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F. Biglioli, M. Goisis, A. Frigerio, M. Guareschi, A. Coggiola, A. Baldazzi, G. Rossetti, R. Brusati; Reconstructive surgery for inveterate facial palsy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5604.
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Purpose:surgery following inveterate facial palsy can be performed using different techniques. For the eyelid, the most common solutions are the gold weight implant and the rotation of a temporal flap, while for the lower two thirds of the face a microsurgical transposition of a latissimus dorsii flap is the most advanced technique. Methods:Between 1976 and 2003, 48 patients suffering from inveterate facial palsy were treated. The average age was 47,8 (range 16–72) and the paralysis had arisen 10,5 years before (range 2–65). Until 1998, only upper eyelid palsies by a temporal flap rotation were treated (31 patients). From April 1999, 17 patients were treated using a microsurgical latissimus dorsii flap (in 7 cases temporal muscle rotation was also performed) following the Harii technique, which means facial reanimation in 1 step harvesting a microsurgical latissimus dorsii flap and positioning it in the pathological cheek by a lifting–way surgical access. Then, after an electrical stimulation test looking for any controlateral nervous branch which can supply the same function, microsurgical anastomoses between the toracodorsal nerve and one or more working controlateral facial nerve branches and between toracodorsal vascular pedicle and the facial vessels are performed. Results:All patients reached eyelid competence, lagophthalmus correction and good (70%) facial symmetry. In 20% of cases a flap re–exploration was necessary. In Nov 2003, 9 patients treated with Harii technique had a good motility of the treated area, while for the other 8 it was too early. The average time to reach a good flap motility was 9 months (range 3–15). Conclusions:Chronic facial nerve palsy brings to irreversible mimic muscles atrophy, whose treatment implies a transfer of new musculature. For lid function, the most common technique is the rotation of a thin string of temporal muscle. For the lower face, the classic methodology implies a sural nerve grafting and, after neuroassonal rehabilitation, a microvascular muscle flap. This means 2 surgical treatments, 2 microsurgical anastomoses and at least 20–24 months for reanimation. With the described technique, facial paralysis is corrected in medium 9 months by a single operation and a single neural anastomosis.
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