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Long Term Surgical And Patient Reported Outcomes After Cross Face Nerve Graft Reconstruction In Pediatric Facial Paralysis
Kevin J. Zuo, MD, MASc1, Martina Heinelt, BESc2, Emily Ho, PhD, OT Reg(Ont)1, Gregory Borschel, MD3, Ronald Zuker, MD1.
1University of Toronto, Toronto, ON, Canada, 2Queen's University, Kingston, ON, Canada, 3Indiana University School of Medicine, Indianapolis, IN, USA.

PURPOSE: Free functioning muscle transfer is the gold standard for pediatric facial paralysis reconstruction and using the contralateral facial nerve for neurotization via a cross face nerve graft enables spontaneous smile restoration. Outcomes of pediatric facial reanimation beyond 10 years are not known, including how smiles change with aging and how adult patients report their facial function and quality of life. This study evaluated long term surgical and patient-reported outcomes for adults who underwent facial reanimation as children. METHODS: This cross-sectional study enrolled patients who underwent facial reanimation with a staged cross face nerve graft and free gracilis muscle transfer as children at least 10 years ago. FACE-Gram software was used to quantify commissure excursion on frontal photographs in repose and maximal smile at three time points: preoperative, early postoperative within 2 years, and current (long term follow up). Patient-reported outcomes were evaluated quantitatively using the FaCE Scale and FACE-Q instruments for patient satisfaction, and qualitatively with semi-structured interviews. Results are reported as mean SD and parametric statistical analysis was performed with alpha of 0.05. RESULTS: Eighteen patients who underwent facial reanimation as children more than 10 years ago were included (14 females, 5 males; 10 congenital, 8 acquired; age at stage 1 surgery 7.4 3.6 years). Commissure excursion was measured as -1.3 3.5 mm preoperatively, 5.9 2.3 mm postoperatively within 2 years, and 7.6 3.5 mm at long term follow up (mean 20.5 6.9 years). Commissure excursion increased 7.2 4.9 mm from preoperative to early postoperative time points (p<0.0001) and did not significantly increase or decrease at long term follow up (p>0.05). For patient reported outcomes, mean FaCE scale score for facial movement was 44/100 when including eyebrow function and 79/100 when excluding eyebrow function. Mean FaCE scale scores were 63/100 for eye comfort and 81/100 for social function. On the FACE-Q Satisfaction with Outcome scale, 17/18 respondents somewhat agreed or definitely agreed with the statement, "I am pleased with the result." On the FACE-Q Social Function scale, 16/18 respondents somewhat agreed or definitely agreed with the statement, "I feel confident when I meet a new person." CONCLUSIONS: Pediatric facial reanimation with cross face nerve grafting improves commissure excursion and this is maintained with aging. Adult patients report overall high satisfaction and social functioning. Ongoing ocular issues remains a problem for many patients, underscoring the importance of refining techniques for reanimation of the eye.


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