Modiolar rotational cheiloplasty: Addressing the central oval in facial paralysis.

Abstract

Current static reanimation of the midface fails to provide adequate functional and aesthetic improvement; there is a need for more effective static correction of the ptotic midface. Our objective herein was to describe a novel method of static midface suspension that produces improved functional and aesthetic outcomes compared to previous techniques. Specifically, our goal was to describe the technique of alar and oral commissure repositioning via modiolar rotational cheiloplasty with alar base transposition, and gingivobuccal sulcoplasty. Retrospective case series. We retrospectively reviewed the results of a series of adult patients desiring surgical intervention for paralysis of the central oval of the face at a tertiary care referral center. We present our technique of modiolar rotational cheiloplasty first with an example case, including subjective outcomes reported by the patient and objective improvements in facial appearance using Massachusetts Eye and Ear Infirmary Facial Assessment by Computer Evaluation Program (MEEI FACE-Gram) software, then demonstrate long-term outcomes from the series. Clinically, patients noted subjective improvement in drooling, buccal stasis of food, dysarthria, nasal obstruction, and overall appearance. Patients with significant atrophy and lateral displacement of the lower lip underwent concomitant wedge resection, which further improved the symmetry and position of the lips. The MEEI FACE-Gram software demonstrated objective improvement in symmetry of smile and position of the philtrum and nasal base in an example case. Modiolar rotational cheiloplasty with alar base transposition is an effective and efficient static procedure for midface palsy that improves both function and appearance. 4 Laryngoscope, 129:2262-2268, 2019.