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Original Investigation Research

Facial Reanimation Procedures Performed With Total Parotidectomy and Facial Nerve Sacrifice

Table 2. Categorical Demographic Data a

Reanimation Group by Repair Type

Nonreanimation Group (n = 196)

Characteristic Sex, No. (%) Male

Nerve (n = 41)

Sling (n = 31) Both (n = 17)

All (n = 89)

P Value

P Value

20 (48.8) 21 (51.2)

22 (71.0) 9 (29.0)

12 (70.6) 5 (29.4)

54 (60.7) 35 (39.3)

122 (62.2) 74 (37.8)

.10

.79

Female

Race, No. (%) White

31 (75.6) 1 (2.4) 9 (22.0)

28 (90.3)

16 (94.1)

75 (84.3)

133 (67.9) 10 (5.1) 53 (27.0)

Black Other

0

1 (5.9)

2 (2.2)

.13

.02

3 (9.7)

0

12 (13.5)

Surgeon specialty, No. (%) ENT

40 (97.6)

30 (96.8)

17 (100)

87 (97.8)

175 (89.3)

Neurosurgery

0

1 (3.2)

0 0 0

1 (1.1) 1 (1.1)

1 (0.5) 6 (3.1) 14 (7.1)

.55

.04

Plastics

1 (2.4)

0 0

General surgery

0

0

Diabetes present, No. (%) Yes

4 (9.8)

3 (9.7)

0

7 (7.9)

33 (16.8) 163 (83.2)

.80

.18

No

37 (90.2)

28 (90.3)

17 (100)

82 (92.1)

Smoking status Yes

3 (7.3)

2 (6.4)

2 (11.8) 15 (88.2)

7 (7.9)

39 (19.9) 157 (80.1)

.80

.009

No

38 (92.7)

29 (93.5)

82 (92.1)

Functional health Independent

40 (97.6)

31 (100)

16 (94.1)

87 (97.8)

192 (98.0)

.24

.54

Partially dependent

1 (2.4)

0

1 (5.9)

2 (2.2)

4 (2.0)

ASA class b I

1 (2.4)

1 (3.2) 5 (16.1) 24 (77.4)

0

2 (2.2)

13 (6.6) 64 (32.7) 107 (54.6)

II

15 (36.6) 24 (58.5)

6 (35.3) 11 (64.7)

26 (29.2) 59 (66.3)

.57

.21

III IV

1 (2.4)

1 (3.2)

0

2 (2.2)

11 (5.6)

b I indicates healthy patient; IV, severe systemic disease. One case in the data set was labeled ASA class not assigned.

identifying nerve endings, and potential compromise of mi crovascular flap when performed. 14 Wallerian degeneration also sets inwithin 72 hours and eliminates the option of nerve stimulation to identify functional movement of distal nerve branches. Static procedures and regional muscle transfers (eg, temporalis tendon and masseter muscle transfer) also share the same surgical field as parotidectomy and are amenable to concurrent repair. Free flap reconstruction of radical paroti dectomy defects have been described in combination with static and dynamic facial rehabilitation to achieve dynamic movement and improvement in patient disfigurement scales. 15-18 Early eyelid loading has been shown to prevent the sequelae of paralytic lagophthalmos and does not showan in creased rate of complication. 19-21 Some evidence exists in the literature on the utility of immediate facial reanimation pro cedures at the time of facial nerve sacrifice. In a retrospective study, Yawn et al 6 found that acute hypoglossal-facial anas tomosis repair was associatedwith a 4.97-fold greater odds of achieving a House-Brackmann grade of 3 or less. Ultimately, the decision to perform concurrent reanimation may vary on a case-by-case basis but should include consideration of pa tient factors, such as extent of nerve sacrifice, risk of pro longed anesthetic time, and disease prognosis. Abbreviations: ASA, American Society of Anesthesiologists class; ENT, ear, nose, and throat. a Percentages have been rounded and may not total 100.

The availability of a reconstructive surgeon comfortable with facial reanimation procedures is another consideration. Those patients receiving free tissue reconstruction were sig nificantly more likely to receive a facial rehabilitation proce dure, and a 2-teamapproach is often used in these reconstruc tive cases. The teamperforming free tissue reconstructionmay also routinely perform facial nerve rehabilitation and have an increased comfort level with these procedures. Availability of a reconstructive surgeon familiarwith facial rehabilitationmay dictate whether the patient undergoes concurrent rehabilita tion. Otolaryngologists performed most of the concurrent re animation procedures during parotidectomywith facial nerve sacrifice. This situationmay be associatedwith otolaryngolo gists’ comfort inareas of ablativeparotidectomy surgery aswell as facial reanimation. In addition, at most institutions, oto laryngologists perform reconstruction after oncologic sur gery of the head and neck. Those patients receiving nerve-type repairs only were younger than those receiving sling-type procedures. Unmea sured patient factors such as extent of disease, risk of pro longed general anesthetic, and patient prognosis, may con tribute to intraoperative decision making. We found a statistically significant difference in smoking status between

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(Reprinted) JAMA Facial Plastic Surgery January/February 2019 Volume 21, Number 1

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