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Botulinum Toxin Therapy versus Anterior Belly of Digastric Transfer in the Management of Marginal Mandibular Branch of the Facial Nerve Palsy: A Patient Satisfaction Survey

  • Butler, Daniel P (Department of Plastic and Reconstructive Surgery, The Royal Free Hospital) ;
  • Leckenby, Jo I (Department of Plastic and Reconstructive Surgery, The Royal Free Hospital) ;
  • Miranda, Ben H (Department of Plastic and Reconstructive Surgery, The Royal Free Hospital) ;
  • Grobbelaar, Adriaan O (Department of Plastic and Reconstructive Surgery, The Royal Free Hospital)
  • Received : 2015.04.29
  • Accepted : 2015.09.14
  • Published : 2015.11.15

Abstract

Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

Keywords

References

  1. Moffat DA, Ramsden RT. The deformity produced by a palsy of the marginal mandibular branch of the facial nerve. J Laryngol Otol 1977;91:401-6. https://doi.org/10.1017/S0022215100083869
  2. Conley J, Baker DC. Paralysis of the mandibular branch of the facial nerve. Plast Reconstr Surg 1982;70:569-77. https://doi.org/10.1097/00006534-198211000-00007
  3. Terzis JK, Tzafetta K. Outcomes of mini-hypoglossal nerve transfer and direct muscle neurotisation for restoration of lower lip function in facial palsy. Plast Reconstr Surg 2009; 124:1891-904. https://doi.org/10.1097/PRS.0b013e3181bf81f6
  4. Mayou BJ, Watson S, Harrison DH, et al. Free microvascular and microneural transfer of the extensor digitorum brevis muscle for the treatment of unilateral facial palsy. Br J Plast Surg 1981;34:362-7. https://doi.org/10.1016/0007-1226(81)90032-1
  5. Tulley P, Webb A, Chana JS, et al. Paralysis of the marginal mandibular branch of the facial nerve: treatment options. Br J Plast Surg 2000;53:378-85. https://doi.org/10.1054/bjps.2000.3318
  6. Salles AN, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: improvement of facial symmetry observed up to 6 months. Aesth Plast Surg 2009;33:582-90. https://doi.org/10.1007/s00266-009-9337-9
  7. Maio M, Bento RF. Botulinum toxin in facial palsy: an effective treatment for contralateral hyperkinesis. Plast Reconstr Surg 2007;120:917-27. https://doi.org/10.1097/01.prs.0000244311.72941.9a
  8. Mehta RP, Hadlock TA. Botulinum toxin and quality of life in patients with facial paralysis. Arch Facial Plast Surg 2008; 10:84-7.
  9. Chen CK, Tang YB. Myectomy and botulinum toxin for paralysis of the marginal mandibular branch of the facial nerve: a series of 76 cases. Plast Reconstr Surg 2007;120:1859-64. https://doi.org/10.1097/01.prs.0000287136.22709.77
  10. Edgerton MT. Surgical correction of facial paralysis: a plea for better reconstruction. Ann Surg 1967;165:985-98. https://doi.org/10.1097/00000658-196706000-00014
  11. Tan ST. Anterior belly of digastric muscle transfer: a useful technique in head and neck surgery. Head Neck 2002;24: 947-54. https://doi.org/10.1002/hed.10150
  12. Borodic G, Bartley M, Slattery W, et al. Botulinum toxin for aberrant facial nerve regeneration: double-blind, placebo controlled trial using subjective endpoints. Plast Reconstr Surg 2005;116:36-43.
  13. Kahn JB, Gliklich RE, Boyev KP, et al. Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale. Laryngoscope 2001;111:387-98. https://doi.org/10.1097/00005537-200103000-00005
  14. VanSwearingen JM, Brach JS. The facial disability index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther 1996;76:1288-98. https://doi.org/10.1093/ptj/76.12.1288

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