Nerve Transfer with Microsurgery
Treatment of permanent facial paralysis nerve transplantation, especially as a result of developments in microsurgery technique facial paralysis surgery of the options. In short-term complete facial paralysis (less than 2 years) and partial (incomplete) facial paralysis, if the communication between muscle and nerve continues, existing facial expressions can be strengthened with nerve transplants. Here, the time elapsed after facial paralysis affects the success of the surgery. (Note: This situation differs in partial facial paralysis, it may be more than 2 years. by nerve transplants success is possible.) The probability of success of nerve transplants is decided with the help of clinical examination and EMG.
Common nerve transplant options:
What is a masseter nerve transplant?
Also known as trigeminal nerve transplant. The masseter nerve is the chewing branch of the trigeminal (5th nerve) nerve. Combining the masseter nerve with microsurgery to signal the branches of the facial nerve is called 'masseter nerve transplant'. As seen in the photo, 'nerve to masseter' and 'buccal branch of facial nerve' are in close neighborhood.
How is masseter nerve transplant surgery performed?
In masseter nerve transplantation, the surgery is started by making an incision in front of the ear on the side of the patient with facial paralysis. After the skin is removed, the masseter nerve in the cheek area and the branches of the facial nerve are connected end-to-end using microsurgery. Thus, the signals coming from the masseter nerve, which normally works the masticatory muscles, are transferred to the facial nerve on the paralyzed face and activates the facial mimic and functional muscles.
Recovery after masseter nerve transplant surgery
If everything proceeds normally, the patient is discharged the morning after masseter nerve transplant surgery. There is a one-week recovery period. During the recovery period, patients should not hit the cheek area and avoid exercise and heavy lifting; It is recommended to avoid hard brushing.
What is the success percentage after masseter nerve transplant surgery?
Success varies from person to person. The age of the patient, the level of facial palsy (House Brackman scale), the time from facial paralysis to nerve transplant surgery are effective in success.
How soon after masseter nerve transplant surgery does mobilization begin on the paralyzed side?
Movement is not expected for the first 3-4 months after the operation. Movement about 4-5. starts after month. The time to occur depends on 2 factors: (1) the time from facial paralysis to nerve transplant surgery (2) younger patients recover faster than older patients. Roughly speaking, if the nerve repair is performed within 6 months after facial paralysis, mobilization begins in about 6 months (after 6 months in elderly patients).
How does recovery and rehabilitation proceed after the start of movement?
Masseter sinir nakli yapılan tarafta yüz hareketleri görüldükten sonra fizik tedavi başlar ve sinirin kuvveti ve kontrolü takip eden birkaç yıl içerisinde artar. İlk başta 'ısırma' eylemi ile gülümseme görülürken yeteri miktarda eğitim ve fizik tedavi sonrasında öğrenme gerçekleşir. Beynin inanılmaz adaptasyonu sonucunda hastalarda zaman içinde 'ısırma' olmadan eforsuz ve doğal gülümseme fonksiyonunun gelmesi sıktır. Hastaların yaklaşık %70'i yeterli emek ve egzersiz ile bunu öğrenebilir.
What are the advantages of masseter nerve transplant compared to other nerve transplants?
It is also an advantageous method in terms of avoiding speech and swallowing disorders experienced in traditional nerve transplants (12th hypoglossal nerve transplant). Chewing function in the masseter nerve is not seen due to the compensation of other muscles.
Hypoglossus Nerve Transplant
It is a surgery that aims to eliminate the effects of permanent facial paralysis as a result of the transfer of the hypoglossus (12th cranial nerve) to the facial nerve (7th cranial nerve). The 12th nerve is the nerve responsible for language movements. In this surgery, using microsurgery techniques, two nerve endings are combined to enable facial mimic muscles to work.
A similar surgery: When the masseter nerve is used, movement is observed in the paralyzed side with a bite, and when the hypoglossus nerve is used, the person moves his tongue. This does not happen automatically after surgery. It is a process that the patient learns with physical therapy and education. Patience and persistence are required for the brain to be reprogrammed. This movement, which was made with thought at first, becomes automatic over time.
Cross-facial Nerve Transplant
They are one or two stage surgeries. Two-stage surgeries give better results. The first stage is a nerve cable graft called the leg (sural nerve). 3-4 a of 3-4 cm on the outer back of the leg
With the help of a det incision, the leg sensory nerve over 20 cm is removed. Since this nerve is not involved in the movement of the leg, but in the feeling of the leg, its deficiency does not create a movement difficulty.
The first surgery is performed on the healthy face. One of the branches of the healthy facial nerve is connected with the sural nerve using microsurgical method. The other end of the sural nerve is extended to the paralyzed side using a special tunnel method.
This nerve repair on the healthy side of the face takes about 9 to 12 months to provide nerve conduction to the paralyzed side of the face. If Tinel's sign is taken on the paralysis side, a second surgery is performed. In the second surgery, the tip of the sural nerve taken from the leg is connected to one of the facial nerve branches on the paralyzed side. Since this nerve repair takes a long time to result, its use in combination with masseter nerve transplantation is common in practice.