Worldwide Testing of the eFACE Facial Nerve Clinician-Graded Scale.

Background: The electronic, clinician-graded facial function scale (eFACE) is a potentially useful tool for assessing facial function. Beneficial features include its digital nature, use of visual analogue scales, and provision of graphic outputs and scores. The authors introduced the instrument to experienced facial nerve clinicians for feedback, and examined the effect of viewing a video tutorial on score agreement.

The boy who lost his smile: facioscapulohumeral dystrophy in the head and neck.

Background: Facioscapulohumeral dystrophy is the third most common muscular dystrophy and the one most likely to present primarily in the head and neck.

Methods: In this report, we present a case of a young child with subtle progressive bilateral facial weakness whose workup ultimately led to this diagnosis. Paralysis in this disorder is secondary to worsening muscle atrophy, which typically progresses in a cephalad to caudad direction.

Masseteric nerve use in facial reanimation.

Purpose Of Review: To review the growing literature on the use of the masseteric nerve in facial reanimation, from direct neurotization, to 'baby-sitter' techniques, to its use in powering neuromuscular free tissue transfer. We focus on the indications for the different uses based on the timing of the facial paralysis and other patient factors.

Recent Findings: The use of the masseteric nerve in facial reanimation is gaining widespread acceptance for use in an expanding number of clinical scenarios.

A comparison of facial nerve grading systems.

Purpose: This study aimed to compare a computerized tool to standard objective clinical scales for global and zone-specific assessment of facial nerve function.

Methods: This was a retrospective review of 77 patients with facial paralysis who underwent facial videography. Videos were independently scored by 3 facial nerve specialists using the House-Brackmann Scales (HBI and HBII).

Surgical site infections after gracilis free flap reconstruction for facial paralysis.

Compared with other free tissue transfer procedures, the gracilis free muscle transfer (GFMT) for facial reanimation is unique in that the recipient site is typically uninvolved by malignancy or infection. In this study, the authors examined the incidence, bacteriology, and outcomes of surgical site infection (SSI) after gracilis free muscle transfer for facial reanimation. From 2003 to 2011, 105 patients underwent 107 GFMT operations, with 6 SSIs.

Color Doppler ultrasound: effective monitoring of the buried free flap in facial reanimation.

Objective: The gracilis muscle free flap has become a reliable means for smile reanimation for patients with facial paralysis. Because it is a buried flap, it presents a postoperative monitoring challenge. We sought to evaluate our experience with color Doppler ultrasound in the monitoring of gracilis free flap viability in the immediate postoperative setting.

Platysmectomy: an effective intervention for facial synkinesis and hypertonicity.

Objectives: To describe a procedure to permanently address platysmal synkinesis and hypertonicity and to report changes in quality of life associated with platysmectomy using the Facial Clinimetric Evaluation instrument.

Methods: Chemodenervation significantly relieves platysmal synkinesis in almost all patients with significant face and neck synkinesis associated with dynamic facial expressions. We recently began to offer platysmectomy as part of a permanent solution to chronic superficial torticollis-like neck symptoms.

Free gracilis transfer for smile in children: the Massachusetts Eye and Ear Infirmary Experience in excursion and quality-of-life changes.

Background: Free muscle transfer for facial reanimation has become the standard of care in recent decades and is now the cornerstone intervention for dynamic smile reanimation. We sought to quantify smile excursion and quality-of-life (QOL) changes in our pediatric free gracilis recipients following reanimation.

Methods: We quantified gracilis muscle excursion in 17 pediatric patients undergoing 19 consecutive pediatric free gracilis transplantation operations, using our validated SMILE program, as an objective measure of functional outcome.

Surgical treatment of the periocular complex and improvement of quality of life in patients with facial paralysis.

Objective: A devastating sequela of facial paralysis is the inability to close the eye. The resulting loss of corneal protection can potentially lead to severe consequences. Eyelid weight placement, lower eyelid suspension, and brow ptosis correction are frequently performed to protect the eye.

Good correlation between original and modified House Brackmann facial grading systems.

Objectives/hypothesis: Subjective scales of facial function were plagued with reporting variations until the House-Brackmann scale was described in 1985. Despite its utility, weaknesses were identified, including noninclusion of synkinesis phenomena and insensitivity to segmental weakness. Therefore, the scale was recently revised to address these weaknesses.

Transoral resection for squamous cell carcinoma of the base of the tongue.

Objective: To review the oncologic and functional outcomes of patients with squamous cell carcinoma of the base of the tongue who underwent transoral tumor resection and neck dissection with or without postoperative adjuvant therapy.

Design: Retrospective medical record review.

Setting: Tertiary referral center.

Scapula osteocutaneous free flap reconstruction of the head and neck: impact of flap choice on surgical and medical complications.

Background: The scapula osteocutaneous free flap is frequently used to reconstruct complex head and neck defects given its tissue versatility. Because of minimal atherosclerotic changes in its vascular pedicle, this flap also may be used as a second choice when other osseous flaps are not available because of vascular disease at a preferred donor site.

Methods: We performed a retrospective chart review evaluating flap outcome as well as surgical and medical complications based upon the flap choice.