Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2015; 42(06): 735-740
DOI: 10.5999/aps.2015.42.6.735
Original Article

Botulinum Toxin Therapy versus Anterior Belly of Digastric Transfer in the Management of Marginal Mandibular Branch of the Facial Nerve Palsy: A Patient Satisfaction Survey

Daniel P Butler
Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK
,
Jo I Leckenby
Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK
,
Ben H Miranda
Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK
,
Adriaan O Grobbelaar
Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK
› Author Affiliations
› Further Information
   Permissions and Reprints

Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy.

Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant.

Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01).

Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

Keywords

Facial paralysis - Botulinum toxins - Facial asymmetry


Publication History

Received: 29 April 2015

Accepted: 14 September 2015

Article published online:
05 May 2022

© 2015. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Moffat DA, Ramsden RT. The deformity produced by a palsy of the marginal mandibular branch of the facial nerve. J Laryngol Otol 1977; 91: 401-406
    CrossrefPubMedGoogle Scholar
  • 2 Conley J, Baker DC. Paralysis of the mandibular branch of the facial nerve. Plast Reconstr Surg 1982; 70: 569-577
    CrossrefPubMedGoogle Scholar
  • 3 Terzis JK, Tzafetta K. Outcomes of mini-hypoglossal nerve transfer and direct muscle neurotisation for restoration of lower lip function in facial palsy. Plast Reconstr Surg 2009; 124: 1891-1904
    CrossrefPubMedGoogle Scholar
  • 4 Mayou BJ, Watson S, Harrison DH. et al. Free microvascular and microneural transfer of the extensor digitorum brevis muscle for the treatment of unilateral facial palsy. Br J Plast Surg 1981; 34: 362-367
    CrossrefPubMedGoogle Scholar
  • 5 Tulley P, Webb A, Chana JS. et al. Paralysis of the marginal mandibular branch of the facial nerve: treatment options. Br J Plast Surg 2000; 53: 378-385
    CrossrefPubMedGoogle Scholar
  • 6 Salles AN, Toledo PN, Ferreira MC. Botulinum toxin injection in long-standing facial paralysis patients: improvement of facial symmetry observed up to 6 months. Aesth Plast Surg 2009; 33: 582-590
    CrossrefPubMedGoogle Scholar
  • 7 de Maio M, Bento RF. Botulinum toxin in facial palsy: an effective treatment for contralateral hyperkinesis. Plast Reconstr Surg 2007; 120: 917-927
    CrossrefPubMedGoogle Scholar
  • 8 Mehta RP, Hadlock TA. Botulinum toxin and quality of life in patients with facial paralysis. Arch Facial Plast Surg 2008; 10: 84-87
    CrossrefPubMedGoogle Scholar
  • 9 Chen CK, Tang YB. Myectomy and botulinum toxin for paralysis of the marginal mandibular branch of the facial nerve: a series of 76 cases. Plast Reconstr Surg 2007; 120: 1859-1864
    CrossrefPubMedGoogle Scholar
  • 10 Edgerton MT. Surgical correction of facial paralysis: a plea for better reconstruction. Ann Surg 1967; 165: 985-998
    CrossrefPubMedGoogle Scholar
  • 11 Tan ST. Anterior belly of digastric muscle transfer: a useful technique in head and neck surgery. Head Neck 2002; 24: 947-954
    CrossrefPubMedGoogle Scholar
  • 12 Borodic G, Bartley M, Slattery W. et al. Botulinum toxin for aberrant facial nerve regeneration: double-blind, placebo controlled trial using subjective endpoints. Plast Reconstr Surg 2005; 116: 36-43
    PubMedGoogle Scholar
  • 13 Kahn JB, Gliklich RE, Boyev KP. et al. Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale. Laryngoscope 2001; 111: 387-398
    CrossrefPubMedGoogle Scholar
  • 14 VanSwearingen JM, Brach JS. The facial disability index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther 1996; 76: 1288-1298
    CrossrefPubMedGoogle Scholar