Facial Plastic Surgery & Aesthetic Medicine最新文献

Injury to the depressor labii inferioris (DLI) is a frequent cause of lower lip asymmetry following deep plane facelift and structural neck contouring. This study characterizes the in vivo innervation of the DLI through intraoperative facial nerve mapping during selective facial neurectomy in 20 consecutive patients. In all cases, dual innervation of the DLI was observed: a superficial branch of the marginal mandibular nerve (MMN) supplies the lateral DLI, while an inferomedial cervical branch innervates the medial DLI. Both branches are located superficially and closely adherent to the deep surface of the superficial musculoaponeurotic system (SMAS) and platysma, placing them at risk during sub-SMAS and subplatysmal dissections. These findings challenge the conventional anatomical teaching that the DLI is solely innervated by the MMN. Incorporating this understanding of the DLI's dual innervation into surgical planning may help reduce the incidence of iatrogenic nerve injury and improve both functional and aesthetic outcomes in lower facial rejuvenation procedures.

Introduction: Facial palsy (FP) can impair nonverbal communication, and patients often report difficulty recognizing emotional expressions in others. Objective: To compare early cortical processing of emotional facial expressions in healthy controls, FP patients, and patients who had undergone facial reanimation surgery using magnetoencephalography (MEG) and analyzing the M170 component, a face-sensitive neuromagnetic response. Methods: Neuromagnetic responses were recorded with a whole-head 306-sensors MEG system. We studied M170 responses to angry, happy, sad, and neutral faces in 10 healthy controls, 5 untreated FP patients, 11 patients with hypoglossal-facial nerve transfer (HFNT), and 4 patients with temporalis muscle transfer. Results: Untreated FP patients had delayed M170 latencies (174.8 ± 14.5 ms) and increased amplitudes (430.2 ± 214.2 fT) compared with controls (162.8 ± 8.6 ms and 306.0 ± 185.0 fT). HFNT patients demonstrated reduced latencies (167.7 ± 12.5 ms) and amplitudes (285.5 ± 125.2 fT) relative to FP patients, approximating control values. No significant hemispheric effects or emotion-specific modulation were observed. Conclusion: These findings suggest that facial reanimation via HFNT may promote partial normalization of cortical processing of facial emotions, reflecting adaptive neuroplasticity. This study supports the facial feedback hypothesis, whereby the ability to express facial emotions contributes to effective emotion recognition.

Background: Variable terminology is used in the literature to describe facial synkinesis and hypertonicity following incomplete recovery from facial paralysis and its associated medical and surgical treatments. Study Objectives: Establish a nomenclature consensus for this condition among a group of facial nerve experts. Design Type: Consensus study. Methods: Using modified Delphi methodology, an international, multidisciplinary group of facial nerve experts reviewed the terminology for the name of the clinical condition and treatments of interest. Online surveys and a virtual discussion were performed to establish consensus, defined a priori as agreement by 80% of the group. Results: Twenty-five facial nerve experts established consensus after three Delphi rounds. Consensus terminology for the condition is "facial synkinesis" with 84% agreement. Medical treatment is termed "chemodenervation" with 100% agreement. Surgical treatments including "selective facial neurectomy," "selective facial neurotomy," "selective facial myectomy," and "selective facial myotomy," were defined and reached agreement of 100%. Conclusions: This international group of facial nerve experts has recommended standardized nomenclature for the condition of facial synkinesis and its various treatments. While "facial synkinesis" reached consensus as the preferred term, some experts noted it may insufficiently describe the full clinical spectrum, which includes muscle hypertonicity, weakness, and spontaneous twitching.

Objective: To evaluate objective and subjective outcomes in patients with ocular synkinesis before and 1 month after daily ophthalmic oxymetazoline, using standardized photographs, the Sunnybrook Facial Grading Scale, and patient-reported measures. Background: Ophthalmic oxymetazoline, an alpha-adrenergic agonist Food and Drug Administration approved for acquired blepharoptosis, stimulates eyelid retractors but has not been studied for ocular synkinesis. Method: Adult outpatients with ocular synkinesis self-administered 0.1% oxymetazoline in the clinic and daily for 30 days. Assessments included standardized photos, synkinesis-specific questionnaires, and paired Mann-Whitney U tests for pre-/post-treatment comparisons. Results: Twenty-eight patients (median age = 58, 79% female) were included. Patient race was identified through the electronic medical record, with 4 patients identified as Black, 23 identified as White, and 1 identified as "Other." Etiologies of facial paralysis included Bell's palsy (n = 16), iatrogenic (n = 10), and herpes zoster (n = 2). One-hour post-administration, mean Sunnybrook synkinesis scores decreased (7.8 vs. 6.2, p < 0.001). Palpebral fissure height during maximal synkinesis increased by 24.7% (standard deviation = 27, p < 0.001). Oral-ocular synkinesis scores decreased by 22% (p < 0.001). Among 25 respondents, 20 would continue to use it if covered by insurance, and 19 would recommend it. Conclusion: Ophthalmic oxymetazoline is a daily, noninvasive, well-tolerated treatment that reduces symptoms of ocular synkinesis-related blepharospasm.

Introduction: Side-to-end hypoglossal-facial nerve transfer (HFT) is an established facial reanimation technique. However, evidence regarding predictors of outcomes is limited. Objective: To evaluate predictors of facial and tongue outcomes after HFT in a large series of patients with facial palsy. Methods: A retrospective review of 64 patients undergoing side-to-end HFT was conducted. Additional masseteric nerve transfer and/or cross-facial nerve grafting were performed in selected cases. Facial outcomes were evaluated with the House-Brackmann (HB) scale, the Sunnybrook Facial Grading System, and eFACE. Tongue outcomes were assessed using Martin's scale and Oral and Pharyngeal Disability Index. Multivariate regression analyses identified independent associations. Results: HB grade III or IV was achieved in 95.3% of patients. Significant improvements were observed in all facial function scales (p < 0.001). Tongue function was preserved in 98.4%. Patient-reported scores indicated good perceived oral-pharyngeal outcomes (79.3, interquartile range = 67.9-87.4). Higher age predicted poorer facial (β = -0.303, p = 0.009) and tongue (β = -0.371, p = 0.006) outcomes. Delayed recovery onset correlated with worse facial results (β = -0.389, p = 0.001). Double nerve reinnervation was associated with better facial outcomes (p = 0.007). Conclusions: This technique offers effective facial reanimation with minimal tongue morbidity. Older age and delayed recovery onset were associated with poorer outcomes, supporting tailored surgical strategies.

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.