Stabilization and reanimation of the lower lip in facial palsy. Retrospective study about 66 patients and literature review. Proposition of a decision algorithm

Several techniques for the stabilization and the reanimation of the paralyzed lower lip have been proposed, sometimes combined but the authors are rather vague. Thanks to our cases and a literature review, we suggest an algorithm. Sixty-six patients haven been reviewed. The static and dynamic clinical evaluation have been done thanks to the study of the medical files, photographs and videos samples. The different techniques we have used were: (a) botulinum toxin in the contralateral depressor labii inferioris (DLI) (n=66), contralateral DLI myectomy (n=1); (b) a strip of fascia lata (n=16) either combined with a lengthening temporalis myoplasty (MAT) (n=10) or only realizing a passive suspension thanks to one vector (n=4), or a passive suspension with two strips (n=2); (c) digastric muscle transfer (n=4). When the elevator muscles are sounds, botulin toxin (± myectomy) is proposed if the lower lip is not inverted. Otherwise, a suspension thanks to a digastric muscle transfer or a passive suspension with a horizontal and a vertical strips are recommended. If the elevator muscles are no more operational, a MAT with a passive suspension with one vector is considerated and if the lower lip is inverted, a digastric muscle transfer with a fascia lata strip or a MAT with two strips is proposed. This algorithm submission allows to refine the treatment of the stabilization and the reanimation of the lower lip.