Surgical treatment of bilateral facial paralysis: six case reports

Surgical treatment of bilateral facial paralysis: six case reports Eur J Plast Surg (2003) 26:66 DOI 10.1007/s00238-002-0412-6 INVITED COMMENTAR Y D. Labbé Published online: 15 April 2003 © Springer-Verlag 2003 The subject of this contribution is a very difficult one: Zucker et al. [4] obtained at least 1.37 cm. We consider the palliative treatment of bilateral facial paralysis. As that an amplitude of 1 cm of the commissure allows a indicated by the authors, the literature is scanty on this voluntary smile of good quality. Two patients of six re- subject, and the published series are very small. The only quired a revision of the lower lip, but this is very few article recently published is that by Zuker et al. [4] on considering the difficulty of this technique. We prefer ten cases. They present the results of free gracilis trans- lengthening of the bilateral temporalis muscles in one fer anastomosed to the nerve to the masseter. The proce- stage [2]. However, our experience in bilateral facial pa- dure is long (16 h) and has been done in two stages. ralysis is quite limited, but the initial results seem very For bilateral facial paralysis the nerve supply is from encouraging. In this technique the transfer is deep in the a branch of cranial nerve V together with a revascular- sliding plane of the buccal fat pad and thus to the lip. Us- ization of the free flap. Rather than using the muscle in- ing the total muscle and subsequent loss of chewing nervated by cranial nerve V, it seems reasonable, as the function allows the plasticity of the brain to come into authors state, to use a pedicled muscle. The authors used play and thus a “temporal smile” is obtained independent the temporal muscle as described by Rubin et al. [1]. of the movements of the mandible. There can also be a They did not elongate the muscle using a temporal anas- satisfactory spontaneous smile [1], even if the smile is tomosis, as can be seen in Fig. 1. Instead, they used a never totally that seen with a normal display of emotion palmaris longus tendon which was taken through the [2]. lower lip and attached to the two muscles. The function The publication of treatment results of this difficult of the lower lip obtained in this way gave good salivary problem is extremely interesting, particularly the presen- continence. The use of this technique in the upper lip and tation of the technical details and the difficulties encoun- the attempt to give definition of the nasolabial fold is tered and how these are dealt with. Progress in this area less successful. cannot come without looking carefully at techniques and The specific problem of the Möbius patient is the hy- their results. peractivity of the lower lip. This was treated by Rubin using a myomectomy of the depressors of the lower lip and a partial transfer of the masseter to the commissure References and to the lower lip [1]. Voluntary movements are unfor- 1. Conley J, Baker DC (1983) Myths and misconceptions in the tunately not shown in the photographs of at least 1 cm. rehabilitation of facial paralysis. Plast Reconstr Surg 71: 538–539 2. Labbé D, Huault M (2000) Lengthening temporalis myoplasty and lip reanimation. Plast Reconstr Surg 105:1289–1297 This commentary refers to the article which can be found at 3. Rubin LR, Rubin JP, Simpson RL, Rubin TR (1999) The search for the neurocranial pathways to the fifth nerve nucleus in the reanimation of the paralyzed face. Plast Reconstr Surg 103: D. Labbé ( ) 1723–1728 4 Place Fontette, 14300 Caen, France 4. Zuker R, Goldberg C, Manktelow R (2000) Facial animation in e-mail: children with Möbius syndrome after segmental gracilis muscle Tel.: +33-2-31501790, Fax: +33-2-31852903 transplant. Plast Reconstr Surg 106:1–8 European Journal of Plastic Surgery Springer Journals

Surgical treatment of bilateral facial paralysis: six case reports

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