The authors are presenting a series of 10 cases of complete unilateral facial paralysis submitted to (I) end-to-end microsurgical coaptation of the masseteric branch of the trigeminal nerve and distal branches of the paralyzed facial nerve, and (II) cross-face sural nerve graft. The ages of the patients ranged from 5 to 63 years (mean: 44.1 years), and 8 (80%) of the patients were females. The duration of paralysis was no longer than 18 months (mean: 9.7 months). Follow-up varied from 6 to 18 months (mean: 12.6 months). Initial voluntary facial movements were observed between 3 and 6 months postoperatively (mean: 4.3 months). All patients were able to produce the appearance of a smile when asked to clench their teeth. Comparing the definition of the nasolabial fold and the degree of movement of the modiolus on both sides of the face, the voluntary smile was considered symmetrical in 8 cases. Recovery of the capacity to blink spontaneously was not observed. However, 8 patients were able to reduce or suspend the application of artificial tears. The authors suggest consideration of masseteric-facial nerve coaptation, whether temporary (baby-sitter) or permanent, as the principal alternative for reconstruction of facial paralysis due to irreversible nerve lesion with less than 18 months of duration.
From the *Division of Plastic Surgery, Hospital das Clinicas, Sao Paulo, Brazil; †Division of Plastic Surgery, Hospital da Pontifícia Universidade Católica, Campinas, Brazil; and ‡Division of Microsurgery Surgery, Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Hospital, Sao Paulo, Brazil.
Received September 15, 2008, and accepted for publication, after revision, December 19, 2008.
Reprints: Joes Carlos Marques Faria, MD, PhD, Rua Maestro Cardim 377, 80 Andar, Sao Paulo 01323-000, Brazil. E-mail: firstname.lastname@example.org.