Mimetic surgery for the paralyzed face

Abstract

One hundred ten patients with facial nerve paralyses were treated by various surgical methods. Eighty-six patients had total facial nerve paralyses and 24 had segmental paralyses. In the total paralysis group, 62 patients had oncologic procedures or tumor induced paralysis. In the segmental paralysis group, 14 patients had malignancies. Two patients had idiopathic facial nerve paralysis. In the total paralysis group, 59 had neural reconstructions, 7 neuromuscular pedicles, and 20 muscle-fascia transpositions. The segmental paralysis group was divided into an upper facial palsy group (n = 11) and lower facial palsy group (n = 13). Five patients had neural transpositions, 5 had muscle-fascia transpositions, and 14 had plastic reconstructions. The results were analyzed by various methods and grading systems. The data indicate that neural repairs produce better results than muscle-fascia transpositions or plastic reconstructions. Within the repairs, the procedures are listed in an hierarchical order of cosmetic and functional results. The average follow-up for the entire group was 2.8 years. The average follow-up for the neural repair group was 3.2 years, and for the muscle fascia transpositions, 14.1 months.

Neural repair in facial paralysis: Clinical and experimental studies

“…The nature of a facial nerve injury and duration of facial paralysis, two factors not examined specifically in this report, have impor-tant consequences for neural regeneration [21]. It is generally accepted that immediate reconstructions of sharp transections of the facial nerve by primary direct end-to-end anastomoses of neural stumps produce the best recovery results [15,21]. This is especially true in the distal segmental branches of the nerve.…”

“…The immediate neural environment plays an important role. Clinically a variety of strategies are available for overcoming facial nerve deficits [15]. Crushing or compression injuries produce almost total recovery [5], while complete transectional injuries produce variable results.…”

“…loss of the proximal nerve stump or neural soma, and loss of the distal neural stump or striated muscles of facial expression. Loss of the proximal nerve stump or its connections to the motor nucleus of the facial nerve (for example, following acoustic neurinoma surgery) requires an alternative source for motor neurite outgrowth [ 15]. In younger adult patients who do not have other cranial neuropathies we prefer to use the facial-hypoglossal nerve anastomosis.…”

“…In younger adult patients who do not have other cranial neuropathies we prefer to use the facial-hypoglossal nerve anastomosis. We have abandoned the use of split hypoglossal nerves, spinal accessory nerve, ansa hypoglossi nerve, neuro-muscular pedicles and cross-facial autologous nerve grafts because they do not provide adequate motor innervation in order to achieve satisfactory mimetic facial activity [15,21]. When the distal transected nerve stump or its segmental neural branches are missing and/or the striated muscles of facial expression have been sacrificed (e.g.…”

Combination of hypoglossal-facial nerve surgical reconstruction and neurotrophin-3 gene therapy for facial palsy

“…tensionless end-to-end anastomosis of the facial nerve stumps represents a first-choice method with optimal outcomes, 5,35 this approach is not feasible when the proximal facial nerve stump is unavailable, a situation that occurs frequently. Consequently, an alternative reconstruction method based on hypoglossal-facial nerve anastomosis has been performed.…”