Neurotization Preferences in Smile Reanimation: A Discrete Choice Experiment.
Adult
Facial Muscles
/ innervation
Facial Paralysis
/ physiopathology
Female
Humans
Male
Middle Aged
Nerve Regeneration
/ physiology
Nerve Transfer
/ methods
Patient Education as Topic
Patient Preference
/ psychology
Qualitative Research
Retrospective Studies
Smiling
/ physiology
Surveys and Questionnaires
/ statistics & numerical data
Treatment Outcome
Trigeminal Nerve
/ physiology
Video Recording
Young Adult
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 Sep 2021
01 Sep 2021
Historique:
entrez:
25
8
2021
pubmed:
26
8
2021
medline:
31
12
2021
Statut:
ppublish
Résumé
Common donor nerve options in smile reanimation include ipsilateral trigeminal motor or contralateral facial nerve branches. Neurotization preference may be influenced by multiple factors, whose relative importance remains poorly understood. In this article, decision-making in smile reanimation is assessed using a stated preference model. Qualitative interviews with facial palsy patients identified five relevant attributes for study: smile type ("smile when biting" versus "smile spontaneously" as proxies for trigeminal versus cross-facial neurotization), number of operations, success rates, complication rates, and side effects. Community volunteers (n = 250) completed a discrete-choice experiment relevant to free muscle transfer for smile reanimation. Preoperative and postoperative states were demonstrated through video vignettes, together with explanation of surgical risks, consequences, and benefits. Attribute importance was modeled using hierarchical Bayes estimation. Two hundred forty-one responses met quality controls. Attribute importance ranked as follows: chance of success, 37.3 percent; smile type, 21.4 percent; side effects, 13.9 percent; complication rates, 13.8; and number of operations, 13.6 percent. All attributes significantly correlated with decision making (p < 0.0001). An aggregate response model revealed most participants (67.6 percent; standard error, 3.0 percent) preferred smile reanimation by cross-facial (assuming a success rate of 80 percent) as opposed to ipsilateral trigeminal motor branch neurotization. When the success rate for cross-facial neurotization was reduced below 67 percent, trigeminal neurotization was preferred. Despite a higher risk of failure, most respondents preferred a cross-facial as opposed to trigeminal neurotization strategy for smile reanimation. These findings highlight the complexity of decision-making and need for individualized risk tolerance assessment in the field of facial reanimation.
Sections du résumé
BACKGROUND
BACKGROUND
Common donor nerve options in smile reanimation include ipsilateral trigeminal motor or contralateral facial nerve branches. Neurotization preference may be influenced by multiple factors, whose relative importance remains poorly understood. In this article, decision-making in smile reanimation is assessed using a stated preference model.
METHODS
METHODS
Qualitative interviews with facial palsy patients identified five relevant attributes for study: smile type ("smile when biting" versus "smile spontaneously" as proxies for trigeminal versus cross-facial neurotization), number of operations, success rates, complication rates, and side effects. Community volunteers (n = 250) completed a discrete-choice experiment relevant to free muscle transfer for smile reanimation. Preoperative and postoperative states were demonstrated through video vignettes, together with explanation of surgical risks, consequences, and benefits. Attribute importance was modeled using hierarchical Bayes estimation.
RESULTS
RESULTS
Two hundred forty-one responses met quality controls. Attribute importance ranked as follows: chance of success, 37.3 percent; smile type, 21.4 percent; side effects, 13.9 percent; complication rates, 13.8; and number of operations, 13.6 percent. All attributes significantly correlated with decision making (p < 0.0001). An aggregate response model revealed most participants (67.6 percent; standard error, 3.0 percent) preferred smile reanimation by cross-facial (assuming a success rate of 80 percent) as opposed to ipsilateral trigeminal motor branch neurotization. When the success rate for cross-facial neurotization was reduced below 67 percent, trigeminal neurotization was preferred.
CONCLUSIONS
CONCLUSIONS
Despite a higher risk of failure, most respondents preferred a cross-facial as opposed to trigeminal neurotization strategy for smile reanimation. These findings highlight the complexity of decision-making and need for individualized risk tolerance assessment in the field of facial reanimation.
Identifiants
pubmed: 34432695
doi: 10.1097/PRS.0000000000008302
pii: 00006534-202109000-00024
doi:
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
407e-415eInformations de copyright
Copyright © 2021 by the American Society of Plastic Surgeons.
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