Comparative objective and subjective analysis of temporalis tendon and microneurovascular transfer for facial reanimation

The aim of this study was to compare objectively and subjectively the resul ts after temporalis tendon and microneurovascular transfer for reanimation of the paralysed face. For the objective analysis, measurements of the distances between static an d dynamic points in three-dimensional space were performed at rest and duri ng smiling. The patients were assessed subjectively by non-professionals sc oring videotapes. The range of motion of the oral commissure on smiling was 1.7 mm (0.8, mean and SE) after tendon and 5.5 mm (1.6) after microneurovascular transfer (P < 0.05) without showing teeth, and 0.6 mm (1.3) vs 3.6 mm (2.4, ns) with s howing teeth. Compared with the healthy side, the excursions reached 6% (16 ) after tendon and 71% (26, P < 0.05) after microneurovascular transfer for smiling without, and -4% (14) vs 19% (14, ns) for smiling with showing tee th, respectively. Virtually no difference was found in the measurements at rest as well as in the subjective evaluation. Swelling of the cheek (28%) a nd tethering of the skin (24%) were shown to be the most disturbing symptom s after microneurovascular transfer. Better excursion and symmetry of the oral commissure were achieved by micro neurovascular reconstruction for voluntary smile. However, the aesthetic ou tcome after microneurovascular transfer is markedly impaired by chronic com plications including swelling of the cheek and tethering of the skin, which were not detected by the three-dimensional measurement technique used. We conclude that the aesthetic appearance should be considered equally importa nt as the range of motion in the reanimated face.