Surgery 'Reanimates' Smile in Patients with Facial Paralysis, Reports Paper in Neurosurgery

Article ID: 590586

Released: 20-Jun-2012 10:00 AM EDT

Source Newsroom: Wolters Kluwer Health: Lippincott Williams and Wilkins

Surgeons Reminded Not to Overlook Treatment for Facial Paralysis in Patients with Neurofibromatosis Type 2

Newswise — Philadelphia, Pa. (June 20, 2012) - A surgical technique using a muscle flap from the thigh restores facial motion—and the ability to smile—in patients with facial nerve paralysis resulting from neurofibromatosis type 2 (NF2), reports a study in this month's special "Operative Neurosurgery" supplement to Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Dr. Kalpesh T. Vakharia and colleagues of Harvard Medical School report good results with "smile reanimation" in NF2 patients with facial nerve paralysis. They hope their study will help remind doctors to include facial rehabilitation in their treatment plan for patients with NF2.

Good Results with Gracilis Muscle Flap for 'Smile Reanimation'Neurofibromatosis type 2 is an inherited condition that causes patients to develop noncancerous tumors. Tumors typically occur along the auditory nerve, with the potential to cause hearing loss. When the facial nerve is affected—by either tumors or surgery to remove them—facial paralysis commonly results.

In addition to functional problems (such as problems with speech and eating or closing the eye), facial paralysis is a disfiguring condition that takes away facial expressiveness—including the ability to smile. "Despite the significant impact of facial paralysis on these patients, little attention has been given to the treatment of this in patients with NF2," according to Dr Vakharia and coauthors.

They report their experience with a muscle and nerve transfer technique for restoring facial motion in five patients with NF2 and facial paralysis. All patients had severe paralysis of one side of the face, with drooping and lack of motion at the corner of the mouth (oral commissure) on the paralyzed side. The patients were three men and two women, aged 12 to 50 years; most had facial paralysis as a complication of previous surgery.

To restore facial motion, surgeons transplanted a small flap of muscle from the inner thigh—the gracilis muscle—to the face. The gracilis muscle flap, including associated nerve and blood vessels, was used to replace the damaged area causing facial paralysis. Patients received physical therapy during the recovery period after surgery.

Before-and-after photographs showed that the gracilis flap procedure was successful in restoring the patients' ability to smile. Sophisticated geometrical measurements found a significant increase in the ability to lift the oral commissure on the paralyzed side. Just a few millimeters meant the difference between no movement and a natural-looking smile.

"When questioned about their impressions of their faces, the patients uniformly expressed a dramatic improvement in their ability to express happiness nonverbally," the researchers write. Patients also had significant improvement in scores on a quality of life questionnaire.

Some patients said that the procedure restored the ability to smile spontaneously. That's a potentially important advantage, because while other procedures can restore facial motion, the patient has to make a conscious effort to smile.

Although the study is small, it shows that the gracilis muscle flap is an effective treatment for the facial paralysis in patients with NF2, Dr Vakharia and coauthors believe. They remind all professionals involved in the care of patients with this "devastating complication" to incorporate some type of facial rehabilitation therapy into their treatment plan.


About NeurosurgeryNeurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).


Chat now!