Facial Plastic and Reconstructive Surgery

A multitude of consequences can occur following an injury to the facial nerve. In some instances, the face remains flaccid resulting in an inability to move the corner of the mouth (oral commissure). Other times, the facial nerve regenerates, resulting in facial hypertonicity. Hypertonicity leads to an inability to move the corner of the mouth and significant facial asymmetry.

Figures 1-2 describe outcomes for trigeminal nerve transfer, which is performed in patients with flaccid facial palsy. Figures 3-5 describe outcomes for selective denervation in patients who suffer from facial hypertonicity and synkinesis.

Outcomes tracking for facial palsy is imperative, and the Facial Nerve Center at Mass Eye and Ear uses various tools for analysis. Patients undergo facial function scoring using a validated clinician-graded assessment tool (eFACE). Additionally, using computer software (Emotrics+), objective measurements of facial landmarks are utilized to assess facial function.

Figure 1: Upgrading the flaccid smile

For patients with facial paralysis, the Facial Nerve Center commonly performs nerve transfer procedures to restore movement to the paralyzed face. This figure demonstrates improvements in oral commissure excursion following re-innervation from a branch of the trigeminal nerve. Oral commissure excursion is measured in millimeters. These measurements are generated using Emotrics+ computer software.

Change in oral commisure excursion in patients who underwent 5th-to-7th nerve transfer

Figure 2: Improvements to eFACE scores following re-innervation from trigeminal nerve

Improvements in objective clinician-graded facial palsy outcomes (eFACE) following re-innervation from a branch of the trigeminal nerve have also been recorded. Higher eFACE scores are considered better than lower scores, with a normal score between 95 and 100.

Change in dynamic eFACE score in patients who underwent 5th-to-7th nerve transfer

Figure 3: Downgrading facial hypertonicity

For patients with facial hypertonicity, the Facial Nerve Center performs selective denervation. This figure demonstrates improvements in objective clinician-graded facial palsy (eFACE scores) for patients with facial hypertonicity and synkinesis.

Change in oral commissure movement eFACE score in patients who underwent selective denervation

Figure 4: Oral commissure excursion

Improvements in oral commissure excursion (measured in milimeters) for patients with facial hypertonicity and synkinesis following selective denervation.

Change in oral commisure excursion in patients who underwent selective denervation

Figure 5: Lower lip asymmetry

Improvements in lower lip asymmetry (measured in millimeters) following selective denervation for patients with facial synkinesis and hypertonicity.

Change in lower lip asymmetry in patients who underwent selective denervation