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The 2003 Annual Meeting of OASYS_NEW |
Abstract: Aberrant reinnervation of the facial nerve is a complication of facial recovery after paralysis, causing postparetic facial synkinesis. Postparetic facial synkinesis is the presence of unintentional movement in another area of the face when intentionally performing movement in one area of the face, including more common seen with dominant oculo-to-oral synkiness, or in reverse, oro-to-ocular synkinesis; less dominant in oculo-to neck or oro-to-neck, or oro-to forehead synkinesis. Most patients are more concerned with oro-ocular synkinesis. Between 1986 and 2000, 116 patients with facial paralysis were treated with functioning free muscle transplantation. Seven were due to aberrant reinnervation of the facial nerve. Five patients were sequel of Bell°¦s palsy and two were traumatic sequel. The strategy of reconstruction for this type of facial paresis is a three-stage procedure. In stage I operation, cross-face nerve graft was set. The stage II operation, one year after the stage I operation, was a destructive surgery to remove the zygomatic and buccal branches of the injured facial nerve and its innervated facial muscles as possible, which were related to the upper lip movement. This destruction surgery could cause the mouth movement to the intact side but no more of oro-ocular synkinesis movement. In stage III operation, one week after stage II destruction operation, restoration of the facial smiling was performed by functioning free gracilis muscle transplantation, innervated by cross-face nerve graft. These seven patients have at least one year follow-up and results are encouraged. Patient°¦s ambition, well explanation preoperatively, well knowledge of facial anatomy of facial nerve branches and muscles, experience and confidence in free muscle transplantation for facial reanimation are all the necessarily required conditions for good results for such complex reconstruction.