Facial reanimation in the 7th and 8th decade of life

Background: Treatment of facial paralysis in the older population is often relegated to static rather than dynamic reanimation for fear of poor outcomes. This pervasive approach lacks physiologic foundation nor is evidence based. Hence, the authors present an extensive literature review demonstrating weak evidence supporting this misguided concept, followed by detailed outcomes from three centers of the largest reported series to date of patients over 60 years after reanimation performed in three techniques - lengthening temporalis myoplasty, free functional muscle, and nerve transfers. Methods: PubMed search spanning over 40 years identified all reports on reanimation in patients over 60. Additionally, detailed demographics, surgical techniques, and outcomes of 30 patients over 60 were analyzed. Results: Of 629 articles, only 45 patients were identified, describing case reports or small series, lacking details or consistent long-term follow-up. In the clinical series, average age, preoperative House- Brackman score, and comorbidities was similar among the groups. Highest excursion was observed in the free functional muscle group, followed by the nerve transfer, and temporalis myoplasty, averaging 10.4, 6.8, and 3.1 mm respectively. The most notable philtral deviation correction was in the LTM group, followed by the free muscle, and nerve transfer, averaging 5.6, 2.2, and 1.13 mm respectively. Complication rates were highest in the free muscle group. Conclusion: Facial palsy patients shouldn't be denied dynamic restoration based on age alone. Although surgical technique may vary based on duration of palsy, surgeon experience and preference, each presenting advantages and disadvantages, dynamic restoration is feasible regardless of age. Financial Disclosure and Products: The authors have no commercial or financial associations related to the submitted manuscript, and no commercial or financial conflicts of interest. No funding was received for the performance of this research of production of the manuscript. Corresponding author: Shai Rozen, MD., UT Southwestern Medical Center, 1801 Inwood Rd., Dallas, TX 75390, Phone: 214-645-3117, Email: shai.rozen@utsouthwestern.edu ©2018American Society of Plastic Surgeons

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