A new study published in Plastic and Reconstructive Surgery suggested that dynamic facial reanimation surgery benefits patients over age 60 who have facial palsy and should not be denied to them solely because of their age.
Treatment of facial paralysis in the older population is often relegated to static rather than dynamic reanimation for fear of poor outcomes. This study refutes this pervasive viewpoint and demonstrates evidence of success for one-stage dynamic reanimation including muscle advancements, free functional muscle transfers, or nerve transfers.
Hopefully, the results of this study will improve awareness among clinicians and significantly improve the lives of patients who develop facial palsy. Researchers reviewed outcomes in 30 patients over age 60 treated at three facial palsy centers. Twelve of the patients underwent lengthening temporalis myoplasty (LTM), 14 received free functional muscle transfer (FFMT) innervated by the masseter nerve, and four were treated by direct nerve transfer.
The three groups in the clinical series were similar in average age, preoperative House-Brackman score, and comorbidities. The highest average excursion was reported in the FFMT group followed by the nerve transfer and temporalis myoplasty groups. The largest average philtral deviation correction occurred in the LTM group followed by the FFMT and nerve transfer groups.
The FFMT group had the highest complication rate. Out of 629 articles, 57 mentioned an age range over 60, but only 45 patients were reported, with limited detail, providing only weak evidence supporting the misguided concept that dynamic reanimation should be reserved for younger patients. The older patients in the study responded well to the standard treatments for facial paralysis.
While there is some evidence that nerves may regenerate more slowly in older patients that do not in any way take away from the final success of the treatment. All too frequently, older patients are either not offered specific treatments or surgeons subconsciously guide their older patients towards procedures that they feel are more suited to their age. Often there are little or no data to support such decisions.
The restoration of facial symmetry in repose and with spontaneous facial animation gives the patients self-confidence, improved self-image. That allows patients to use facial expressions for the emotional nuance in verbal and non-verbal communications that are so important to our daily lives in society. The study shows that older patients can reliably obtain these goals.
The study results will help surgeons combat their own subconscious bias about offering these procedures to older adults. As noted in the article, the sooner patients begin their treatment, the better their outcomes. Clinicians should consider referral to a center that can offer a variety of facial reanimation procedures as soon as feasible, regardless of the age of their patient, the researchers said.