Facial paralysis is by no means one of he most serious affliction to which man kind is subject. Bacause of the face and its expressions are figuratively a window in the world and the means whereby individuals present themselves to the social environment, loss of its function can be devastating not only from functional but also from a psychological standpoint.
Facial paralysis can be caused by persistant Bell’s Palsy, congenital defect, injury to the nerve as a complication of regional surgery, intracranial disease, accidental external trauma which has resulted in severance of the 7th cranial nerve and other causes.
Though patterns of facial paralysis vary in degrees of involvement and duration, the goals of rehabilitation of facial paralysis should be to achieve normal appearance at rest, controlled balance in expressing emotion and minimal loss of other significant function.
Nerve anastomosis, nerve grafts, nerve rerouting, muscle transfer, muscle grafts, nerve grafting and muscle transplantation with microneurovascular anastomosis are the principal methods currently being employed as dynamic reconstruction.
Static methods include fascia lata suspension and various rhytidoplasties.
Careful pre-operative selection of patients based on what can and cannot be achieved by the proposed surgical technique is paramount to a successful operation.
We treated 7 cases of facial paralysis. 4cases were unilateral facial palsy caued by persistant Bell’s Palsy and were treated with temporal muscle transfer with temporal fascia or fascia lata, contralateral myomectomy and partial rhytidectomy. 3cases were bilateral facial palsy caused by leprosy which were treated with temporal muscle-fascia transfer for the lagophthalmos and fascia lata suspension for the lower face paralysis.
As a result, all the cases which had muscle and fascia transfer could achieve good reanimation of the oral and ocular muscles, except in the case of one elderly leprosy patient. However 3 cases which had fascia lata transplantation for lower face paralysis could achieve only suspending effect of the lips.
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