Mixed facial reanimation technique to treat paralysis in medium-term cases.

摘要: Recent facial paralyses, in which fibrillations of the mimetic muscles are still detectable by electromyography (EMG), allow reanimation based on giving new neural stimuli to musculature. However, if more time has elapsed, can undergo irreversible atrophy, and providing a stimulus is simply not effective. In these cases function provided transferring free flaps into face or transposing masticatory reinstitute major movements, such as eyelid closure smiling. small number cases, patients affected paralysis referred late - than 18 months after onset. reinnervating musculature carries high risk failure because some all may atrophy irreversibly while axonal ingrowth taking place. A mixed technique address this involves neurorrhaphy between masseteric nerve branch for orbicularis oculi, ensure stronger innervation that muscle, associated with transposition temporalis muscle nasiolabial sulcus. This gives good symmetry rest midface, smiling movement achievable, but guaranteed. one-time particularly indicated those who refuse free-flap surgery when be risky, previously operated irradiated fields. More extensive procedures utilizing flap recover smiling, adding cross-face graft restore blinking, proposed motivated patients. Between 2010 2015, five complete unilateral palsy underwent Maxillofacial Surgery Department, San Paolo Hospital (Milan, Italy). Symmetry middle-third at recovery was quite good. Complete voluntary obtained cases. Combining rotation masseteric-to-orbicularis-oculi-facial-nerve seems valid solution medium-term