LEPROSY AFFECTS FACIAL NERVES AT THE MAIN TRUNK - NEUROLYSIS CAN POSSIBLY AVOID TRANSFER PROCEDURES

The predilective sites of lesions in leprous peripheral nerves are wel l established, and their surgical decompression is common practice whe n sensorimotor disorders persist after medication. By contrast, the pr ecise localization of leprous facial neuropathy still remains unclear, and musculofascial transfers have been the only type of surgical trea tment. The goal of this study was to clarify where leprosy affects fac ial nerves and to determine whether neurolysis might suffice to restor e facial function. In five Indian and two Egyptian patients suffering from leprous facial neuritis, the nerves were stimulated transcraniall y at the brainstem to evoke efferent motor nerve action potentials, wh ich were recorded from the exposed nerves. Lesions were detected at th e main trunk proximally from the first bifurcation in all cases. Epine uriotomy revealed fibrosis of the interfascicular epineurium in all in stances, as an indication for interfascicular neurolysis. One patient was able to close his eye and showed a better smile soon after surgery . After 16 and 21 months, respectively, one patient had improved disti nctly, two patients slightly, two patients showing no progress, and tw o patients were lost to follow-up. It is concluded that (1) leprous fa cial neuropathy is located at the main trunk close to the first bifurc ation and not exclusively at the peripheral zygomatic branches, (2) mi crosurgical neurolysis can be considered in leprous facial neuropathy before transfer procedures as long as voluntary or spontaneous activit y is present in the affected muscles, and (3) intraoperative transcran ial electrical stimulation is an effective means of localizing the sit e and proximal extent of leprous facial neuropathy.