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Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
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2018 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 141, no 4, p. 582e-585eArticle in journal (Refereed) Published
Abstract [en]

In reanimation surgery, effortless smile can be achieved by a nonfacial donor nerve. The underlying mechanisms for this smile development, and which is the best nonfacial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural coactivation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic activity in muscles innervated by the masseter, hypoglossal, and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous electromyographic activity in facial muscles was also studied. Smile coactivated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer electromyographically measured coactivations compared with the tongue (two of seven versus five of seven). The trapezius muscle demonstrated no coactivation during mimic movements. Movements of the masseter, tongue, and trapezius muscles induced electromyographically recorded coactivation in the facial muscles. Bite resulted in the strongest coactivation of the zygomaticus major muscle. The authors demonstrated coactivation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong coactivation of the zygomaticus major muscle was noted. The narrower coactivation pattern in the masseter muscle may be advantageous for central relearning and the development of a spontaneous smile. The strong coactivation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation.

Place, publisher, year, edition, pages
2018. Vol. 141, no 4, p. 582e-585e
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-347468DOI: 10.1097/PRS.0000000000004235ISI: 000428668900014PubMedID: 29595736OAI: oai:DiVA.org:uu-347468DiVA, id: diva2:1194661
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2019-10-03Bibliographically approved
In thesis
1. Sequelae after Facial Palsy: Clinical, Anatomical and Electrophysiological Studies
Open this publication in new window or tab >>Sequelae after Facial Palsy: Clinical, Anatomical and Electrophysiological Studies
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sequelae after peripheral facial palsy, which among others include synkinesis, non-functional smile and/or lower lip asymmetry, may be devastating for the patient. Bell’s palsy is the most common form of peripheral facial palsy. 

Aim: The aim was to study a) frequency and potential predictive factors of synkinesis in Bell’s palsy b) new surgical treatment options after facial nerve injury c) coactivation between muscles innervated by the facial nerve and the most common donor nerves in smile reanimation d) anatomical features of the lower lip depressors. 

Methods: I: Frequency, severity and early predictors of synkinesis development were studied in 829 Bell’s palsy patients. II and IV: Anatomical technical feasibility of intra-facial nerve transfers was analyzed. V: Anatomical features of lower lip depressor muscles were studied and a literature review for lower lip depressor myectomies was performed. III: Coactivation of muscles innervated by cranial nerves during voluntary facial movements was measured with electromyography. 

Results: I: In Bell’s palsy, synkinesis frequency was 21.3% at 12-months and Sunnybrook composite score at one month was found to be a good predictor for synkinesis. II and IV: A tension-free oculo-zygomatic and platysma-marginal mandibular nerve transfer was anatomically feasible. Full recovery of the lower lip after platsysma-marginal mandibular nerve transfer was found in a clinical case. III: The masseter muscle had a narrower coactivation pattern compared to the tongue. Bite induced a strong coactivation in the zygomaticus major muscle. V: The width of the depressor labii inferioris was 20 ± 4 mm and the distance from the midline to the lateral muscle border was 32 ± 4 mm. For the depressor anguli oris muscle, the corresponding measurements were 14 ± 3 mm and 54 ± 4 mm. The mean recurrence rate after lower lip myectomy reported in the literature is 21%.  

Conclusion: I: Synkinesis in Bell’s palsy was 21%. Sunnybrook composite score at one month is a good predictor for synkinesis. II: Oculo-zygomatic nerve transfer may be a suitable technique to reduce eye synkinesis and achieve a stronger smile. III: The narrow coactivation pattern in the masseter muscle may be advantageous for spontaneous smile development. IV: The platysma motor nerve transfer is a feasible procedure and can lead to full recovery in lower lip paralysis. V: Knowledge of the width of the depressor muscles is of importance to ensure complete resection in lower lip myectomy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 44
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1601
Keywords
Facial palsy, Marginal mandibular paralysis, Smile reconstruction, Synkinesis
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-394136 (URN)978-91-513-0766-4 (ISBN)
Public defence
2019-11-30, Skoog salen, Ingång 78-79, Akademiska sjukhuset, Uppsala, 09:00 (English)
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Available from: 2019-11-11 Created: 2019-10-03 Last updated: 2019-11-27

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Jensson, DavidEnghag, SaraBylund, NinaJonsson, LarsWikström, JohanGrindlund, Margareta EFlink, RolandRodriguez-Lorenzo, Andres

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