Multivectored Suture Suspension

Abstract

Background

Despite advanced techniques for reanimation of the lower face, many patients opt for static suspension procedures, which are less invasive and have a relatively short recovery period. However, even static suspension procedures require general anesthesia, overnight hospital stay, and significant soft tissue manipulation. We present a minimally invasive technique, the multivectored suture suspension, which addresses these drawbacks.

Objectives

To study the technical feasibility and efficacy of the multivectored suture suspension technique in the paralyzed face.

Design

The study was carried out prospectively in 12 patients with House-Brackmann grade 6 facial paralysis. Nine patients presented within 6 months of tumor resection and 3 patients presented more than 1 year after surgery.

Main Outcome Measures

The parameters evaluated were (1) restoration of nasal breathing; (2) improvement of drooling; (3) restoration of normal speech; (4) cosmetic results; and (5) total surgical time.

Results

With an average follow-up of 14 months, patient evaluation of the outcome parameters was as follows: (1) 10 patients (83%) reported significant and 2 (17%) reported moderate restoration of nasal breathing; (2) 10 patients (83%) reported significant improvement and 2 (17%) reported modest drooling improvement; (3) 8 patients (66%) reported significant improvement and 4 (34%) reported modest improvement of speech; (4) 9 patients (75%) reported complete satisfaction and 3 (25%) reported moderate satisfaction with cosmesis. The average surgical time was 46 minutes. Three revisions were required for suture failure.

Conclusions

The multivectored suture suspension technique is a minimally invasive, reversible method of lower facial reanimation that provides improved cosmesis with restoration of nasal breathing. It can be performed under local anesthesia in an outpatient setting, thereby reducing morbidity and cost.