Facial reanimation with masseteric nerve: babysitter or permanent procedure? Preliminary results.
The authors are presenting a series of 10 cases of complete unilateral facial paralysis submitted to (I) end-to-end microsurgical coaptation of the masseteric branch of the trigeminal nerve and distal branches of the paralyzed facial nerve, and (II) cross-face sural nerve graft. The ages of the patients ranged from 5 to 63 years (mean: 44.1 years), and 8 (80%) of the patients were females. The duration of paralysis was no longer than 18 months (mean: 9.7 months). Follow-up varied from 6 to 18 months (mean: 12.6 months). Initial voluntary facial movements were observed between 3 and 6 months postoperatively (mean: 4.3 months). All patients were able to produce the appearance of a smile when asked to clench their teeth. Comparing the definition of the nasolabial fold and the degree of movement of the modiolus on both sides of the face, the voluntary smile was considered symmetrical in 8 cases. Recovery of the capacity to blink spontaneously was not observed. However, 8 patients were able to reduce or suspend the application of artificial tears. The authors suggest consideration of masseteric-facial nerve coaptation, whether temporary (baby-sitter) or permanent, as the principal alternative for reconstruction of facial paralysis due to irreversible nerve lesion with less than 18 months of duration.
Division of Plastic Surgery, Hospital das Clinicas, Sao Paulo, Brazil. microcirurgia@terra.com.br
Jose Carlos Marques
JC
Faria
Gean Paulo
GP
Scopel
Marcus Castro
MC
Ferreira
D000293:Adolescent; D000328:Adult; D001767:Blinking; D002648:Child; D002675:Child, Preschool; D005158:Facial Paralysis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008406:Masseter Muscle / Q000294:innervation*; D008875:Middle Aged; D009119:Muscle Contraction; D010525:Peripheral Nerves / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult