1
|
Knoedler S, Knoedler L, Hoch CC, Kauke-Navarro M, Kehrer A, Friedman L, Prantl L, Machens HG, Orgill DP, Panayi AC. An ACS-NSQIP Data Analysis of 30-Day Outcomes Following Surgery for Bell's Palsy. J Craniofac Surg 2024; 35:23-28. [PMID: 37695075 PMCID: PMC10841222 DOI: 10.1097/scs.0000000000009739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND There exists a paucity of large-scale, multi-institutional studies that investigate the outcomes of surgery for Bell's palsy (BP). Here, we utilize a large, multi-institutional database to study the risk factors and early-stage outcomes following surgical procedures in BP. METHODS We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008-2019) to identify patients who underwent surgery for the diagnosis of BP. We extracted data on comorbidities and preoperative blood values, and 30-day postoperative outcomes. RESULTS Two hundred fifty-seven patients who underwent surgery for BP symptoms over the 12-year review period were identified. Muscle grafts (n=50; 19%) and fascial grafts (n=48; 19%) accounted for the majority of procedures. The most common comorbidities were hypertension (n=89; 35%) and obesity (n=79; 31%). Complications occurred in 26 (10.1%) cases. Additionally, length of hospital stay was significantly associated with both surgical and medical complications (3.9±4.7 versus 1.5±2.0; P <0.01) and (3.2±3.8 versus 1.4±2.0; P <0.01), respectively. Preoperative creatinine, blood urea nitrogen, and alkaline phosphatase were identified as potential predictors of poor postoperative outcomes. CONCLUSION Based on multi-institutional analysis, complication rates following surgery for BP were found to be overall low and seen to correlate with length of hospital stay. Reoperations and readmissions were the most frequent complications after surgery for BP. The preoperative evaluation of routine laboratory values may help refine patient eligibility and risk stratification. In addition, our findings call for future large-scale prospective studies in the field of facial palsy surgery to further improve the quality of care and optimize perioperative protocols.
Collapse
Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Cosima C. Hoch
- Department of Otolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Leigh Friedman
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Hans-Guenther Machens
- Department of Plastic and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dennis P. Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Vejbrink Kildal V, Meng S, Pruidze P, Reissig L, Weninger WJ, Tzou CHJ, Rodriguez-Lorenzo A. Preoperative assessment of depressor anguli oris to prevent myectomy failure: An anatomical study using high-resolution ultrasound. J Plast Reconstr Aesthet Surg 2024; 88:296-302. [PMID: 38029476 DOI: 10.1016/j.bjps.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Myectomies of the lower lip depressor muscles have unexplained high failure rates. This study aimed to examine the depressor anguli oris (DAO) muscle using high-resolution ultrasound to identify potential anatomical explanations for surgical failures and to determine the accuracy of utilizing preoperative ultrasound assessment to improve myectomies. METHODS Anatomical features of DAO and the surrounding anatomy were examined in 38 hemifaces of human body donors using high-resolution ultrasound and dissection. RESULTS The ultrasound and dissection measurements showed the DAO muscle width to be 16.2 ± 2.9 versus 14.5 ± 2.5 mm, respectively, and the location of the lateral muscle border 54.4 ± 5.7 versus 52.3 ± 5.4 mm lateral to the midline. In 60% of the cases, the facial artery was either completely covered by lateral DAO muscle fibers or was found to be in direct contact with the lateral border. Significant muscle fiber continuity was present between the DAO and surrounding muscles in 5% of cases, whereas continuity between the depressor labii inferioris and surrounding muscles was considerably more common and pronounced. CONCLUSIONS High-resolution ultrasound can accurately reveal important preoperative anatomical information in myectomies. Two potential explanations for the surgical failures were discovered: an overlap of lateral DAO muscle fibers over the facial artery could lead to inadequate resections and continuity with the surrounding muscles might lead to muscle function takeover despite adequate resections. Both can be uncovered preoperatively by the surgeon through a brief, directed ultrasound examination, which may allow for modification of the surgical plan to reduce surgical failure.
Collapse
Affiliation(s)
- Villiam Vejbrink Kildal
- Department of Surgical Sciences, Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden.
| | - Stefan Meng
- Division of Anatomy, Medical University of Vienna, Vienna, Austria; Department of Radiology, Hanusch Hospital, Vienna, Austria
| | - Paata Pruidze
- Division of Anatomy, Medical University of Vienna, Vienna, Austria
| | - Lukas Reissig
- Division of Anatomy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang J Weninger
- Division of Anatomy, Medical University of Vienna, Vienna, Austria; BioImaging Austria (CMI), Vienna, Austria
| | - Chieh-Han John Tzou
- Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior (Krankenhaus Goettlicher Heiland), Vienna, Austria; Facial Palsy Center, Tzou Medical, Vienna, Austria
| | - Andrés Rodriguez-Lorenzo
- Department of Surgical Sciences, Plastic and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| |
Collapse
|
3
|
Kehrer A, Ruewe M, Klebuc M, Platz Batista da Silva N, Lonic D, Heidkrueger P, Knoedler S, Jung EM, Prantl L, Knoedler L. Objectifying the Role of the Depressor Anguli Oris Muscle Using High-Resolution Ultrasound: A Prospective Study. Plast Reconstr Surg 2023; 152:866-870. [PMID: 36780356 DOI: 10.1097/prs.0000000000010287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND In the setting of facial palsy, synkinesis of the depressor anguli oris (DAO) muscle is a common pathology, impairing dynamic and resting facial symmetry.In this prospective study, the authors used high-resolution ultrasound (HRUS) to evaluate the morphologic features of DAO and to quantify bilateral differences in DAO cross-sectional diameter (CSD) in individuals with unilateral synkinesis. METHODS From June of 2020 to May of 2021, 30 patients (19 women, 11 men) with clinically diagnosed unilateral synkinesis underwent evaluation with HRUS. DAO CSD was measured bilaterally, 1 cm inferior to the modiolus, in both the resting and smiling positions. RESULTS The Sunnybrook Facial Grading System Synkinesis Score was 6.20 ± 2.48 (range, 0 to 10). DAO CSD at rest measured 2.41 ± 0.67 mm (range, 1.40 to 4.00 mm) on the control side and 2.66 ± 0.98 mm (range, 1.60 to 5.10 mm) on the affected side. On the control side, DAO CSD was reduced by -0.19 ± 0.43 mm (range, -1.10 to 1.12 mm) during smiling. In contrast, the synkinetic DAO CSD increased by 0.64 ± 0.38 mm (range, 0.00 to 1.59 mm) ( P < 0.001) with animation. The pattern of increased CSD in synkinetic DAO muscles and decreased or unchanged CSD on the control side during smiling was identified in 70% of patients. CONCLUSIONS HRUS demonstrates increased CSD in synkinetic DAO muscles during active smiling. The opposite is true for DAO muscles on the control side, which exhibit decreased CSD with animation. HRUS can be performed preoperatively to objectify DAO dysfunction and guide targeted therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
Collapse
Affiliation(s)
- Andreas Kehrer
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | - Marc Ruewe
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | | | | | - Daniel Lonic
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | - Paul Heidkrueger
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | - Samuel Knoedler
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | | | - Lukas Prantl
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| | - Leonard Knoedler
- From the Departments of Plastic, Hand, and Reconstructive Surgery
| |
Collapse
|
4
|
Volk GF, Kraus CC, Eisenhardt SU, Rozen S. Special Issue: Evidence-Based Diagnosis and Management of Facial Nerve Disorders. Diagnostics (Basel) 2023; 13:3056. [PMID: 37835799 PMCID: PMC10572159 DOI: 10.3390/diagnostics13193056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Although there has been a rapid increase in the number of new publications and studies in relation to the diagnostics, impacts and rehabilitation methods of facial nerve disorders, a general structure in evidence-based medicine is still difficult to establish [...].
Collapse
Affiliation(s)
- Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany;
- Facial-Nerve-Center Jena, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Center of Rare Diseases Jena, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Caroline Cora Kraus
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany;
- Facial-Nerve-Center Jena, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Steffen U. Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Shai Rozen
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| |
Collapse
|
5
|
Kehrer A, Hollmann KS, Klein SM, Anker AM, Tamm ER, Prantl L, Engelmann S, Knoedler S, Knoedler L, Ruewe M. Histomorphometry of the Sural Nerve for Use as a CFNG in Facial Reanimation Procedures. J Clin Med 2023; 12:4627. [PMID: 37510742 PMCID: PMC10380239 DOI: 10.3390/jcm12144627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Facial palsy (FP) is a debilitating nerve pathology. Cross Face Nerve Grafting (CFNG) describes a surgical technique that uses nerve grafts to reanimate the paralyzed face. The sural nerve has been shown to be a reliable nerve graft with little donor side morbidity. Therefore, we aimed to investigate the microanatomy of the sural nerve. Biopsies were obtained from 15 FP patients who underwent CFNG using sural nerve grafts. Histological cross-sections were fixated, stained with PPD, and digitized. Histomorphometry and a validated software-based axon quantification were conducted. The median age of the operated patients was 37 years (5-62 years). There was a significant difference in axonal capacity decrease towards the periphery when comparing proximal vs. distal biopsies (p = 0.047), while the side of nerve harvest showed no significant differences in nerve caliber (proximal p = 0.253, distal p = 0.506) and axonal capacity for proximal and distal biopsies (proximal p = 0.414, distal p = 0.922). Age did not correlate with axonal capacity (proximal: R = -0.201, p = 0.603; distal: R = 0.317, p = 0.292). These novel insights into the microanatomy of the sural nerve may help refine CFNG techniques and individualize FP patient treatment plans, ultimately improving overall patient outcomes.
Collapse
Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Division of Plastic and Facial Palsy Surgery, Hospital Ingolstadt, 85049 Ingolstadt, Germany
| | - Katharina S Hollmann
- Department of Molecular Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Silvan M Klein
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Alexandra M Anker
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Ernst R Tamm
- Department of Human Anatomy and Embryology, University of Regensburg, 93053 Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Simon Engelmann
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Samuel Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Marc Ruewe
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| |
Collapse
|
6
|
Comment on Kehrer et al. Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis-Machine Settings and Technical Aspects for Facial Surgeons. Diagnostics 2022, 12, 1650. Diagnostics (Basel) 2022; 12:diagnostics12102431. [PMID: 36292120 PMCID: PMC9600742 DOI: 10.3390/diagnostics12102431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 01/18/2023] Open
|
7
|
Kehrer A, Prantl L, Knoedler S, Knoedler L. Reply to Nduka et al. Comment on "Kehrer et al. Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis-Machine Settings and Technical Aspects for Facial Surgeons. Diagnostics 2022, 12, 1650". Diagnostics (Basel) 2022; 12:diagnostics12102432. [PMID: 36292121 PMCID: PMC9600021 DOI: 10.3390/diagnostics12102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
We thank Dr. Nduka et al. for this interesting article [...].
Collapse
|