Generally, the totally paralyzed face can never be made normal by any of the current methods of reconstruction. Careful selection of patients based on sound judgment of what can and cannot be achieved by the proposed surgical technique is
paramount
to a
successful operation and a satisfied patient. The results are related to time of delayed injury and repair; the shorter the delay the better are the results. The objectives in correcting facial paralysis are to achieve normal appearance at rest;
symmetry with voluntary motion; control of the ocular, oral, and nasal sphincter; symmetry with involuntary emotion and controlled balance when expressing emotion; and no significant functional deficit secondary to the reconstructive surgery.
It must be employed a number of concepts, for treatment of the paralyzed face by surgeon, depending on the cause, time interval, and wound characteristics, as well as the availability of and necessity for neuromuscular substitution.
Nerve grafts, crossovers, muscle transfers, free muscle and nerve-muscle grafts, micronuerovascular muscle transfers, and regional muscle transposition are the principal methods being developed.
We applied the temporal musle transposition for reanimation of unilatrally paralyzed faces for long times on two patients.
The results of muscle transposition can be enhanced by the patient's learning to activate the transposed muscle by voluntary effort, and are best in patients who are motivated to learn the necessary motor-sensory coordination techniques.
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