Abstract Otology 2000 B02-1

Kris Moe MD (1), François Disant MD (2), Wolfgang Draf MD, PhD, FRCS (3), Ph. Pasche MD (4), William H. Slattery MD (5), Julia K. Terzis MD, PhD (6)

(1) Department of Surgery 8895 University of California, San Diego USA-San Diego, CA
(2) Dép. ORL Hôpital Edouard Herriot Pavillon U F-Lyon Cedex 03
(3) Department of ENT-Diseases, Head Neck and Facial Plastic Surgery Academic Teaching Hospital D-Fulda
(4) Service ORL CHUV CH-Lausanne
(5) House Ear Clinic USA-Los Angeles, CA
(6) Eastern Virginia Medical School USA-Norfolk, Virginia

This panel consists of an international collection of experts on facial reanimation. The format will include short presentations on several and controversial topics in the field, as well as specific case illustrations for the demonstration of how experts deal with challenging problems. Among the topics that will be discussed are: 1. Indications for facial reanimation 2. Choice of appropriate procedure (dynamic vs static) 3. Options in static procedures (forehead/eyebrows, eyelids, cheeks, mouth) 4. Options in dynamic procedures (re-anastomosis, interposition grafting, 7-12 anastomosis, cross-facial grafting, free-muscle transfer, etc) 5. Personal "tricks" and techniques 6. How to avoid complications 7. How to manage complications 8. What is on the horizon for the 21st Century 9. Question and answer period The discussions will be interesting to those of all levels of clinical experience, but will be particularly directed to those who manage these problems on a regular basis and have advanced surgical skills.

Abstract Otology 2000 B02-4

Ph. Pasche MD, B. Jaques Dr,

Service ORL CHUV CH-Lausanne

Patients who have a congenital facial paralysis or a paralysis for longer than two years and who have no evidence of muscle activity are usually candidates for regional muscle transfers or static suspension which provide symmetry at rest, limited voluntary movements, but no emotional expression. Microvascular muscle transfer and reinnervation usually with the contralateral facial nerve is a technique which restores also the involuntary movements, so important to express emotion. The reconstruction involves two procedures spaced one year apart. A cross-face nerve graft is necessary in unilateral facial paralysis to provide facial nerve input from the contralateral side. After one year, when the reinnervation of the nerve graft is archieved, a segmental section of the gracilis muscle with its neurovascular pedicle is transferred to the face and fixed to the residual musculature of the upper lip and to the zygomatic arch. Microvascular anastomosis with the facial vessels is carried out, and nerve repair is done between the recipient nerve in the face and the motor nerve of the gracilis muscle. Reinnervation takes place within 6 to 9 months. Active exercise program helps to maximize strength, excursion, and coordination. Functional improvement can occur for up to two years after the muscle transfer. Although the procedures are complex and technically demanding, it is a valuable alternative to static suspension, especially for young patients when the paralysis affect their self-confidence and social interaction. The autors report their experience about two cases, one for a congenital facial paralysis and one for a Bell's palsy.