases. Mean follow-up was 7.5 months. Closure was successful in 95% of patients. Postoperative NOSE scores improved in 78% of patients (mean improvement = 29 points, p < 0.001), with 67% exceeding the minimally clinically important difference of 14 points. Conclusions: Bipedicled mucosal advancement flap repair for septal perforation is associated with a high rate of closure and significant improvement in nasal breathing.

Preprocedural simulation can be an important tool for patient counseling and setting patient expectations in a plastic surgeon's office. Simulation technologies are used widely in plastic surgery and can involve expensive three-dimensional imaging suites that allow the plastic surgeon to alter patient photographs to simulate postprocedural results. Artificial intelligence (AI) is gaining traction in many facets of the plastic surgery world. However, AI has not been significantly utilized in preprocedural simulation. AI represents a new frontier in plastic surgery simulation as inexpensive AI "generative fill" technology can instantly alter and rejuvenate specifically demarcated areas of patient photographs to render realistic postprocedural results. The authors aimed to assess the feasibility of using AI to simulate whole-face rejuvenation with soft tissue fillers by performing injection simulations on real patient photographs. This article lays the foundation for future studies applying more sophisticated AI models in plastic surgery preprocedural simulation.