RESULTS OF RECONSTRUCTION OF THE FACIAL-NERVE

The results of surgical treatment for facial paralysis are still diffi cult to compare as there is no universal scoring method. The purpose o f 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 1981-1 991. They had lacerations or other trauma to the face which resulted i n loss of continuity of the facial nerve or branches. Three groups wer e considered: (a) 12 patients had injuries involving the trunk and ext ending up to the main branches of the facial nerve; (b) 32 patients ha d parotid laceration or contusion on the parotid area with resulting n erve 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 instance s. The grafting procedure was performed from three weeks to six months after the trauma. The method of evaluation compares the normal with t he paralyzed side. A score is given of 0 (no motion), 1 (weak motion), or 2 (strong motion), for each of six voluntary contractions: forehea d, 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 we re 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 provide d a significant improvement of function in patients with traumatic inj uries to the extratemporal facial nerve. (C) Wiley-Liss, Inc.