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Outcomes Of Facial Paralysis Reconstruction In The Oncologic Setting: 20-year Experience Of 270 Cases
Z-Hye Lee, MD1, Matthew J. Davis, MD2, Austin D. Williams, BS2, Arren E. Simpson, BS2, Alexandra L. Martinez, BS2, Paul W. Gidley, MD1, Peirong Yu, MD1, Matthew M. Hanasono, MD1;
1The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 2Baylor College of Medicine, Houston, TX, USA

Head and neck cancer patients comprise a unique subset of the facial paralysis population. This 20-year series examines risk factors, reconstructive strategies, and their outcomes.
We conducted a retrospective review of all head and neck cancer patients at a tertiary cancer center from 2000-2020 who underwent reconstructive procedures for facial paralysis.
RESULTS: 270 total patients were included. Average age was 64.0 +/- 15.3 years. Medical comorbidities included coronary artery disease (17.4%), type 2 DM (16.0%), hypertension (50.4%), and active smoking (16.7%). Most patients underwent total parotidectomy (71.3%) and temporal bone resection (62.8%). 61.5% presented with preoperative palsy. 23.0% had previous radiation and 60.4% underwent adjuvant radiation. 95.6% underwent free flap soft tissue reconstruction, most commonly with the anterolateral thigh free flap (85.2%). Nerve reconstruction was performed with nerve grafting in 43.7% of patients, primary nerve repair in 8.2%, and nerve transfer in 1.9%. Static procedures including facial slings (59.6%), upper eyelid gold weight placement (48.5%), and lateral tarsal strip (38.5%) were utilized as adjunct procedures. Average post-operative House-Brackmann scores were the following: brow=3.7, eye=3.1, midface=3.4 and oral=3.5. For patients with total facial nerve sacrifice, a history of previous and adjuvant radiation therapy was associated with significantly worse recovery (p=0.044).
CONCLUSION: Oncologic facial paralysis patients pose unique reconstructive challenges due to their older age, medical co-morbidities, need for radiation therapy, and the concurrent soft tissue resurfacing needs. Facial nerve grafting with static procedures as adjuncts are the mainstay options for reconstruction.
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