(268) Injectable Materials for Flaccid Facial Paralysis: A Systematic Review

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

Presenting Author(s)

KS

Karina Samsuhadi, Other

McGovern Medical School, USA

Co-Author(s)

David Zachariah Allen, MD

Resident
University of Texas Health Science Center At Houston
Houston, TX, United States

Co-Author(s)

JJ

Jerrill Jacob, MS

Medical Student
McGovern Medical School
Houston, TX, USA
DX

Daniel Xiao, Other

McGovern Medical School, USA

Senior Author(s)

WK

Wee Tin Kao, MD

The University of Texas Health Science Center At Houston, USA
Tang Ho, MD

Assistant Professor,Chief, Facial Plastics and Reconstructive Surgery
The University of Texas Health Science Center At Houston
Houston, Texas, USA

Disclosure(s):

David Zachariah Allen, MD: No relevant relationships to disclose.

Introduction: Flaccid facial paralysis poses a significant detriment to quality of life and facial injectables have been theorized to be a beneficial office procedure that allows for improvement of facial symmetry. Injectables are both used for weakening the hyperkinetic side of flaccid facial paralysis and to improve the cosmesis of the paralytic side with the goal of restoring pre-morbid symmetry. This review is meant to evaluate the current body of evidence regarding injectable fillers in the context of flaccid facial paralysis and assess its efficacy and utilization.

Methods: This systematic review and meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The databases utilized were Ovid Embase, PubMed‐Medline, and Web of Science databases up until January 1, 2023. Review of references was also performed on initially included studies.

Results: This investigation identified 555 studies with 11 papers meeting inclusion criteria specifically addressing flaccid facial paralysis. Within the 11 papers, there were six prospective cohort studies, three review articles, one retrospective study and one case study. This analysis included a total of 170 patients who were treated in the setting of flaccid paralysis with 135 of the patients being female (79%). The most commonly used injectable materials were botulinum toxin A (5/9) into the contra-lateral side and hyaluronic acid (4/9) into the paralyzed side. Most studies analyzed the effect of fillers on midface and lower-third symmetry. The majority of outcome measurements were subjective with four studies utilizing an objective outcome (surface electromyography, direct measurement of lagophthalmos, facial analysis software).

Conclusions: Injectable options for patients with flaccid facial paralysis appear to have evidence to support its utilization, however more prospective studies with objective outcomes are needed to fully assess the efficacy of the treatment modality.