Prospective evaluation of quality-of-life improvement after correction of the alar base in the flaccidly paralyzed face

Robin W Lindsay, Prabhat Bhama, Marc Hohman, Tessa A Hadlock
JAMA Facial Plastic Surgery 2015, 17 (2): 108-12

IMPORTANCE: Nasal valve collapse caused by facial palsy is an often overlooked but disturbing sequela of flaccid facial paralysis.

OBJECTIVE: To prospectively study the effect of fascia lata sling placement for correction of external nasal valve compromise in patients with flaccid facial paralysis, using a validated disease-specific quality-of-life outcome survey.

DESIGN, SETTING, AND PARTICIPANTS: This was a prospective study of 68 patients from March 2009 to December 2013 who underwent fascia lata sling placement for correction of external nasal valve compromise.

INTERVENTION: Fascia lata sling placement for the correction of external nasal valve compromise .

MAIN OUTCOME AND MEASURE: Nasal Obstruction Symptom Evaluation (NOSE) scale.

RESULTS: Sixty-eight disease-specific quality-of-life determinations were performed using the NOSE scale. Ratings were ascertained preoperatively and postoperatively. Sixty patients completed a NOSE scale prior to surgical intervention, and 40 completed the survey after intervention. There was a statistically significant difference in NOSE scores after fascia lata sling placement The mean preoperative NOSE score was 37.6 (27.1), and the mean postoperative score was 16.6 (17.37) (Wilcoxon signed-rank test; Pā€‰<ā€‰.001). All patients had improvement in their nasal obstruction, which persisted uniformly in follow-up.

CONCLUSIONS AND RELEVANCE: The nasal valve is a zone that has historically been neglected, despite the fact that a highly effective surgical solution has existed for decades. We highlight the significance of nasal valve dysfunction in patients with flaccid facial paralysis, demonstrate a quantitative benefit in disease-specific quality of life after fascia late sling placement for external nasal valve compromise, and suggest an updated treatment algorithm. This method offers a predictably successful, straightforward surgical solution to an overlooked functional problem in the patient with flaccid facial paralysis.


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