Microsurgical treatment of facial palsy: 10 years of clinical experience
(English)Manuscript (preprint) (Other academic)
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.
facial palsy, clinical study, cross facial nerve graft, free microneurvascular muscle flap
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-81517OAI: oai:DiVA.org:liu-81517DiVA: diva2:553083