Changes in Perceived Emotions in Facial Paralysis Patients After Depressor Anguli Oris Excision.

Objectives: Depressor anguli oris (DAO) excision can improve clinician-graded, objective, and patient-reported smile outcomes in patients with nonflaccid facial paralysis (NFFP). However, no prior research has studied changes in perceived emotions after surgery. This study quantifies changes in perceived emotions with smiling after DAO excision in the largest case series presented to date.

Mid-Term Effects of Selective Denervation Surgery on Facial Symmetry in Patients with Nonflaccid Facial Paralysis: Intermediate Follow-Up of Rest and Smile Symmetry.

Although selective denervation (SD) improves clinician-graded, objective, and patient-reported smile symmetry, changes in resting symmetry have not been comprehensively studied. To assess mid-term changes in resting facial symmetry after SD, and to evaluate changes in perceived emotions in faces at rest and with smiling. Nonflaccid facial paralysis (NFFP) patients undergoing SD were studied from September 2021 to October 2022.

Commentary on: "Chemodenervation Algorithm: Functional and Aesthetic Considerations for Facial Harmony in Patients with Post-Facial Paralysis Synkinesis," by Hetzler et al.

In this commentary, we discuss Hetzler et al.'s article, "Chemodenervation Algorithm: Functional and Aesthetic Considerations for Facial Harmony in Patients with Post-Facial Paralysis Synkinesis." The authors do an excellent job of presenting a guide for practitioners to use when initiating chemodenervation treatment for patients with nonflaccid facial paralysis.

Microvascular Gracilis Free Flap: Single and Double Innervation.

Facial paralysis (FP) is a devastating condition that can lead to significant aesthetic, social, and emotional morbidities for patients. For some patients with FP, free gracilis muscle transfer (FGMT) is the best option for smile restoration. Masseteric-driven FGMT produces a reliable voluntary smile.

Symptomatic and Histological Tissue Reaction to Upper Eyelid Platinum Weight.

Objectives: To present a case of non-infectious platinum eyelid weight rejection, the first reported case in otolaryngology literature.

Methods: A case of a non-infectious tissue reaction to a platinum eyelid weight was identified.

Results: A platinum eyelid weight was placed in a 72-year-old female for paralytic lagophthalmos.

Predicting Depressor Anguli Oris Excision Outcomes Using Local Muscle Block.

Although depressor anguli oris (DAO) muscle block is a useful tool to help predict which patients will respond positively to myectomy, DAO excision outcomes have not been correlated with smile changes after muscle block. To compare changes in smile symmetry after DAO muscle block with changes after DAO myectomy. Nonflaccid facial paralysis patients undergoing DAO excision at a tertiary care facial nerve center were prospectively studied from August 2021 to June 2022.

Releasing the Smile: Depressor Anguli Oris Excision in the Context of Managing Nonflaccid Facial Palsy.

Background: Nonflaccid facial palsy is a debilitating entity characterized by hypertonicity, synkinesis, and hypomobility. Patients with nonflaccid facial palsy often have smile asymmetry and restriction because of disruption of normal vector forces on the modiolus. Excision of the depressor anguli oris can lead to improved oral commissure excursion, smile angle, dental show, and symmetry.

Two-photon excitation fluorescent spectral and decay properties of retrograde neuronal tracer Fluoro-Gold.

Fluoro-Gold is a fluorescent neuronal tracer suitable for targeted deep imaging of the nervous system. Widefield fluorescence microscopy enables visualization of Fluoro-Gold, but lacks depth discrimination. Though scanning laser confocal microscopy yields volumetric data, imaging depth is limited, and optimal single-photon excitation of Fluoro-Gold requires an unconventional ultraviolet excitation line.

Lessons from Gracilis Free Tissue Transfer for Facial Paralysis: Now versus 10 Years Ago.

Outcomes following free gracilis muscle transfer have steadily improved during the past decade. Areas for continued improvement include re-creating natural smile vectors, improving midface symmetry, minimizing scarring, improving spontaneity, and increasing reliability using various neural sources. Outcome standardization, pooled data collection, and remote data acquisition methods will facilitate comparative effectiveness research and continued surgical advancements.

The Auto-eFACE: Machine Learning-Enhanced Program Yields Automated Facial Palsy Assessment Tool.

Background: Facial palsy assessment is nonstandardized. Clinician-graded scales are limited by subjectivity and observer bias. Computer-aided grading would be desirable to achieve conformity in facial palsy assessment and to compare the effectiveness of treatments.

Deep Dive into Denervation: Institutional Experience with Selective Denervation in Nonflaccid Facial Palsy.

Selective denervation of facial nerve branches ("Modified Selective Neurectomy") improves smile dynamics in patients with nonflaccid facial palsy, but functional morbidity such as oral incompetence has been reported. A comprehensive outcomes assessment of selective denervation will help clinicians educate patients regarding risks and benefits, and improve decision making as they incorporate this procedure into treatment algorithms. Retrospective review identified selective denervation cases performed by the senior author between February 2019 and February 2020.

Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

Objectives/hypothesis: The prescribing of postoperative antibiotics for patients undergoing Mohs reconstructive surgery has increased in the last decade, while antibiotic resistance has been increasing. We hypothesized that routine prescribing of postoperative antibiotics after Mohs reconstruction does not decrease the risk of surgical site infection.

Study Design: Retrospective, single-institution cohort study.

Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy.

Many transient facial nerve insults, including Bell's palsy, Ramsay Hunt syndrome, Lyme-associated facial paralysis, and temporal bone fractures, ultimately lead to nonflaccid facial palsy (NFFP). NFFP is associated with significant functional, aesthetic, psychological, and social impairments. However, algorithms for comprehensive management of this entity are not well developed and are rapidly evolving.

Assessment of Hedgehog Signaling Pathway Activation for Craniofacial Bone Regeneration in a Critical-Sized Rat Mandibular Defect.

Importance: Osseous craniofacial defects are currently reconstructed with bone grafting, rigid fixation, free tissue transfer, and/or recombinant human bone morphogenetic protein 2. Although these treatment options often have good outcomes, they are associated with substantial morbidity, and many patients are not candidates for free tissue transfer.

Objective: To assess whether polysaccharide-based scaffold (PS) constructs that are cross-linked with smoothened agonist (SAG), vascular endothelial growth factor (VEGF), and bone morphogenetic protein 6 (BMP-6) would substantially increase bone regeneration.

Comparison of Outcomes of Early vs Delayed Graft Reconstruction of Mohs Micrographic Surgery Defects.

Importance: Reconstructing Mohs defects often requires grafting in the form of full-thickness skin grafts (FTSGs) and composite grafts. These grafts can be complicated by a variable and often indeterminable survival rate. Other researchers have found that delaying FTSG reconstruction improves graft outcomes, but the optimal interval between excision and reconstruction remains unclear, and no study has examined the association between delaying composite graft reconstruction and graft survival.

Association of Mohs Reconstructive Surgery Timing With Postoperative Complications.

Importance: Same-day Mohs reconstructive surgery is not always possible; moreover, a delay can offer benefits such as improved surgical planning and increased blood supply to the cauterized wound bed. However, recent work found that delaying reconstruction by more than 2 days increases the postoperative complication rate.

Objective: To review the outcomes of Mohs micrographic surgery (MMS) reconstruction with respect to patient- and surgery-specific variables, especially timing of repair.

An innovative photographic database for cutaneous facial defects.

Objectives/hypothesis: To construct an easy-to-use server-based database that stores photographs of patients undergoing reconstructive surgery for cutaneous facial defects and organizes them in a manner best suited for rapid search and education.

Study Design: An institutional review board-approved user-modifiable database was designed using OnBase software (Hyland Software Inc., Westlake, OH) to store both the photographs of patients undergoing reconstructive surgery and the pertinent clinical data.

Regenerative Medicine in Facial Plastic and Reconstructive Surgery: A Review.

The field of regenerative medicine aims at enhancing tissue healing and regeneration through the exogenous addition of therapeutic growth factors and cells, often in combination with tissue-compatible scaffolds. Perhaps the biggest advances in facial plastic and reconstructive surgery (FPRS) in the coming years will be the result of regenerative medicine techniques. While many articles on regenerative medicine have been published in the FPRS literature, to our knowledge there are no reviews that describe both soft-tissue and bony regeneration strategies, including scaffolds, stem cells, growth factors, and platelet-rich plasma.