Iowa Head and Neck Protocols

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The Department of Otolaryngology and the University of Iowa wish to acknowledge the support of those who share our goal in improving the care of patients we serve. The University of Iowa appreciates that supporting benefactors recognize the University of Iowa's need for autonomy in the development of the content of the Iowa Head and Neck Protocols.

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Platysmectomy

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Indications:

  • Facial paralysis/paresis patients with platysmal synkinesis and hypertonicity
    • Antagonistic muscle pull to zygomaticus muscle group
    • Platysmal action normally involved in expressions of contempt or disgust
    • Performed in patients after demonstrating favorable response to chemodenervation of platysma with botox

Preoperative considerations:

  • Patient demonstrate good response to botox injections in platysma - no administration of botox to the neck 3-4 months before procedure
  • May be done under local anesthesia or can be done under general anesthesia in conjunction with additional procedures (ex. free gracilis transfer for smile reanimation)
  • Patient should be off any blood thinning medications prior to the procedure to decrease risk of hematoma formation
  • Procedure timing: 25-40 minutes

Procedure:

  1. Patient performs tight eye closure and other facial movements leading to platysmal contraction - mark medial and lateral borders of muscle
  2. Mark a 1 cm incision in natural skin crease at the midpoint of the muscle
  3. Administer local anesthesia with 1% lidocaine w/ 1:100,000 epinephrine
  4. Incision is made to the level of the superficial platysma
  5. Dissect superficially to expose the width of the muscle both medial and lateral, raising small inferior and superior skin flaps to expose a 2 cm strip of muscle
  6. The muscle is penetrated with curved dissecting clamp and define the deep border, ensuring preservation of neurovascular supply
  7. Remove a 1 cm band of muscle in segments, using bipolar cautery to obtain hemostasis
  8. Once the section of muscle has been completely removed, the patient is asked to perform tight eye closure and smiling to ensure complete discontinuity of muscle
  9. Skin closure with 4-0 monocryl deep and 5-0 nylon for the skin, then steri-strips and pressure dressing.

 

Outcomes:

In the study by Henstrom et al, outcomes for the procedure were evaluated for 21 patients treated at the Facial Nerve Center Department of Otolaryngology at Massachusetts Eye and Ear Infirmary. There were no intraoperative or early postoperative complications. Patients completed a preoperative and postoperative quality of life FaCE (Facial Clinimetric Evaluation) survey which demonstrated significant improvement in neck specific questions and overall quality of life questions.

*FaCE developed to quantify quality of life issues in patients with facial paralysis

Reference: Henstrom DK, Malo JS, Cheney ML, Hadlock TA. Platysmectomy: An effective intervention for facial synkinesis and hypertonicity. Arch Facial Plast Surg 13: 239-243, 2011.


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