Myectomies are something you can do in the procedure room under local anesthesia in about 20 to 30 minutes. —Caroline Banks, MD
Explore This IssueNovember 2020
By dividing the muscle and transplanting it along multiple vectors, surgeons can help patients achieve a natural smile. “We actually take that one muscle and tease it out into multiple bundles that will move the face in different directions,” Dr. Boahene said. “They can get very close to a normal smile, and that’s a big development in the past four or five years.”
According to a 2018 JAMA Facial Plastic Surgery article, the multivector surgical approach resulted in “statistically significant improvement in the dental display, smile width, and correction of paralytic labial drape.” Four of 12 patients also regained “dynamic wrinkling of the periorbital area with smiling” (JAMA Facial Plast Surg, 2018; doi: 10.1001/jamafacial.2018.0048).
5-to-7 Nerve Transfer. Another option for facial reanimation is 5-to-7 nerve transfer (masseteric- or deep temporal-to-facial nerve transfer). This surgery may be a good choice for patients who experience facial paralysis because of acoustic neuroma or a severed nerve. It’s a time-sensitive surgery that should only be attempted if it has been less than two years since the onset of facial paralysis, as the muscles of the face must still be healthy.
“The sooner you do it, the better,” Dr. Banks said. “We say ‘up to two years,’ but if you can get it done in a year or six months, you’ll have a better result.” A 2019 study reported that 5-to-7 nerve transfer can significantly improve quality of life for patients with flaccid facial paralysis; however, just 20% of patients with postparalysis facial palsy experienced benefits (Plast Reconstr Surg. 2019;143:1060e-1071e. doi: 10.1097/PRS.0000000000005591).
The smile is an important part of human communication. Thanks to advances in management of facial palsy, specialist head and neck surgeons can now help most patients regain their smiles.
Jennifer Fink is a freelance medical writer based in Wisconsin.