Patients with partially recovered facial palsy present an interesting problem. Often after a severe but transient facial nerve insult, such as Bell's palsy, recurrent facial paralysis from Melkerson-Rosenthal syndrome, or iatrogenic neuropraxia, patients recover to a House-Brackmann grade II or III level. They have better function than could be expected with grafting procedures but still have complaints relative to facial asymmetry. In these patients, muscle transfer would play no role at all, as they maintain a fair amount of mimetic function. In order to improve resting facial symmetry, a limited, "mini" facelift technique can provide increased resting support to the affected side, without jeopardizing residual dynamic function. If the affected side has developed a contracture so that the normal side appears flacid in comparison, the unaffected side can be operated on in order to match the contractured side. This is done through standard anterior rhytidectomy incisions. Subdermal flaps are elevated, and the SMAS is simply plicated to an appropriate degree according to the resting position of the opposite side. This asymmetric facelift technique allows the resting position of the two sides of the face to match more closely.
patients, it is critical not to jeopardize regeneration through either an anatomically intact facial nerve or one that has been primarily repaired or grafted at the brainstem or intratemporally. However, the addition ofa dynamic reanimation procedure during the early postoperative period dramatically improves resting facial tone, significantly reducing the cosmetic deformity.
We have established a role for early temporalis muscle transposition in the treatment of this subgroup of patients, with excellent results.4 The surgical technique has been refined to deal effectively with both donor site defect problems and hypertrophic scarring at the oral commisure. Using this dynamic muscle transfer as an adjunct procedure permits efficient restoration of facial tone, symmetry, and purposeful facial movement in a patient population that previously waited up to 3 years after paralysis for any reanimation procedure. Not only is early function restored, but the natural regeneration of facial nerve fibers is not interfered with, so that ultimate restoration ofinnervation to the muscles of facial expression may still occur.
Although this early intervention is still not in widespread use, we believe it improves short-term postoperative outcome significantly and will be more frequently employed as its benefits become more widely recognized.
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