Neck Surgery Helps Ease Facial Paralysis

Removing a strip of the platysma muscle from the neck can relieve chronic rigidity and involuntary movement in patients with facial paralysis, according to a new study.

Researchers at the Massachusetts Eye and Ear Infirmary (Boston, USA) have developed a procedure to address platysmal synkinesis and hypertonicity permanently, based on platysmectomy as part of a permanent solution to chronic superficial torticollis-like neck symptoms. During a 10-month period, 24 patients underwent the procedure; in 19 of the patients, platysmectomy was performed using local anesthesia without sedation. In the remaining 5 patients, platysmectomy was performed using general anesthesia (GA) concurrent with free gracilis transfer for smile reanimation. Preoperative and postoperative facial clinimetric evaluation (FCE) data were available from 21 of these patients (88%).

The results showed that no intraoperative or postoperative complications occurred. Comparing responses on the FCE questionnaire available both before and after the surgery showed that overall scores rose from 46.7 to 55.2, indicating an improved quality of life after the procedure. However, five patients reported an overall decrease in quality of life, but with stable or improved scores on specific questions about neck and facial tightness. Three patients reported their face felt worse after the procedure, which the researchers related to vagueness of the questions and that facial tightness could have reflected evolving scar or ongoing worsening of hyperkinesis in the face. The study was published in the July/August 2011 issue of the Archives of Facial Plastic Surgery.

“Treatment of the synkinetic neck using this modality is simple and yields a significant subjective benefit,” concluded lead author Douglas Henstrom, MD, and colleagues of the department of otolaryngology–head and neck surgery. “Since the platysma muscle is used only during the expressions of contempt and disgust, completely cutting through the muscle is not expected to create bothersome deficits.”

Platysmectomy involves an incision to expose the platysma muscle, stretching from the shoulders and chest through the neck, and then removing a continuous 1-cm wide band of it (in segments). The procedure was developed when researchers noticed that the platysma was often enlarged in patients with rigid, spastic, or synkinetic findings, and that platysmectomy could reduce its downward pull against the upward pull of the zygomaticus muscles used to smile.

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Massachusetts Eye and Ear Infirmary