title: Modified technique for rehabilitation of facial paralysis using autogenous fascia lata grafts.
abstract: OBJECTIVE
  In this retrospective study we used a modified surgical technique for midface reanimation in patients with facial nerve paralysis. Facial atonicity can cause functional impairment regarding speech articulation, oral competence, breathing, and eyelid closure. Furthermore, esthetic and psychological aspects play an important role in patients' emotional interaction and social integration. The chosen rehabilitative technique should offer support against prolapse of facial structures and remedy of functional disabilities and, thereby, prevention of social stigmatization due to disease-related changes in appearance.
  
  
  METHODS
  Between 2005 and 2013, fascia lata grafts were used as static support in 15 cases of unilateral facial paralysis. Two fascia lata grafts were subcutaneously inserted in the upper and lower lips crossing the midline and sutured at 4 points, including the unaffected part of the orbicularis oris muscle and modiolus. The slings were suspended against the zygomatic arch with an osteosynthesis plate.
  
  
  RESULTS
  The patients perceived surgery results as considerably improving their appearance, speech, and alimentation. In 93.3% of cases, no postoperative complications occurred. The follow-up results (8 months to 8 years) remained stable.
  
  
  CONCLUSIONS
  This retrospective study showed the advantages of static facial reanimation in appropriate cases. The bony fixated support of the fascial slings allows an immediate improvement of facial symmetry. Additional attachment points including the unaffected part of the orbicularis oris muscle and the use of 2 independent fascia lata slings allow a more accurate adjustment of suspension forces and an incomplete dynamic reanimation of the mouth corner. With respect to its simplicity and minimal invasiveness, this surgical procedure is associated with low morbidity and rapid improvement of the patient's esthetic appearance.
authors.affiliation: Resident, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany. Electronic address: Lemound.Juliana@mh-hannover.de.
authors.forename: Juliana
authors.initials: J
authors.lastname: Lemound
authors.affiliation: Resident, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Stoetzer
authors.affiliation: Consultant, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Kokemüller
authors.affiliation: Consultant, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Schumann
authors.affiliation: Head of Department, Department of Craniomaxillofacial Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Nils-Claudius
authors.initials: NC
authors.lastname: Gellrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064592:Autografts / Q000637:transplantation*; D001860:Bone Plates; D004644:Emotions; D004954:Esthetics; D005143:Eyelids / Q000502:physiology; D005152:Facial Muscles / Q000601:surgery; D005155:Facial Nerve Diseases / Q000601:surgery; D005158:Facial Paralysis / Q000601:surgery*; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008046:Lip / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000502:physiology / Q000601:surgery; D012119:Respiration; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology; D016896:Treatment Outcome; D055815:Young Adult; D015050:Zygoma / Q000601:surgery