Single-Stage Versus 2-Stage Facial Reanimation With a Free Functional Muscle Flap: Protocol for a Systematic Review
Bibliographic record
Abstract
BACKGROUND: Facial paralysis is a condition that has several etiologies and is associated with significant physical and psychosocial complications. Classically, 2-stage facial reanimation was used to treat patients with unilateral facial paralysis; however, single-stage facial reanimation has seen an increase in use. Studies comparing both techniques are limited, and to the best of our knowledge, no systematic reviews have compared these techniques. OBJECTIVE: We aim to perform a systematic review that explores how the outcomes of single-stage facial reanimation with a free functional muscle flap compare against those of 2-stage facial reanimation. METHODS: This systematic review protocol has been written according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) and NICE (National Institute for Health and Care Excellence) guidelines. The search strategy will involve 3 stages: electronic databases (MEDLINE, Embase, and Web of Science Core Collection), trial registers (ClinicalTrials.gov), and snowballing. Studies published from 1995 to 2025 will be screened using inclusion and exclusion criteria. Data will be extracted into a standardized spreadsheet, and the risk of bias and quality of evidence will be assessed. Two reviewers will screen, extract, and assess the included studies. Discrepancies will be discussed and rectified with a third reviewer, if needed. A narrative synthesis of the findings will be performed and presented with descriptive and statistical analyses, where possible, using GraphPad Prism (GraphPad Software). RESULTS: The review formally began in February 2025 and will be performed and reported according to this protocol and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A PRISMA flow diagram and checklist have been used to summarize the current search and study selection. A narrative synthesis and tables will be used to summarize the results of the included studies. Where possible, statistical analyses will be presented using graphs and figures. The final systematic review is expected to be published in December 2025. CONCLUSIONS: This systematic review will aim to summarize the outcomes of the single-stage and 2-stage facial reanimation techniques and explore the differences between these surgical techniques, if any. The results will provide updated information for patients and clinicians. Moreover, the review may help identify potential areas for further research and policy development. TRIAL REGISTRATION: PROSPERO CRD42024556255; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024556255. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/64009.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.078 | 0.114 |
| Meta-epidemiology (narrow) | 0.007 | 0.006 |
| Meta-epidemiology (broad) | 0.022 | 0.021 |
| Bibliometrics | 0.013 | 0.011 |
| Science and technology studies | 0.004 | 0.006 |
| Scholarly communication | 0.008 | 0.009 |
| Open science | 0.005 | 0.005 |
| Research integrity | 0.009 | 0.007 |
| Insufficient payload (model declined to judge) | 0.062 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".