Regional muscle flap-plasty and adjuvant measures for rehabilitation of the paralyzed face

BACKGROUND: The loss of facial nerve activity reduces the quality of life in regard to functional disturbances and to the appearance of the patient. As far as possible a reconstruction of the facial nerve should be advocated. Only this procedure allows the natural variety of differentiated facial expression. If reconstruction of the facial nerve is not indicated or turns out to be unsatisfactory, a dynamic muscle transposition should be considered. PATIENTS AND METHODS: The patient records of the ENT-Departments in Fulda for the period from 1988 to 1995 and in M?nchengladbach from 1993 to 1995 were reviewed to survey the experience of secondary plastic rehabilitation of the paralysed face. Our special interest focussed on the oral region with dynamic muscle transfer. The techniques leading to rehabilitation of the lid region were included in this study. RESULTS: Transfer of the temporalis muscle was performed 12 times and a masseter muscle flap 4 times to rehabilitate the oral region. Static rehabilitation (canthoplasty, tarsorrhaphy) of the lid was performed 8 times, implantation of a gold weight in the upper lid 5 times and dynamic rehabilitation of the lid region with a temporalis muscle transposition once. CONCLUSIONS: Rehabilitation of the oral region is best managed with a temporalis muscle flap because of its favourable vector of tension and its broad, flat form. Masseter muscle transposition is particularly indicated if a temporalis muscle transfer is not possible or if resection of the facial nerve because of malignancy of the parotid gland has to be performed and nerve reconstruction is not advisable.