How to rehabilitate long-term facial paralysis.
OBJECTIVE
To project the surgical resuscitation methods that we apply to the lower part of the face and the eyes with the aim of preventing functional and psychological problems that can occur in patients with facial paralysis.


METHODS
Twenty-two patients with facial nerve paralysis due to acoustic neuroma, trauma, cholesteatoma, and parotid carcinoma were included in this study. In the lower facial region, the temporal muscle was suspended to the lower lip. In the upper facial region, eyelid gold implantation was performed. The reanimation results of the upper and lower facial regions were graded as excellent, good, fair, and poor in consideration of the symmetry after rest and smile according to May classification in the third month after the surgery.


RESULTS
The study group comprised 15 men (68.2%) and 5 women (31.8 %) (mean age, 63.82 ± 14.18 years; range, 8-78 years). Of the patients, 18.2% (n = 4) had acoustic neuroma, 40.9% (n = 9) had facial trauma, 27.3% (n = 6) had cholesteatoma, and 13.6% (n = 3) had parotid carcinoma.Reanimation techniques were applied to 40.9% (n = 9) of the patients during the first 2-4 years, whereas 59.1% (n = 13) of patients underwent surgery after 4 years.In a total of 17 patients (77.3%) who had lower lip intervention, 4 patients (23.5%) had excellent results, 7 patients (41.2%) had good results, and 6 patients (35.3%) had moderate results.In the 22 patients who underwent the eyelid procedure, 5 patients (22.7 %) had excellent results, 13 patients (59.1 %) had good results, and 3 patients (18.2 %) had moderate results. Poor results were not observed in any patient.


CONCLUSIONS
Facial paralysis is a disease that causes serious functional and psychological problems in patients. Therefore, the choice of treatment method is dependent on the etiology, duration of paralysis, expectations of the patient, and experience of the surgeon. Being less invasive methods, obtaining immediate results, requiring single surgical stage, and having long-lasting results and dynamic muscle transfer and static suspension methods are preferred.
Department of Otorhinolaryngology-Head and Neck Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey.
Tolgar Lütfi
TL
Kumral
Yavuz
Y
Uyar
Güler
G
Berkiten
Ayça Tazegül
AT
Mutlu
Enes
E
Ataç
Gürcan
G
Sünnetçi
Güven
G
Yildirim
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005149:Facial Expression; D005158:Facial Paralysis / Q000503:physiopathology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015361:Rhytidoplasty / Q000379:methods*; D012904:Smiling; D013703:Temporal Muscle / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult