Fakülteler / Faculties

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Author: search.filters.author.Ozucer, BerkeSubject: search.filters.subject.facial palsy

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    Contralateral Depressor Labii Inferioris Chemodenervation for Congenital Unilateral Lower Lip Palsy
    (2020) Cam, Osman Halit; Ozucer, Berke; 32487835
    Introduction: Congenital unilateral lower lip palsy - also known as asymmetric crying facies - is isolated asymmetry of the lower lip unilaterally. It is characterized by isolated lower lip asymmetry during smiling and speech. Although etiology is unknown, depressor labii inferioris (DLI) weakness is hold responsible. Aim: Purpose of this study was to evaluate the effectiveness of contralateral depressor labii inferioris botulinum toxin injection on patients' concern levels and patient satisfaction. Ten units of botulinum toxin A injection was carried out to the healthy contralateral side. Methodology: Eleven patients were treated. Patients' pretreatment and posttreatment concern regarding asymmetry during speech and smiling was evaluated with a questionnaire. Patients' perception of treatment satisfaction was also evaluated with a questionnaire. Results: Mean score related to concern about asymmetric appearance during smiling decreased from 1.6 +/- 0.8 to 0.5 +/- 0.5. Mean score related to concern about asymmetric appearance during speech decreased from 1.6 +/- 0.5 to 0.4 +/- 0.5. Eleven out of 11 patients reported improvement with speech whereas 10 out of 11 patients reported improvement with smiling. No weakness about oral competence was reported. Conclusion: Most congenital unilateral lower lip palsy patients are concerned regarding their asymmetric appearance while smiling or speaking. Chemodenervation of the contralateral DLI muscle reduces concern levels and has high patient satisfaction. Chemodenervation of the contralateral healthy DLI muscle is a valid, practical treatment option.
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    Effect of Distal Masseter to Facial Nerve Transfer in Paralytic Patients with Preserved Facial Nerve Continuity on Improving Scaled Measurement of Improvement in Lip Excursion (SMILE): A Vectoral Analysis
    (2020) Ozucer, Berke; Cam, Osman Halit; 33554200
    Objective: Distal masseter-to-facial neurorrhaphy is an option to improve smile excursion in facial paralysis patients in the early period without truncating the facial nerve truncus and by ensuring the continuity of the facial nerve. This study aimed to study the effect of distal masseter-to-facial neurorrhaphy on smile excursion. Methods: Charts of eight patients were retrospectively examined. Screenshots showing the best possible smiles were taken from preoperative videos. Screenshots were taken from postoperative videos showing the best combination of a natural smile on the healthy side and a smile with clenched teeth on the paralytic side. Emotrics and Photoshop software were used for computing vertical, horizontal, and overall excursion from facial landmarks. Scaled measurements of improvement in lip excursion and lip angle was evaluated. Symmetry was evaluated by accepting the healthy side as 100 percent, and the paralytic side was calculated as a percentage of the healthy side. Results: Five patients had total facial paralysis and three had facial paresis. Mean postoperative follow-up period was 15.0 +/- 10.2 months. The average interval between facial denervation and nerve repair was 14.0 +/- 4.1 months (range, 11-23). All neurorrhaphies were coapted end-to-end to either the zygomatic or the buccal branch without an interposition graft. Mean postoperative initial movement occurred at 95.5 +/- 20.5 days (range, 72-138). Paralytic side to healthy side horizontal excursion changed from preoperative 72.5 +/- 17.4% to postoperative 93.4 +/- 6.9%. Vertical excursion changed from preoperative 38.4 +/- 24.6% to postoperative 89.3 +/- 11.8%. Overall excursion changed from preoperative 68.4 +/- 19.6% to postoperative 92.9 +/- 10.4%. Paralytic side to healthy side mean lip angle changed from 64.7% preoperative to 95.2% postoperatively. All changes were statistically significant (p<0.05). Conclusion: Facial paralysis patients with an asymmetric smile benefit from distal masseter-to-facial nerve transfer and it improves smile excursion dramatically. This effect was especially prominent in the vertical component of the smiling vector.