RESULTS OF RECONSTRUCTION OF THE FACIAL-NERVE

The results of surgical treatment for facial paralysis are still difficult to compare as there is no universal scoring method. The purpose of this communication is to review the results of reconstruction of the extratemporal facial nerve with nerve grafts using our own evaluation system. Fifty-nine patients were operated on during the period 1981-1991. They had lacerations or other trauma to the face which resulted in loss of continuity of the facial nerve or branches. Three groups were considered: (a) 12 patients had injuries involving the trunk and extending up to the main branches of the facial nerve; (b) 32 patients had parotid laceration or contusion on the parotid area with resulting nerve defects extending from a main branch up to distal branches; and (c) 15 patients had injuries on the distal branches: frontal, zygomatic, or mandibular. The sural nerve was used as the graft in all instances. The grafting procedure was performed from three weeks to six months after the trauma. The method of evaluation compares the normal with the paralyzed side. A score is given of 0 (no motion), 1 (weak motion), or 2 (strong motion), for each of six voluntary contractions: forehead, closure of eyelids and lips, traction, elevation, and depression of the lips. The assessment of involuntary mimic actions was done while observing blinking, speaking, smiling, and laughing. Mass movements were scored negatively. The numbers were recorded and the ratio between the paralyzed and normal side gave an estimate of the lack of symmetry. Differences between the preoperative and postoperative scores showed that improvement had been achieved by surgery. Nerve grafting provided a significant improvement of function in patients with traumatic injuries to the extratemporal facial nerve. (C) Wiley-Liss, Inc.