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Microsurgical treatment of facial palsy: 10 years of clinical experience
Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för biomedicin och kirurgi, Hand och plastikkirurgi. Linköpings universitet, Hälsouniversitetet.
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
Abstract [en]

The aim of this study is to analyse retrospectively the outcome of microsurgical treatment of patients with facial palsy at the University Hospital of Linköping during the period 1990-2000. Ten patients with facial palsy during 1 year or more completed the evaluation.

Patients subjected to cross facial nerve grafting (CFNG) only included 3 females. The CFNGs appeared to be fimctional in all patients. The measurements revealed good symmetry of the eye rim at rest and at eye closure. All three patients had an asymmetric angle of the mouth with a mean dropping of 2.3 mm at rest and 5.5 mm when smiling. The House-Brackmann grade was 4-5. The average Facial Grading System score was 33. The mean decrease in quality of life was 34%. The mean improvement after treatment was 48%. The degree of post-lesional impairment and the degree of postoperative satisfaction were inversely related. All patients were aware of their disability but they had not completely accepted the current facial status.

The group of patients with CFNG and a free muscle flap transfer included six females and one male. The transferred muscle flaps were activated by the CFNGs. Symmetry of the eye rims at rest was observed in 4 cases and with closure in 3 cases. In asymmetric cases, the mean difference was 1. 8 mm at rest. With eyes closed the mean difference was 4.4 mm. The angle of the mouth was asymmetric in all patients, the mean lowering being 3 mm at rest and 7.5 mm at smile. The House Brackmann grade was 4-5 and the average Facial Grading System score was 31. Four patients with early or congenital facial palsy could not provide data on impairment of quality of life. In the others, the post-lesional impairment was 63%. For all patients in this group the average postoperative improvement was 76%. The patients expressed a rather good acceptance of the achieved status after reconstruction.

Surgical methods to correct facial paresis should be directed towards achieving a symmetric resting tone on the injured side as well as symmetric movements. At present, our methods, when utilised on proper indications and with a precise timing, can give the patient a reasonably good but not perfect result. Further refinements of the technique are needed and should be sought through experimental studies.

Emneord [en]
facial palsy, clinical study, cross facial nerve graft, free microneurvascular muscle flap
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-81517OAI: oai:DiVA.org:liu-81517DiVA, id: diva2:553083
Tilgjengelig fra: 2012-09-18 Laget: 2012-09-18 Sist oppdatert: 2012-09-18bibliografisk kontrollert
Inngår i avhandling
1. Facial nerve injury and microsurgical repair: Experimental and clinical studies
Åpne denne publikasjonen i ny fane eller vindu >>Facial nerve injury and microsurgical repair: Experimental and clinical studies
2002 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Facial palsy is a relatively common clinical condition with a variety of causes. Irrespective of its etiology, facial palsy always represents a very serious problem for the patient. This underlines the need for more effective treatment procedures. Retrospective evaluation of a clinical material of 16 patients with facial palsy treated at the University Hospital of Linköping during the period 1990-2000 showed that to improve the results of microsurgical nerve repair experimental research - controlled studies on homogeneous materials - is imperative.

To produce relevant experimental data we used a rat model. Dissections showed that the mandibular branch (MB) of the rat facial nerve is suitable for experimental studies. Electron rnicroscopy revealed that the normal rat MB contains some 2,200 axons, 1,825 of which are myelinated and show a unimodal size distribution with a mode at 4.5 µm. It was also found that the normal rat MB contains myelinated and unmyelinated sympathetic axons and that about half the C-fibers in the normal rat MB belong to capsaicin-sensitive putative polymodally nociceptive sensory neurons. Importantly, repair of the MB through transmedian grafting in one stage and in two stages, respectively, had largely similar outcomes in terms of anatomy.

These data evoked questions concerning the functional outcome of the two types of repair. Electrophysiological analysis (force recordings andelectromyography) revealed that repair of the rat MB through transmedian grafting in one stage gives a somewhat better functional restoration than repair in two stages.

The observations on the rat MB called for experimental studies on the effects of denervation and repair on mimic muscle. We found that the rat dilator naris muscle (DNM) is suitable for that purpose. The normal DNM contains 1,200 fast MyHC fibers with MyHC IIB fibers predominating. It is a very fast contracting muscle without static functions. A brief denervation of the DNM followed by spontaneous reinnervation by the MB did not influence fiber number, had long-term effects on fiber diameter, and had little effect on fiber types. Fiber number, fiber diameter, and occurrence of fiber types in the DNM remained abnormal both after immediate and delayed surgical repair of the MB. Long-term denervation of the DNM had severe effects on qualitative histology, fiber number, fiber diameter and fiber type distribution. Hence, a long delay between facial nerve injury and repair reduces the chances of restoring normal facial muscle function.

Conventional cross facial grafting includes division of a facial nerve branch (the donor nerve) on the intact side of the face. This non-optimal situation prompted us to test cross-facial grafting with a less traumatic end-to-side procedure in the rat. After coaptation of a sural nerve graft to the rat MB in an end-to-side fashion, including opening of a perineurial window, axons in the donor nerve emitted myelinated and umnyelinated sprouts into the graft. A predegenerated graft did not stimulate sprouting more than a fresh graft. Retrograde tracing with fast blue and fluoro-ruby showed that many sprouts originate from facial motor axons. Of all traced facial motoneurons 50% projected exclusively into the graft, 45% projected into the graft and the donor MB and 5% projected exclusively into the donor MB. This shows that the end-to- side procedure can be used for cross-facial repair of the rat MB.

Altogether these results provide new experimental data, which hopefully will contribute to improvements of the microsurgical treatment of patients with facial palsy.

sted, utgiver, år, opplag, sider
Linköping: Linköpings universitet, 2002. s. 97
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 716
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-25666 (URN)10042 (Lokal ID)91-7373-159-5 (ISBN)10042 (Arkivnummer)10042 (OAI)
Disputas
2002-02-22, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (svensk)
Opponent
Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2012-09-18bibliografisk kontrollert

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