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Okland TS, Willens SH, Pepper JP. Synkinesis and Communicative Participation. Facial Plast Surg Aesthet Med 2023; 25:258-263. [PMID: 36260346 DOI: 10.1089/fpsam.2022.0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background: Facial palsy (FP) impacts verbal and nonverbal communication, but the effect of synkinesis on communicative ability is unknown. Objective: Among patients with nonflaccid FP, or synkinesis, is there a correlation between disease-specific quality-of-life and communicative ability or dysfunction? Methods: Retrospective study of a series of adult patients with unilateral synkinesis. Subjects were evaluated using the Communicative Participation Item Bank (CPIB) Short Form, Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Associations between these scales were evaluated by computing Pearson correlation coefficients. Results: A total of 69 confirmed synkinesis patients were included. Synkinesis patient mean (standard deviation) CPIB score was 20.68 (±8.27; range of scale 0-30), indicative of communication restriction. A strong correlation was observed between total CPIB and FaCE scores (r = 0.66), indicating patients with synkinesis who reported better facial function also reported greater communicative ability. There was a weak correlation between CPIB and SAQ scores (r = -0.27). Conclusion: Synkinesis is associated with significant deficits in communicative ability. Communication restrictions track strongly with the FaCE scale.
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Affiliation(s)
- Tyler S Okland
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sierra Hewett Willens
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jon-Paul Pepper
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Markiewicz MR, Callahan N, Miloro M. Management of Traumatic Trigeminal and Facial Nerve Injuries. Oral Maxillofac Surg Clin North Am 2021; 33:381-405. [PMID: 34116905 DOI: 10.1016/j.coms.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the area of craniomaxillofacial trauma, neurosensory disturbances are encountered commonly, especially with regard to the trigeminal and facial nerve systems. This article reviews the specific microanatomy of both cranial nerves V and VII, and evaluates contemporary neurosensory testing, current imaging modalities, and available nerve injury classification systems. In addition, the article proposes treatment paradigms for management of trigeminal and facial nerve injuries, specifically with regard to the craniomaxillofacial trauma setting.
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Affiliation(s)
- Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, 3435 Main Street, 112 Squire Hall, Buffalo, NY 14214, USA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA; Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA; Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY, USA.
| | - Nicholas Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Room 110, 801 S. Paulina Street, Chicago, IL 60612, USA; Department of Otolaryngology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Michael Miloro
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Room 110, 801 S. Paulina Street, Chicago, IL 60612, USA
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Hudson C, Olson K. Management of Acute Soft Tissue Injuries of the Cheek and Principles of Scar Revision. Facial Plast Surg 2021; 37:480-489. [PMID: 33517573 DOI: 10.1055/s-0041-1722923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Facial soft tissue injury is a challenging and complex problem for the facial plastic and reconstructive surgeon for cosmetic and functional reasons. This article will focus on the management of soft tissue injuries of the cheek, one of the most important presenting areas of the face. The cheek, like any other part of the face, is susceptible to several types of injury and any of these injuries have the potential to disfigure and debilitate. Knowledge of anatomical structures and wound healing principles is critical to devising an appropriate management plan and achieving superior patient outcomes in scar revision cases. Multiple techniques to improve long-term scarring from facial soft tissue injuries are available.
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Affiliation(s)
- Caroline Hudson
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Krista Olson
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston, Texas
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Facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery. Eur Arch Otorhinolaryngol 2020; 277:2315-2318. [PMID: 32215738 DOI: 10.1007/s00405-020-05931-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Unexpected facial nerve damage can occur during parotid gland tumor surgery. We sought to determine the incidence and treatment outcomes of unexpected facial nerve injuries in patients with parotid gland tumor surgery. METHODS We retrospectively enrolled in this study five patients, who underwent facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery January 2012-August 2019. RESULTS There were five patients (0.008%) with unexpected facial nerve injuries during the parotid gland tumor surgery of 577 patients in our hospital for approximately 8 years. The most common injury site of facial nerve was the marginal mandibular branch (n = 3), followed by the buccal branch (n = 1), and the cervicofacial division (n = 1). In the case of unexpected facial nerve damage, our treatment is immediate primary neurorrhaphy and steroid treatment. Three patients of five recovered and two did not worsen immediately after surgery. CONCLUSION Unexpected facial nerve injury during parotid gland tumor surgery is extremely unfortunate. In this case, immediate primary neurorrhaphy and systemic steroids are recommended to restore facial function and reduce cosmetic deficits.
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Tuna Edizer D, Dönmez Z, Gül M, Yiğit Ö, Yiğitcan B, Adatepe T, Uzun N. Effects of Melatonin and Dexamethasone on Facial Nerve Neurorrhaphy. J Int Adv Otol 2018; 15:43-50. [PMID: 30541731 DOI: 10.5152/iao.2018.3273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate the effects of topical and systemic administrations of melatonin and dexamethasone on facial nerve regeneration. MATERIALS AND METHODS In total, 50 male albino Wistar rats underwent facial nerve axotomy and neurorrhaphy. The animals were divided into 5 groups: control, topical melatonin, systemic melatonin, topical dexamethasone, and systemic dexamethasone. Nerve conduction studies were performed preoperatively and at 3, 6, 9, and 12 weeks after drug administrations. Amplitude and latency of the compound muscle action potentials were recorded. Coapted facial nerves were investigated under light and electron microscopy. Nerve diameter, axon diameter, and myelin thickness were recorded quantitatively. RESULTS Amplitudes decreased and latencies increased in both the melatonin and dexamethasone groups. At the final examination, the electrophysiological evidence of facial nerve degeneration was not significantly different between the groups. Histopathological examinations revealed the largest nerve diameter in the melatonin groups, followed by the dexamethasone and control groups (p<0.05). Axon diameter of the control group was smaller than those of the melatonin (topical and systemic) and topical dexamethasone groups (p<0.05). The melatonin groups had almost normal myelin ultrastructure. CONCLUSION Electrophysiological evaluation did not reveal any potential benefit of dexamethasone and melatonin in contrast to histopathological examination, which revealed beneficial effects of melatonin in particular. These agents may increase the regeneration of facial nerves, but electrophysiological evidence of regeneration may appear later.
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Affiliation(s)
- Deniz Tuna Edizer
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Zehra Dönmez
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Gül
- Department of Histology and Embryology, İnönü University School of Medicine, Malatya, Turkey
| | - Özgür Yiğit
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Birgül Yiğitcan
- Department of Histology and Embryology, İnönü University School of Medicine, Malatya, Turkey
| | - Turgut Adatepe
- Department of Electrophysiology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Nurten Uzun
- Department of Neurology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
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Treatment of Head and Neck Arteriovenous Malformations Involving the Facial Nerve. Ann Plast Surg 2018; 81:S44-S53. [DOI: 10.1097/sap.0000000000001494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Su D, Li D, Wang S, Qiao H, Li P, Wang B, Wan H, Schumacher M, Liu S. Hypoglossal-facial nerve "side-to-side" neurorrhaphy for facial paralysis resulting from closed temporal bone fractures. Restor Neurol Neurosci 2018; 36:443-457. [PMID: 29889081 DOI: 10.3233/rnn-170794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Closed temporal bone fractures due to cranial trauma often result in facial nerve injury, frequently inducing incomplete facial paralysis. Conventional hypoglossal-facial nerve end-to-end neurorrhaphy may not be suitable for these injuries because sacrifice of the lesioned facial nerve for neurorrhaphy destroys the remnant axons and/or potential spontaneous innervation. OBJECTIVE we modified the classical method by hypoglossal-facial nerve "side-to-side" neurorrhaphy using an interpositional predegenerated nerve graft to treat these injuries. METHODS Five patients who experienced facial paralysis resulting from closed temporal bone fractures due to cranial trauma were treated with the "side-to-side" neurorrhaphy. An additional 4 patients did not receive the neurorrhaphy and served as controls. RESULTS Before treatment, all patients had suffered House-Brackmann (H-B) grade V or VI facial paralysis for a mean of 5 months. During the 12-30 months of follow-up period, no further detectable deficits were observed, but an improvement in facial nerve function was evidenced over time in the 5 neurorrhaphy-treated patients. At the end of follow-up, the improved facial function reached H-B grade II in 3, grade III in 1 and grade IV in 1 of the 5 patients, consistent with the electrophysiological examinations. In the control group, two patients showed slightly spontaneous innervation with facial function improved from H-B grade VI to V, and the other patients remained unchanged at H-B grade V or VI. CONCLUSIONS We concluded that the hypoglossal-facial nerve "side-to-side" neurorrhaphy can preserve the injured facial nerve and is suitable for treating significant incomplete facial paralysis resulting from closed temporal bone fractures, providing an evident beneficial effect. Moreover, this treatment may be performed earlier after the onset of facial paralysis in order to reduce the unfavorable changes to the injured facial nerve and atrophy of its target muscles due to long-term denervation and allow axonal regrowth in a rich supportive environment.
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Affiliation(s)
- Diya Su
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Dezhi Li
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiwei Wang
- U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Hui Qiao
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Ping Li
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Binbin Wang
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Hong Wan
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Michael Schumacher
- U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Song Liu
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.,Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
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Salomone R, Jácomo AL, Nascimento SBD, Lezirovitz K, Hojaij FC, Costa HJZR, Bento RF. Polyethylene glycol fusion associated with antioxidants: A new promise in the treatment of traumatic facial paralysis. Head Neck 2018. [PMID: 29522265 DOI: 10.1002/hed.25122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recent studies in invertebrates have taught us that early cell membrane regeneration is determinant for axonal recovery and survival after trauma. Many authors obtained extraordinary results in neural regeneration using polyethylene glycol fusion protocols, which also involved microsutures and antioxidants. METHODS Sixty rats were evaluated with functional and histological protocol after facial nerve neurotmesis. Groups A and B had their stumps coapted with microsuture after 24 hours of neurotmesis and groups C and D after 72 hours. In addition to the microstructure, groups B and D used the polyethylene glycol-fusion protocol for the modulation of the Ca+2 . RESULTS At the sixth week, the latency of group D and duration of group B was lower than groups A and C (P = .011). The axonal diameter of the groups that used polyethylene glycol-fusion was higher than those who did not use polyethylene glycol-fusion (P ≤ .001). CONCLUSION Although not providing a functional improvement, polyethylene glycol-fusion slowed down demyelination.
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Affiliation(s)
- Raquel Salomone
- Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil
| | - Alfredo Luiz Jácomo
- Department of Surgery, Discipline of Human Structural Topography, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Karina Lezirovitz
- Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil
| | - Flávio Carneiro Hojaij
- Department of Surgery, Discipline of Human Structural Topography, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Ricardo Ferreira Bento
- Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil
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Abstract
The functional and psychosocial impact of facial paralysis on the patient is significant. In response, a broad spectrum of treatment options exist and are provided by a multitude of health care practitioners. The cause and duration of the facial weakness can vary widely and the optimal care pathway varies. To optimize patient outcome, those involved in the care of patients with facial palsy should collaborate within comprehensive multidisciplinary teams (MDTs). At an international level, those involved in the care of patients with facial paralysis should aim to create standardized guidelines on which outcome domains matter most to patients to aid the identification of high quality care. This review summarizes the causes and treatment options for facial paralysis and discusses the subsequent importance of multidisciplinary care in the management of patients with this condition. Further discussion is given to the extended role of the MDT in determining what constitutes quality in facial palsy care to aid the creation of accepted care pathways and delineate best practice.
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Affiliation(s)
- Daniel P Butler
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Adriaan O Grobbelaar
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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Patterns of target tissue reinnervation and trophic factor expression after nerve grafting. Plast Reconstr Surg 2013; 131:989-1000. [PMID: 23385987 DOI: 10.1097/prs.0b013e3182870445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reinnervation of target tissues determines functional outcomes after nerve grafting, which is important in traumatic injury caused by accidents or consequences resulting from surgical removal of tumors. Previous studies documented the influences of nerve repair mainly based on nerve morphometry but rarely compared the final outcomes according to target reinnervation patterns by nerve fibers of different categories. METHODS In a mouse model of nerve grafting, the authors analyzed the innervation indexes of different target tissues after transection-reimplantation on the sciatic nerve, which were defined as a parameter on the operated side normalized to that on the control side. RESULTS Muscle reinnervation appeared to be the best compared with skin reinnervation (p < 0.0001) and sweat gland reinnervation (p < 0.0001) at postoperative month 3. The sudomotor reinnervation was relatively higher than the cutaneous reinnervation (p = 0.014). The abundance of trophin transcripts for brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and neurotrophin 3 (NT3) was higher in plantar muscles on the operated side than those on the control side. In contrast, transcripts of BDNF, GDNF, nerve growth factor, and NT3 were all similar in the footpad skin between the operated and control sides. CONCLUSIONS The results suggested that, compared with the skin, muscles achieved the best reinnervation after nerve grafting, which was related to higher expression of BDNF, GDNF, and NT3 in muscles than in the skin.
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Gold weight implantation and lateral tarsorrhaphy for upper eyelid paralysis. J Craniomaxillofac Surg 2012; 41:e49-53. [PMID: 22901733 DOI: 10.1016/j.jcms.2012.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 07/14/2012] [Accepted: 07/16/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Upper eyelid paralysis leads to lagophthalmos with the risk of exposure keratitis, corneal ulceration and blindness. METHODS Consecutive patients undergoing gold weight implantation and/or lateral tarsorrhaphy were identified from our prospective database and reviewed. RESULTS Sixty-three patients were identified, 36 of whom underwent immediate reanimation procedure either during cancer excision (n = 35) or repair of facial laceration (n = 1). Twenty-seven patients had a delayed procedure either following tumour excision (n = 21) or unresolved Bell's palsy (n = 3), or facial palsy due to complex craniofacial fracture (n = 3). Nine patients required revision to achieve optimal weight. Fifty-two patients had full eye closure. The remaining 11 patients had almost complete eye closure. CONCLUSIONS Facial paralysis is devastating for the patient and immediate facial reanimation should be performed. We have demonstrated that gold weight implantation and lateral tarsorrhaphy are simple and effective in achieving eye closure.
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Terzis JK, Karypidis D. Therapeutic strategies in post-facial paralysis synkinesis in pediatric patients. J Plast Reconstr Aesthet Surg 2012; 65:1009-18. [PMID: 22483723 DOI: 10.1016/j.bjps.2012.03.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 01/26/2012] [Accepted: 03/08/2012] [Indexed: 01/08/2023]
Abstract
UNLABELLED Synkinetic movements comprise abnormal involuntary contractions of one or more facial muscle groups which follow the desired contraction of another facial muscle group. They are frequently encountered in patients with long standing facial paralysis and seriously affect their psychological status due to the impairment of their facial appearance, function and emotional expressivity. PATIENTS AND METHODS Eleven pediatric patients (2 male and 9 female) presenting with post-facial paralysis synkinesis were included in the study. Mean age was 10.3±4 years and mean denervation time 72.5 months. RESULTS Patients underwent the following types of treatment: --Cross facial nerve grafting (CFNG) and secondary microcoaptations with botulinum toxin injection which had an improvement of 100% (3 in the 3 grade synkinesis scale) (n=2). --Cross facial nerve grafting (CFNG) and secondary microcoaptations without botulinum toxin injection which had an improvement of 66%(2 in the 3 grade synkinesis scale) (n=5). --CFNG and direct muscle neurotization with (n=2) or without (n=1) botulinum toxin injection where the improvement was 33%. --Contralateral nasalis muscle myectomy was performed in one patient along with CFNG and secondary microcoaptations which resulted in 66% synkinesis improvement. Biofeedback was invariably undertaken by all patients. Postoperative improvement in eye closure and smile was also noted in the respective cases treated for synkinesis ranging from 25 to 50%, with all patients achieving optimum functional return. CONCLUSION CFNG with secondary microcoaptations and botulinum toxin injections was found to be a very efficient surgical modality addressing post-facial palsy synkinesis with high improvement in facial function and symmetry. Facial neuromuscular re-education contributes considerably in the treatment.
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Affiliation(s)
- Julia K Terzis
- International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave, Suite 620, Long Island City, NY 11101, USA.
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