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  1. Article ; Online: Is pre-operative electromyography a reliable tool in differentiating acute and chronic facial palsy? A preliminary evaluation in patients treated with triple innervation facial reanimation.

    Allevi, Fabiana / Abate, Nicole / Bolognesi, Federico / Tarabbia, Filippo / Rabbiosi, Dimitri / Bellasio, Martina Maddalena / Lozza, Alessandro / Biglioli, Federico

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

    2024  

    Abstract: Electromyographic evaluation is a reliable tool for confirming facial palsy and assessing its severity. It allows differentiating facial paresis and paralysis, and further distinguishes acute palsies, still showing muscle fibrillations, from chronic ... ...

    Abstract Electromyographic evaluation is a reliable tool for confirming facial palsy and assessing its severity. It allows differentiating facial paresis and paralysis, and further distinguishes acute palsies, still showing muscle fibrillations, from chronic cases. This article aims to show that EMG fibrillations might represent a better criterion to differentiate acute and chronic palsies than the standard 18-24 months' cut-off usually employed for classification and treatment purposes. We performed a cohort study using the eFACE tool for comparing triple innervation facial reanimation results in patients with EMG fibrillation treated <12 months, 12-18 months, and >18 months from paralysis onset. Patients showed a statistically significant post-operative improvement in all eFACE items, both in the whole sample and in the three groups. Only the deviation from the optimal score for the gentle eye closure item in group 2 didn't reach statistical significance (p = 0.173). The post-operative results were comparable in the three groups, as the Kruskal-Wallis test showed a difference only for the platysmal synkinesis item scores, which were significantly lower in group 3 (p = 0.025).
    Language English
    Publishing date 2024-04-02
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 91267-0
    ISSN 1878-4119 ; 1010-5182 ; 0301-0503
    ISSN (online) 1878-4119
    ISSN 1010-5182 ; 0301-0503
    DOI 10.1016/j.jcms.2024.04.001
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  2. Article ; Online: Intra-surgical optimized identification of masseteric nerve for central facial nerve neurorrhaphy: A retrospective study.

    Abdelkarim, Ahmed / Allevi, Fabiana / Bolognesi, Federico / Tarabbia, Filippo / Elyounsi, Mohamed / Abdelrahim, Mohamed / Abda, Essam A / El-Shazly, Mohamed / Biglioli, Federico

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

    2023  Volume 51, Issue 9, Page(s) 580–585

    Abstract: It is the aim of the study to provide a detailed intraoperative assessment of the masseteric nerve and the facial branch of the smiling muscles complex through the same superficial musculoaponeurotic system (SMAS) incision. This observational ... ...

    Abstract It is the aim of the study to provide a detailed intraoperative assessment of the masseteric nerve and the facial branch of the smiling muscles complex through the same superficial musculoaponeurotic system (SMAS) incision. This observational retrospective study aimed to define the straightest and safest surgical route to identify the facial nerve for the smiling muscles complex and the masseteric nerve, using distance from the tragus and zygomatic arch as anatomical landmarks. 30 patients were included in the study. The mean distance from the tragus to the masseteric nerve was 40.03 mm, the mean distance from the zygomatic arch was 12.24 mm, and the mean depth from the SMAS was 10.84 mm. Data were consistent, with little variation. The distance from the zygoma was found to be higher in male patients. There was a positive correlation between the depth to the nerve and the distance from the zygoma, but no correlation between body mass index and the other parameters studied. Within the limitations of the study it seems that the proposed standardized direct approach to the masseteric nerve is a reproducible technique that may be used to increase the safety of the procedure, reduce the operating time, and decrease the amount of dissection and related postoperative scarring, thereby fostering positive results.
    Language English
    Publishing date 2023-08-15
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 91267-0
    ISSN 1878-4119 ; 1010-5182 ; 0301-0503
    ISSN (online) 1878-4119
    ISSN 1010-5182 ; 0301-0503
    DOI 10.1016/j.jcms.2023.08.010
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  3. Article ; Online: Periocular management in recent facial palsy patients treated with triple innervation technique: A retrospective case series.

    Atta, Mohamed O / Allevi, Fabiana / Bolognesi, Federico / Abdelkarim, Ahmed / Valsecchi, Federico / Tarabbia, Filippo / Rabbiosi, Dimitri / Ahmed, Anany / Biglioli, Federico

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

    2023  Volume 51, Issue 4, Page(s) 246–251

    Abstract: Facial paralysis decreases eye protection mechanisms leading to ocular problems up to corneal ulceration, and blindness. This study aimed to evaluate the outcomes of periocular procedures for recent facial paralysis. Medical records of patients with ... ...

    Abstract Facial paralysis decreases eye protection mechanisms leading to ocular problems up to corneal ulceration, and blindness. This study aimed to evaluate the outcomes of periocular procedures for recent facial paralysis. Medical records of patients with unilateral recent complete facial palsy who did periocular procedures at the Maxillofacial Surgery Department of San Paolo Hospital (Milan, Italy) between April 2018 and November 2021 were retrospectively reviewed. 26 patients were included. All patients were evaluated 4 months after surgery. The first group included 9 patients who underwent upper eye lid lipofilling and midface suspension with fascia lata graft; they had no ocular dryness symptoms and no need for eye protection measures in 33.3% of cases, significant reduction of ocular symptoms and need for eye protection measures in 66.6% of patient, 0-2 mm lagophthalmos in 66.6% and 3-4 mm lagophthalmos in 33.3%. The second group of 17 patients who underwent upper eyelid lipofilling, midface suspension with fascia lata graft and lateral tarsorrhaphy, had no ocular dryness symptoms and no need for eye protection measures in 17.6% of patient, significant reduction of ocular symptoms and need for eye protection measures in 76.4% of patient, 0-2 mm lagophthalmos in 70.5%, 3-4 mm lagophthalmos in 23.5% and one patient 5,8%had 8 mm lagophthalmos and persistent symptoms. No ocular complication, cosmetic complain or donner site morbidity were reported. Upper eyelid lipofilling, midface suspension with fascia lata graft and lateral tarsorrhaphy decrease ocular dryness symptoms and need for eye protection measures and improve lagophthalmos: the association of the reinnervation with these complementary techniques is therefore highly recommended in order to immediately protect the eye.
    MeSH term(s) Humans ; Facial Paralysis/complications ; Facial Paralysis/surgery ; Eyelid Diseases/surgery ; Eyelid Diseases/complications ; Retrospective Studies ; Dental Implants ; Eyelids/surgery ; Lagophthalmos
    Chemical Substances Dental Implants
    Language English
    Publishing date 2023-04-29
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 91267-0
    ISSN 1878-4119 ; 1010-5182 ; 0301-0503
    ISSN (online) 1878-4119
    ISSN 1010-5182 ; 0301-0503
    DOI 10.1016/j.jcms.2023.04.006
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  4. Article: Insights on the Choice and Preparation of the Donor Nerve in Corneal Neurotization for Neurotrophic Keratopathy: A Narrative Review.

    Serra, Pietro Luciano / Giannaccare, Giuseppe / Cuccu, Alberto / Bolognesi, Federico / Biglioli, Federico / Marcasciano, Marco / Tarabbia, Filippo / Pagliara, Domenico / Figus, Andrea / Boriani, Filippo

    Journal of clinical medicine

    2024  Volume 13, Issue 8

    Abstract: The article introduces neurotrophic keratopathy (NK), a condition resulting from corneal denervation due to various causes of trigeminal nerve dysfunctions. Surgical techniques for corneal neurotization (CN) have evolved, aiming to restore corneal ... ...

    Abstract The article introduces neurotrophic keratopathy (NK), a condition resulting from corneal denervation due to various causes of trigeminal nerve dysfunctions. Surgical techniques for corneal neurotization (CN) have evolved, aiming to restore corneal sensitivity. Initially proposed in 1972, modern approaches offer less invasive options. CN can be performed through a direct approach (DCN) directly suturing a sensitive nerve to the affected cornea or indirectly (ICN) through a nerve auto/allograft. Surgical success relies on meticulous donor nerve selection and preparation, often involving multidisciplinary teams. A PubMed research and review of the relevant literature was conducted regarding the surgical approach, emphasizing surgical techniques and the choice of the donor nerve. The latter considers factors like sensory integrity and proximity to the cornea. The most used are the contralateral or ipsilateral supratrochlear (STN), and the supraorbital (SON) and great auricular (GAN) nerves. Regarding the choice of grafts, the most used in the literature are the sural (SN), the lateral antebrachial cutaneous nerve (LABCN), and the GAN nerves. Another promising option is represented by allografts (acellularized nerves from cadavers). The significance of sensory recovery and factors influencing surgical outcomes, including nerve caliber matching and axonal regeneration, are discussed. Future directions emphasize less invasive techniques and the potential of acellular nerve allografts. In conclusion, CN represents a promising avenue in the treatment of NK, offering tailored approaches based on patient history and surgical expertise, with new emerging techniques warranting further exploration through basic science refinements and clinical trials.
    Language English
    Publishing date 2024-04-14
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm13082268
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  5. Article ; Online: 3D analysis of smiling function in healthy people: Influence of sex and age.

    Gibelli, Daniele / Tarabbia, Filippo / Restelli, Sofia / Orabona, Giovanni Dell'Aversana / Dolci, Claudia / Califano, Luigi / Biglioli, Federico / Sforza, Chiarella

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2019  Volume 73, Issue 1, Page(s) 184–199

    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Aging/physiology ; Face/diagnostic imaging ; Face/physiology ; Female ; Healthy Volunteers ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Sex Characteristics ; Smiling/physiology
    Language English
    Publishing date 2019-05-22
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2019.05.036
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  6. Article ; Online: Facial thirds-based evaluation of facial asymmetry using stereophotogrammetric devices: Application to facial palsy subjects.

    Codari, Marina / Pucciarelli, Valentina / Stangoni, Fabiano / Zago, Matteo / Tarabbia, Filippo / Biglioli, Federico / Sforza, Chiarella

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

    2017  Volume 45, Issue 1, Page(s) 76–81

    Abstract: Many conditions can compromise facial symmetry, resulting in an impairment of the affected person from both esthetic and functional points of view. For these reasons, a detailed, focused, and objective evaluation of facial asymmetry is needed, both for ... ...

    Abstract Many conditions can compromise facial symmetry, resulting in an impairment of the affected person from both esthetic and functional points of view. For these reasons, a detailed, focused, and objective evaluation of facial asymmetry is needed, both for surgical planning and for treatment evaluation. In this study, we present a new quantitative method to assess symmetry in different facial thirds, objectively defined on the territories of distribution of trigeminal branches. A total of 70 subjects (40 healthy controls and 30 patients with unilateral facial palsy) participated. A stereophotogrammetric system and the level of asymmetry of the subjects' hemi-facial thirds was evaluated, comparing the root mean square of the distances (RMSD) between their original and mirrored facial surfaces. Results show a high average reproducibility of area selection (98.8%) and significant differences in RMSD values between controls and patients (p = 0.000) for all of the facial thirds. No significant differences were found on different thirds among controls (p > 0.05), whereas significant differences were found for the upper, middle, and lower thirds of patients (p = 0.000). The presented method provides an accurate, reproducible, and local facial symmetry analysis that can be used for different conditions, especially when only part of the face is asymmetric.
    Language English
    Publishing date 2017-01
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 91267-0
    ISSN 1878-4119 ; 1010-5182 ; 0301-0503
    ISSN (online) 1878-4119
    ISSN 1010-5182 ; 0301-0503
    DOI 10.1016/j.jcms.2016.11.003
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  7. Article ; Online: A multicenter survey on computer-aided design and computer-aided manufacturing mandibular reconstruction from Italian community.

    Ferri, Andrea / Varazzani, Andrea / Bolzoni, Alessandro Remigio / Monaca, Marco Della / Tarabbia, Filippo / Tarsitano, Achille / Zavattero, Emanuele / Gessaroli, Manlio / Copelli, Chiara / De Riu, Giacomo / Baj, Alessandro

    Microsurgery

    2019  Volume 39, Issue 7, Page(s) 673–674

    MeSH term(s) Computer-Aided Design ; Health Care Surveys ; Humans ; Italy ; Mandibular Reconstruction/methods
    Language English
    Publishing date 2019-08-24
    Publishing country United States
    Document type Editorial ; Multicenter Study
    ZDB-ID 605524-2
    ISSN 1098-2752 ; 0738-1085
    ISSN (online) 1098-2752
    ISSN 0738-1085
    DOI 10.1002/micr.30505
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  8. Article ; Online: Thoracodorsal nerve graft for reconstruction of facial nerve branching.

    Biglioli, Federico / Colombo, Valeria / Pedrazzoli, Marco / Frigerio, Alice / Tarabbia, Filippo / Autelitano, Luca / Rabbiosi, Dimitri

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

    2014  Volume 42, Issue 1, Page(s) e8–14

    Abstract: Object: Surgical treatment of parotid malignancies may frequently involve facial nerve amputation to achieve oncological radical resection. The entire facial nerve branching from its exit from the stylomastoid foramen to the periphery of the gland is ... ...

    Abstract Object: Surgical treatment of parotid malignancies may frequently involve facial nerve amputation to achieve oncological radical resection. The entire facial nerve branching from its exit from the stylomastoid foramen to the periphery of the gland is often sacrificed. The first reconstructive strategy is the immediate reconstruction of the facial nerve by directly anastomosing the trunk of the facial nerve to its distal branches by interpositional nerve grafting. The present study was performed to determine the adequacy of thoracodorsal nerve grafting for immediate repair of the facial nerve. The anatomical features of the thoracodorsal nerve make it particularly appropriate to match its trunk to the stump of the facial nerve at its exit from the stylomastoid foramen. Up to seven branches of the thoracodorsal nerve may be distally anastomosed to the severed distal branches of the facial nerve. More complex reconstruction may be addressed simultaneously by contemporary harvesting a de-epithelialized free flap from the same site based on thoracodorsal vessel perforators and preparing a rib graft from the same donor site.
    Methods: Between October 2003 and August 2010, seven patients affected by parotid tumors (6 with parotid malignancies and 1 with multiple recurrences of pleomorphic adenoma) underwent radical parotidectomy with intentional sacrifice of the facial nerve to obtain oncological radical resection. In all patients, the facial nerve was reconstructed with an interpositional thoracodorsal nerve graft. In four patients, a de-epithelialized free flap based on the latissimus dorsi was transposed to cover soft tissue defects. Moreover, two of these patients also required a rib graft to reconstruct both the condyle and ramus of the mandible. With the exception of one patient affected by recurrent pleomorphic adenoma, all patients underwent radiotherapy after surgical treatment.
    Results: All patients in our study recovered mimetic facial function. Facial muscles showed clinical signs of recovery within 5-14 (mean: 7.8) months, with varying degrees of mimetic restoration, and almost complete facial symmetry at rest in all patients. The House-Brackmann final score was I in two patients, II in two patients, and III in three patients.
    Conclusions: A thoracodorsal nerve graft to replace extratemporal facial nerve branching is a valid alternative technique to multiple classical nerve grafts, with good matching at both the proximal and distal anastomoses.
    MeSH term(s) Adenocarcinoma/surgery ; Adenoma, Pleomorphic/surgery ; Adult ; Aged ; Anastomosis, Surgical/methods ; Bone Transplantation/methods ; Dissection/methods ; Facial Muscles/physiology ; Facial Nerve/surgery ; Female ; Follow-Up Studies ; Free Tissue Flaps/transplantation ; Humans ; Male ; Mandible/surgery ; Mandibular Condyle/surgery ; Muscle, Skeletal/transplantation ; Neoplasm Recurrence, Local/surgery ; Parotid Gland/surgery ; Parotid Neoplasms/surgery ; Perforator Flap/transplantation ; Radiotherapy, Adjuvant ; Reconstructive Surgical Procedures/methods ; Recovery of Function/physiology ; Spinal Nerves/transplantation
    Language English
    Publishing date 2014-01
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 91267-0
    ISSN 1878-4119 ; 1010-5182 ; 0301-0503
    ISSN (online) 1878-4119
    ISSN 1010-5182 ; 0301-0503
    DOI 10.1016/j.jcms.2013.03.001
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  9. Article ; Online: Masseteric-facial nerve neurorrhaphy: results of a case series.

    Biglioli, Federico / Colombo, Valeria / Rabbiosi, Dimitri / Tarabbia, Filippo / Giovanditto, Federica / Lozza, Alessandro / Cupello, Silvia / Mortini, Pietro

    Journal of neurosurgery

    2016  Volume 126, Issue 1, Page(s) 312–318

    Abstract: OBJECTIVE Facial palsy is a well-known functional and esthetic problem that bothers most patients and affects their social relationships. When the time between the onset of paralysis and patient presentation is less than 18 months and the proximal stump ... ...

    Abstract OBJECTIVE Facial palsy is a well-known functional and esthetic problem that bothers most patients and affects their social relationships. When the time between the onset of paralysis and patient presentation is less than 18 months and the proximal stump of the injured facial nerve is not available, another nerve must be anastomosed to the facial nerve to reactivate its function. The masseteric nerve has recently gained popularity over the classic hypoglossus nerve as a new motor source because of its lower associated morbidity rate and the relative ease with which the patient can activate it. The aim of this work was to evaluate the effectiveness of masseteric-facial nerve neurorrhaphy for early facial reanimation. METHODS Thirty-four consecutive patients (21 females, 13 males) with early unilateral facial paralysis underwent masseteric-facial nerve neurorrhaphy in which an interpositional nerve graft of the great auricular or sural nerve was placed. The time between the onset of paralysis and surgery ranged from 2 to 18 months (mean 13.3 months). Electromyography revealed mimetic muscle fibrillations in all the patients. Before surgery, all patients had House-Brackmann Grade VI facial nerve dysfunction. Twelve months after the onset of postoperative facial nerve reactivation, each patient underwent a clinical examination using the modified House-Brackmann grading scale as a guide. RESULTS Overall, 91.2% of the patients experienced facial nerve function reactivation. Facial recovery began within 2-12 months (mean 6.3 months) with the restoration of facial symmetry at rest. According to the modified House-Brackmann grading scale, 5.9% of the patients had Grade I function, 61.8% Grade II, 20.6% Grade III, 2.9% Grade V, and 8.8% Grade VI. The morbidity rate was low; none of the patients could feel the loss of masseteric nerve function. There were only a few complications, including 1 case of postoperative bleeding (2.9%) and 2 local infections (5.9%), and a few patients complained about partial loss of sensitivity of the earlobe or a small area of the ankle and foot, depending on whether great auricular or sural nerves were harvested. CONCLUSIONS The surgical technique described here seems to be efficient for the early treatment of facial paralysis and results in very little morbidity.
    MeSH term(s) Anastomosis, Surgical ; Facial Nerve/surgery ; Facial Paralysis ; Female ; Humans ; Hypoglossal Nerve/surgery ; Male ; Neurosurgical Procedures
    Language English
    Publishing date 2016-04-01
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2015.12.JNS14601
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  10. Article ; Online: Immediate facial reanimation in oncological parotid surgery with neurorrhaphy of the masseteric-thoracodorsal-facial nerve branch.

    Biglioli, Federico / Tarabbia, Filippo / Allevi, Fabiana / Colombo, Valeria / Giovanditto, Federica / Latiff, Mahfuz / Lozza, Alessandro / Previtera, Antonino / Cupello, Silvia / Rabbiosi, Dimitri

    The British journal of oral & maxillofacial surgery

    2016  Volume 54, Issue 5, Page(s) 520–525

    Abstract: The extracranial facial nerve may be sacrificed together with the parotid gland during a radical parotidectomy, and immediate reconstruction of the facial nerve is essential to maintain at least part of its function. We report five patients who had had ... ...

    Abstract The extracranial facial nerve may be sacrificed together with the parotid gland during a radical parotidectomy, and immediate reconstruction of the facial nerve is essential to maintain at least part of its function. We report five patients who had had radical parotidectomy (two with postoperative radiotherapy) and immediate (n=3) or recent (n=2) reconstructions of the masseteric-thoracodorsal-facial nerve branch. The first mimetic musculature movements started 6.2 (range 4-8.5) months postoperatively. At 24 months postoperatively clinical evaluation (modified House-Brackmann classification) showed grade V (n=3), grade IV (n=1), and grade III (n=1) repairs. This first clinical series of masseteric-thoracodorsal-facial nerve neurorrhaphies has given encouraging results, and the technique should be considered as an option for immediate or recent reconstruction of branches of the facial nerve, particularly when its trunk is not available for proximal neurorrhaphy.
    Language English
    Publishing date 2016-06
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 605685-4
    ISSN 1532-1940 ; 0266-4356
    ISSN (online) 1532-1940
    ISSN 0266-4356
    DOI 10.1016/j.bjoms.2016.02.014
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