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