Facial palsy reconstruction.

The facial nerve stimulates the muscles of facial expression and the parasympathetic nerves of the face. Consequently, facial nerve paralysis can lead to facial asymmetry, deformation, and functional impairment. Facial nerve palsy is most commonly idiopathic, as with Bell palsy, but it can also result from a tumor or trauma. In this article, we discuss traumatic facial nerve injury. To identify the cause of the injury, it is important to first determine its location. The location and extent of the damage inform the treatment method, with options including primary repair, nerve graft, cross-face nerve graft, nerve crossover, and muscle transfer. Intracranial proximal facial nerve injuries present a challenge to surgical approaches due to the complexity of the temporal bone. Surgical intervention in these cases requires a collaborative approach between neurosurgery and otolaryngology, and nerve repair or grafting is difficult. This article describes the treatment of peripheral facial nerve injury. Primary repair generally offers the best prognosis. If primary repair is not feasible within 6 months of injury, nerve grafting should be attempted, and if more than 12 months have elapsed, functional muscle transfer should be performed. If the affected nerve cannot be utilized at that time, the contralateral facial nerve, ipsilateral masseter nerve, or hypoglossal nerve can serve as the donor nerve. Other accompanying symptoms, such as lagophthalmos or midface ptosis, must also be considered for the successful treatment of facial nerve injury.

Speech Outcomes in 5-Year-Old Korean Children with Bilateral Cleft Lip and Palate.

Background Among the cleft types, bilateral cleft lip and palate (BCLP) generally requires multiple surgical procedures and extended speech therapy to achieve normal speech development. This study aimed to describe speech outcomes in 5-year-old Korean children with BCLP and examine whether normal speech could be achieved before starting school. Methods The retrospective study analyzed 52 children with complete BCLP who underwent primary palatal surgery at a tertiary medical center. Three speech-language pathologists made perceptual judgments on recordings from a speech follow-up assessment of 5-year-old children. They assessed the children's speech in terms of articulation, speech intelligibility, resonance, and voice using the Cleft Audit Protocol for Speech-Augmented-Korean Modification. Results The results indicated that at the age of five, 65 to 70% of children with BCLP presented articulation and resonance within normal or acceptable ranges. Further, seven children with BCLP (13.5%) needed both additional speech therapy and palatal surgery for persistent velopharyngeal insufficiency and speech problems even at the age of five. Conclusion This study confirmed that routine follow-up speech assessments are essential as a substantial number of children with BCLP require secondary surgical procedures and extended speech therapy to achieve normal speech development.

Effect of neck extension on intraocular pressure in paediatric patients undergoing palatoplasty.

BACKGROUND: Intraocular pressure (IOP) can increase with postural changes, which can cause ocular complications. Neck extension is commonly used during palatoplasty to improve surgical angulation. This study evaluates whether neck extension affects IOP during palatoplasty. METHODS: In this prospective observational study, IOP was measured using a rebound tonometer at four specific time points: T1, 10 min after anaesthesia while in the supine position; T2, 5 min after neck extension; T3, at completion of palatoplasty with neck extended; and T4, 5 min after returning to the supine position. The primary outcome was the IOP at T2, and the secondary outcomes were the IOPs at T3 and T4. Haemodynamic and respiratory variables were also measured at each time point. RESULTS: Thirty-seven patients were included. IOP at T2 was significantly higher than at T1 (15.8 ±â€¯3.4 mmHg vs 10.5 ±â€¯2.8 mmHg, P < 0.001), and IOPs at T3 and T4 were also significantly higher than at T1 (T3 vs T1: 18.9 ±â€¯3.6 mmHg vs 10.5 ±â€¯2.8 mmHg, P < 0.001; T4 vs T1: 13.3 ±â€¯3.7 mmHg vs 10.5 ±â€¯2.8 mmHg, P < 0.001). However, no significant differences were observed for the haemodynamic and respiratory variables at any time point. CONCLUSION: Our findings indicate that the intraoperative neck extension position during palatoplasty significantly increases IOP in paediatric cleft palate patients undergoing a palatoplasty.

Three-Dimensional Analysis of Flap Volume Change in Total Tongue Reconstruction: Focus on Reinnervated Dynamic Tongue Reconstruction.

In general, flap volume decreases over time and further in the case of a denervated muscle flap. In our institution, dynamic reconstruction, including functional muscle flaps, has been used to aid functional recovery in the past 6 years. This study aimed to determine the effect of volume change of the fat and muscular sections of reconstructed tongue flaps after motor nerve reinnervation in dynamic total tongue reconstruction using 3-dimensional measurement and analysis. A retrospective chart review was performed on 21 patients who underwent total tongue reconstruction using an anterolateral thigh free flap from 2015 to 2020. The fat and muscle volumes of the flap were measured using computed tomography data obtained before surgery (T0), 2 weeks after surgery (T1), and 6 months after surgery (T2) using a 3-dimensional rendering software. Among the 21 patients that underwent tongue reconstruction, 10 underwent dynamic reconstruction, whereas 11 underwent conventional reconstruction using a fasciocutaneous flap. T2 volume compared with T1 was 69.08% in the conventional reconstruction group, and the fat and muscle portions in the dynamic reconstruction group were 77.04% and 69.06%, respectively. No significant difference was noted in the volume change between the 2 groups. After dynamic tongue reconstruction, the muscular volume of the flap had similar volume reduction rate as the fat volume. The dynamic reconstruction was effective not only for functional muscle transfer but also for maintaining the volume of the reconstructed muscle flap.

Reliability and Validity of Emotrics in the Assessment of Facial Palsy.

The globally accepted evaluation method for facial palsy is the House-Brackmann facial grading system; however, it does not reflect minute changes. Several methods have been attempted, but there is no universally accepted evaluation method that is non-time-consuming and quantitative. Recently, Emotrics, a two-dimensional analysis that incorporates machine-learning techniques, has been used in various clinical fields. However, its reliability and validity have not yet been determined. Therefore, this study aimed to examine and establish the reliability and validity of Emotrics. All patients had previously received speech therapy for facial palsy at our hospital between January and November 2022. In speech therapy at our hospital, Emotrics was routinely used to measure the state of the patient's facial palsy. A frame was created to standardize and overcome the limitation of the two-dimensional analysis. Interrater, intrarater, and intrasubject reliability were evaluated with intraclass correlation coefficients (ICC) by measuring the indicators that reflect eye and mouth functions. Validity was evaluated using Spearman's correlation for each Emotrics parameter and the House-Brackmann facial grading system. A total of 23 patients were included in this study. For all parameters, there was significant interrater and intrarater reliability (ICC, 0.61 to 0.99). Intrasubject reliability showed significant reliability in most parameters (ICC, 0.68 to 0.88). Validity showed a significant correlation in two parameters (p-value < 0.001). This single-center study suggests that Emotrics could be a quantitative and efficient facial-palsy evaluation method with good reliability. Therefore, Emotrics is expected to play a key role in assessing facial palsy and in monitoring treatment effects more accurately and precisely.

Impact of Dynamic Tongue Reconstruction on Sequential Changes of Swallowing Function in Patients Undergoing Total or Near-Total Glossectomy.

PURPOSE: This study aimed to compare the effects of motor-innervated free flap on sequential changes of swallowing function in patients undergoing total or near-total glossectomy with laryngeal preservation. MATERIALS AND METHODS: The medical charts of 21 patients who underwent tongue reconstruction after total or near-total glossectomy between April 2015 and December 2020 were retrospectively reviewed. Patients were divided into groups by reconstruction type: conventional, reconstruction using an anterolateral thigh free flap (n = 11), and dynamic, reconstruction using an anterolateral thigh with innervated vastus lateralis flap (n = 10). Demographics, surgical details, and survival outcomes were investigated. A videofluoroscopic penetration-aspiration scale and functional outcome swallowing scale were analyzed according to postoperative time courses, classified as within 6 months, 6 to 12 months, and after 12 months postoperative. A time-to-event analysis was performed for gastrostomy tube status. RESULTS: The dynamic group showed improved swallowing outcomes at 6 to 12 months postoperative (dynamic vs conventional group, penetration-aspiration scale: 3 ± 1.51 vs 6 ± 1.63, P = 0.024; functional outcome swallowing scale: 1.89 ± 1.36 vs 4 ± 1.41, P = 0.009). In the multivariate analysis, the dynamic group showed a decreased probability of decompensated swallowing function at 6 to 12 months postoperative (odds ratio, 0.062; 95% confidence interval, 0.004-1.084; P = 0.057). A time-to-event analysis revealed no significant difference in gastrostomy tube status between the dynamic and the conventional group. CONCLUSIONS: Considering higher mortality in patients subjected to total or near-total glossectomy, dynamic reconstruction with motor-innervated free flap is worth to perform in terms of enhancing the swallowing function within 1-year postoperative period, thereby improving the quality of life.

A comprehensive review of surgical techniques in unilateral cleft lip repair.

Unilateral cleft lip is a common congenital anomaly that affects the appearance and function of the upper lip and nose. Surgical repair of cleft lip aims to restore the normal anatomy and functionality of the affected structures. In recent years, several advances have been made in the field of cleft lip repair, including new surgical techniques and approaches. This comprehensive review discusses the surgical management of patients with unilateral cleft lip and palate and provides step-by-step instructions for the surgical procedures.

Primary Cleft Rhinoplasty with Custom Suture Needle for Alar Cartilage Repositioning in Unilateral Cleft Lip Patients: 3D Nasal Analysis.

OBJECTIVE: Primary nasal correction has been demonstrated to be a beneficial practice for patients with unilateral cleft lip and palate. However, there is currently no consensus among cleft surgeons regarding the ideal approach to addressing the malpositioned cartilages. This study aims to introduce a new surgical technique for repositioning deformed lower lateral cartilage during primary cleft rhinoplasty, which involves using a customized suture needle. DESIGN: Retrospective cohort study. SETTING: Tertiary university-affiliated hospital. PARTICIPANTS: This retrospective study included 51 patients with unilateral cleft lip and palate who underwent primary rhinoplasty during the labial repair. MAIN OUTCOME MEASURES: A morphological analysis of the nose was conducted using three-dimensional (3D) photographs. The cleft-to-noncleft side ratios of various nasal parameters, including nasal tip volume, nostril width, height, and area, were calculated at three time points: preoperative (T0), 3 months postoperative (T1), and 1 year postoperative (T2). RESULTS: Significant improvement (p < 0.05) was observed in the cleft-to-noncleft side ratios of nasal volume and nostril parameters. The nasal volume ratio and nostril height ratio remained stable, with no significant differences between the T1 and T2 periods. The nostril width ratio increased from 0.96 ± 0.13 at T1 to 1.05 ± 0.16 at T2, indicating an appropriate degree of surgical overcorrection of nasal width during primary lip repair. CONCLUSION: Primary cleft rhinoplasty using a Chang's needle allows direct suture placement in the intercartilaginous region with minimally invasive approach, thereby preserving growth potential of the nose and restoring the nasal symmetry.

Artificial intelligence-based numerical analysis of the quality of facial reanimation: A comparative retrospective cohort study between one-stage dual innervation and single innervation.

This study aimed to investigate the difference in facial reanimation surgery using functional gracilis muscle transfer between the masseteric nerve alone and its combined use with cross face nerve graft (CFNG), which has not been explored before. A novel analysis method based on artificial intelligence (AI) was employed to compare the outcomes of the two approaches. Using AI, 3-dimensional facial landmarks were extracted from 2-dimensional photographs, and distance and angular symmetry scores were calculated. The patients were divided into two groups, with Group 1 undergoing one-stage CFNG and masseteric nerve dual innervation, and Group 2 receiving only masseteric nerve. The symmetry scores were obtained before and 1 year after surgery to assess the degree of change. Of the 35 patients, Group 1 included 13 patients, and Group 2 included 22 patients. The analysis revealed that, in the resting state, the change in the symmetry score of the mouth corner showed distance symmetry (2.55 ± 2.94, 0.52 ± 2.75 for Group 1 and Group 2, respectively, p = 0.048) and angle symmetry (1.21 ± 1.43, 0.02 ± 0.22 for Group 1 and Group 2, respectively, p = 0.001), which were significantly improved in Group 1, indicating a more symmetric pattern after surgery. In the smile state, only the angle symmetry was improved more symmetrically in Group 1 (3.20 ± 2.38, 1.49 ± 2.22 for Group 1 and Group 2, respectively, p = 0.041). Within the limitations of the study it seems that this new analysis method enabled a more accurate numerical symmetry score to be obtained, and while the degree of mouth corner excursion was sufficient with only the masseteric nerve, accompanying CFNG led to further improvement in symmetry in the resting state.

Deep-plane facelift technique for managing extensive hemifacial tumors: A retrospective study.

This study aimed to evaluate functional and aesthetic outcomes in patients undergoing deep-plane facelifts for the management of extensive hemifacial tumors. The retrospective study included patients who had been diagnosed with benign tumors with extensive hemifacial involvement. All patients underwent tumor debulking via a dual-plane facelift approach, assisted by an ICG camera to visualize the facial nerve structures. To manage the laxity of the skin envelope, the deep-plane face-lift was performed by suspending the superficial musculoaponeurotic layer, followed by suture fixation to the parotid-masseteric fascia. Clinical outcomes, including complications, House-Brackmann grading for facial paralysis, and tumor recurrence rate were investigated. Quantitative facial nerve examination was carried out using FACE-gram software (Massachusetts Eye and Ear Infirmary, Boston, USA) to measure mouth corner movement at rest and when smiling. Using preoperative and 1-year postoperative 3D photographs, facial symmetry was assessed using comparisons of facial volume and the root-mean-square deviation (RMSD) value to represent the height difference between each hemiface. In total, 25 patients who met the inclusion criteria were recruited to the study. Regarding the types of tumor, 13 of the 25 patients were diagnosed with vascular lesions and the other 12 with neurofibromatosis plexiform. Following surgery, two patients showed temporary palsy of the buccal branches - grade II on the House-Brackmann scale - but neural functioning was eventually restored during the follow-up period. During resting, the mouth corner excursion ratio was significantly improved, from 1.11 ± 0.19 preoperatively to 1.02 ± 0.08 postoperatively (p = 0.022). The facial volume ratio was significantly improved in the lower face, from 1.57 ± 0.66 preoperatively to 1.19 ± 0.18 postoperatively (p = 0.008). The RMSD was significantly decreased, from 4.56 ± 2.35 mm preoperatively to 2.08 ± 0.99 mm postoperatively (p < 0.001), representing a decrease in facial asymmetry. Within the limitations of the study, it seems that the ICG camera-assisted deep-plane facelift technique allows preservation of facial nerve functioning and enhances facial symmetry when managing extensive hemifacial tumors.

Swallowing analysis in hemi-tongue reconstruction using motor-innervated free flaps: A cine-magnetic resonance imaging study.

BACKGROUND: This study aimed to explore the outcomes of motor-innervated free flaps in hemi-tongue reconstruction by assessing the tongue mobility through midsagittal images from cine-magnetic resonance imaging. METHODS: In this retrospective study, 47 patients who underwent tongue reconstruction following hemi-glossectomy and 10 control subjects without any surgical history were included. Patients were classified into two groups: the motor and no-motor innervation group. Various spatial parameters related to tongue mobility that were acquired from midsagittal sections were compared during consecutive swallowing phases. RESULTS: Overall, the motor group showed improved functional swallowing scale compared with the no-motor group. In case of tongue base resection, the motor group showed improved mobility of the tongue base during pharyngeal phase, whereas the no-motor group showed increased laryngeal elevation for compensatory movement. CONCLUSION: The tongue reconstruction with motor-innervated free flaps may facilitate swallowing capacity in patients with a hemi-tongue defect combined with tongue base resection.

Effect of Acellular Dermal Matrix on Long-Term Speech Outcomes in Primary Palatoplasty with Radical Intravelar Veloplasty.

OBJECTIVE: This study investigates whether the use of acellular dermal matrix (ADM) affects the long-term speech outcomes in patients undergoing primary palatoplasty with radical intravelar veloplasty. DESIGN: Retrospective cohort study. SETTING: Tertiary university-affiliated hospital. PARTICIPANTS: A consecutive cohort of 112 patients who underwent primary palatoplasty with radical intravelar veloplasty from August 2014 to March 2018 were included. MAIN OUTCOME MEASURES: A 2 × 2 cm-sized ADM was incorporated as an interpositional graft between the oral and nasal lining at the soft-hard palate junction. The perceptual analysis of hypernasality and articulation was performed when the age of the patient reached at least 36 months. Cleft-related characteristics and surgical factors affecting the speech outcomes were investigated. RESULTS: The ADM was applied in 57 patients with a mean follow-up of45.76 months (SD, 10.69), while no ADM was used in 55 patients with a mean follow-up of 48.43 months (SD, 14.98). Regarding the hypernasality outcome, 33.3% (19 of 57 patients) of the ADM group and 27.3% (15 of 55 patients) of the control group showed a greater than mild-to-moderate degree. The distribution of hypernasality and articulation grade showed no significant difference between the two groups. After controlling for potential risk factors that may affect the speech outcomes, the use of ADM showed no significant relationship with velopharyngeal insufficiency. CONCLUSION: The use of ADM use in primary palatoplasty with radical intravelar veloplasty is not associated with the alteration of speech function in early childhood.

Functional Outcome Comparison of Free Gracilis Muscle Anchoring Methods in Patients with Facial Paralysis: Upper Lip Red Line Incision versus Facelift Incision Approach.

BACKGROUND: The greatest challenge of a free-muscle transfer in facial reanimation surgery is anchoring muscle to perioral soft tissue. An additional incision provides a better way to anchor the transferred muscle but leaves a visible scar. Herein, we compared the functional and aesthetic outcomes in a conventional facelift incision approach with and without the addition of a red line incision. METHODS: This study included patients experiencing unilateral facial paralysis who underwent free gracilis transfer between December 2016 and December 2018. Anchoring through facelift incision with extended neck incision was performed in the control group, while a red line incision was added in the red line group by avoiding extended neck incision. Oral commissure excursion, upper lip and commissure height differences, and symmetry were measured. RESULTS: A total of 24 patients met the criteria and were included in this study. Of these, 10 patients were assigned to the red line group and 14 to the control group. The red line and control groups demonstrated a similar symmetry index in both resting (0.96 ± 0.18 and 0.92 ± 0.10, respectively; p = 0.435) and smiling (0.94 ± 0.12 and 0.91 ± 0.10, respectively; p = 0.314). However, the upper lip height difference demonstrated greater postoperative improvement (resting: 2.12 ± 1.13 vs. 3.92 ± 1.41 mm, p = 0.002, and smiling: 1.68 ± 0.88 vs. 3.41 ± 1.69 mm, p = 0.004, respectively). A scar could be easily concealed on the mucocutaneous line of the lip. CONCLUSION: This novel method for muscle anchoring in facial reanimation surgery allows surgeons to approach perioral muscle more directly. This leads to improved surgical results by securely anchoring the transferred muscles using a fixation point that is more medially located than in other approaches. Our method is effective and offers an improved surgical outcome for the free functional gracilis muscle transfer.

Neck Extension and Intraocular Pressure Elevation During Palatoplasty in a Patient with Patau Syndrome and Congenital Glaucoma: A Case Report.

Patau syndrome (trisomy 13) is a severe disorder associated with multiple systemic defects. Patau syndrome is commonly associated with ocular abnormalities but rarely associated with congenital glaucoma. To obtain a better surgical view, palatoplasty requires neck extension during surgery. The intraocular pressure (IOP) of patients with Patau syndrome can increase owing to the neck extension position while undergoing palatoplasty, particularly in those with congenital glaucoma. Here, we describe a case with increased IOP measured using a rebound tonometer during palatoplasty in a pediatric patient with Patau syndrome and congenital glaucoma. This case shows that it may be important to reduce the degree of neck extension and shorten the operation time to minimize any increase in the IOP during palatoplasty in pediatric patients with Patau syndrome accompanied by congenital glaucoma.

Comparison of Cleft Lip Nasal Deformities Between Lesser-Form and Incomplete Cleft Lips: Implication for Primary Rhinoplasty.

OBJECTIVE: This study investigated various manifestations of nasal deformities in lesser-form cleft lips, including the minor-form, microform, and mini-microform, by photogrammetric comparison with incomplete cleft lips. DESIGN: Retrospective study. SETTING: Tertiary university-affiliated hospital. PARTICIPANTS: A total of 160 patients with unrepaired unilateral incomplete cleft lips ranging from lesser-form to two-thirds way clefts. MAIN OUTCOME MEASURES: The severity of nasal deformities was assessed by photogrammetric measurements of linear and angular variables. The symmetry ratio between the cleft and non-cleft sides was obtained by measuring various nasal parameters and comparing them among the different labial cleft groups. RESULTS: The degree of nasal deformities increased with the extent of labial clefts among the 3 labial cleft groups (lesser-form, halfway, and two-thirds way clefts) in terms of alar base width ratio (1.102, 1.197, 1.309; P < .05), nostril width ratio (1.287, 1.387, 1.551; P < .05), and columellar angle (11.5, 14.45, 18.197; P < .05). Each parameter indicated lesser-form, halfway, and two-thirds way clefts, respectively. However, only the lateral lip height ratio (0.942, 0.851, 0.87; P < .05) and nostril width ratio (1.207, 1.35, 1.29; P < .05) significantly differed among the 3 subgroups. Each parameter indicated mini-microform, microform, and minor-form, respectively. CONCLUSIONS: The cleft nasal deformities in lesser-form cleft lip present comparable severities among its subtypes, which implies that the extent of the labial cleft is not correlated with nasal deformities. Each nose in the lesser form cleft should be individually assessed for primary rhinoplasty and requires tailored correction.

Extended Superficial Musculoaponeurotic System Face-Lift With Vertical Vector for Asian Patients: A 3-Dimensional Analysis of Facial Contour.

In this study, the authors report the experience of extended superficial musculoaponeurotic system (SMAS) face-lift with the vertical vector in Asian ethnicity and investigate the 3-dimensional change of facial contour. A total of 32 patients with Korean ethnicity underwent extended SMAS face-lift with vertical vector from 2015 to 2018. Patients with aging face were included for the study subjects, whereas those who were diagnosed with any craniofacial deformity were excluded. Using 3-dimensional photogrammetry, surface contour analysis was performed in the cheek region to calculate the mean, maximal, and minimal difference of surface projection and global root mean square error between the preoperative and 1-year postoperative period. The change of horizontal facial widths and jawline angle was evaluated. In contour analysis, the mean difference of surface contour was highest in anterior, followed by lateral cheek and lower face, sequentially. The maximal difference of surface contour was highest in anterior cheek, followed by lateral cheek and lower face, whereas the minimal difference of surface contour was lowest in lower face, followed by anterior cheek and lateral cheek, sequentially. No significant differences in the midfacial and lower facial distances were observed between the preoperative and postoperative periods. There was significant increase of jawline angle, from 20.78 to 23.14 degree of mean value ( P =0.001). In conclusion, the extended SMAS face-lift with vertical vector can be an optimal option for Asian subjects in terms of the midfacial volumetric shift, sharpening of jawline and avoidance of midfacial widening.

Scalp Reconstruction Strategy Based on the Etiology of the Scalp Defects.

ABSTRACT: Scalp defects of various etiologies require distinct reconstruction strategies. Therefore, the authors divided scalp defects into the following categories: scar alopecia, open scalp wound, benign or low-grade malignant tumor, and high-grade malignancy. The authors reviewed the experience with scalp reconstruction of a single center to determine the factors that affect the reconstructive choices.Patients who underwent scalp reconstruction between 2008 and 2020 were retrospectively reviewed. Reconstruction methods were classified according to the etiology of the defect and were compared for each etiology. Accordingly, a reconstruction algorithm for scalp defects was proposed.A total of 180 patients were included in this study, and the reconstruction methods demonstrated significant differences according to etiology (P < 0.05). For scar alopecia and open scalp wounds, reconstruction methods such as direct repair, local flap transfer, and tissue expander placement were used depending on the defect size. Patients with benign or low-grade malignancies mainly underwent reconstruction with local flaps or skin grafts and tissue expanders for covering the defects. Patients with high-grade malignancies underwent reconstruction with free flaps if they were scheduled for preoperative or postoperative radiation therapy.Various factors, suchas the etiology, size, location, and depthofthe defect, should be considered in scalp reconstruction. The defect etiology is an important factor that determines the reconstructive goal. Our algorithm is based on the etiology of defects and is intended to aid physicians in choosing the appropriate treatment for various scalp defects.

Numerical Approach to Facial Palsy Using a Novel Registration Method with 3D Facial Landmark.

Treatment of facial palsy is essential because neglecting this disorder can lead to serious sequelae and further damage. For an objective evaluation and consistent rehabilitation training program of facial palsy patients, a clinician's evaluation must be simultaneously performed alongside quantitative evaluation. Recent research has evaluated facial palsy using 68 facial landmarks as features. However, facial palsy has numerous features, whereas existing studies use relatively few landmarks; moreover, they do not confirm the degree of improvement in the patient. In addition, as the face of a normal person is not perfectly symmetrical, it must be compared with previous images taken at a different time. Therefore, we introduce three methods to numerically approach measuring the degree of facial palsy after extracting 478 3D facial landmarks from 2D RGB images taken at different times. The proposed numerical approach performs registration to compare the same facial palsy patients at different times. We scale landmarks by performing scale matching before global registration. After scale matching, coarse registration is performed with global registration. Point-to-plane ICP is performed using the transformation matrix obtained from global registration as the initial matrix. After registration, the distance symmetry, angular symmetry, and amount of landmark movement are calculated for the left and right sides of the face. The degree of facial palsy at a certain point in time can be approached numerically and can be compared with the degree of palsy at other times. For the same facial expressions, the degree of facial palsy at different times can be measured through distance and angle symmetry. For different facial expressions, the simultaneous degree of facial palsy in the left and right sides can be compared through the amount of landmark movement. Through experiments, the proposed method was tested using the facial palsy patient database at different times. The experiments involved clinicians and confirmed that using the proposed numerical approach can help assess the progression of facial palsy.

The impact of dynamic tongue reconstruction using functional muscle transfer: A retrospective review of 94 cases with functional outcome analysis for various glossectomy defects.

The aim of this study was to evaluate the functional outcomes of dynamic tongue reconstruction in various types of glossectomy defects. A retrospective review of patients who underwent tongue reconstruction following cancer resection was performed. Patients were divided into two groups by the type of procedure: dynamic reconstruction using motor-innervated free flaps and conventional reconstruction with fasciocutaneous free flaps. Demographics, including patient and tumor characteristics, and surgical factors, including the type of glossectomy and flap, were investigated. Functional outcomes were compared through quantitative assessment of tongue movement, speech capacity, videofluoroscopic barium swallow, and percutaneous endoscopic gastrostomy (PEG) tube dependency. 94 patients were enrolled in this study. The conventional reconstruction was performed in 52 patients and dynamic reconstruction was performed in 42 patients. Overall, the dynamic group showed improved swallowing capacity (videofluoroscopic swallowing scale, mean ± standard deviation, dynamic group, 3.24 ± 0.79, versus conventional group, 2.88 ± 1.08; p = 0.07). No significant differences in tongue motion and speech outcomes were noted between the groups. In multivariate logistic analysis controlling of various confounders, the dynamic reconstruction was significantly related to improved swallowing outcomes (adjusted odds ratio, 0.148; 95% confidence interval 0.03-0.725; p = 0.018). Dynamic reconstruction was not significantly related to the rate of PEG tube dependency. Within the limitations of the study, it seems that the dynamic tongue reconstruction using motor innervated free flaps can improve swallowing outcome by reproducing the original sling action of tongue musculature and preserving the tongue volume.

Curved-line cleft lip repair in unilateral complete cleft lip patients: Comparative analysis of lip dimensions after cheiloplasty.

This study aimed to restore upper lip symmetry and minimize tissue sacrifice using a curved line design and wire technique and analyze the postoperative outcomes. In this retrospective study, medical records of patients with complete unilateral cleft lip who underwent unilateral cheiloplasty between August 2017 and February 2019 were reviewed. The postoperative clinical photos were analyzed to determine vertical, diagonal philtral heights and the horizontal lengths of the upper lip. The average of the cleft side to non-cleft side length ratios were compared between the curved line group and conventional group. At 3, 6, and 12 months, the average vertical length ratios were significantly greater in the curved line group than in the conventional group (0.927-0.823, p = 0.007; 0.940 to 0.885, p = 0.037; and 0.947 to 0.883, p = 0.040, respectively), but the average horizontal length ratios were not significantly different between the two groups. Within the limitations of the study it seems that curved line cheiloplasty aids in preventing short lip deformity development at regular term without significantly sacrificing the horizontal length and, therefore, should be adopted whenever appropriate.