The correction of permanent facial paralysis is frequently a reconstructive problem, often a neurologic one and sometimes both. At present war wounds are uppermost in mind; bizarre clinical pictures may be presented, and judgment must be applied according to present knowledge.
If the lesion is such that nerve graft or anastomosis can be accomplished, these procedures may be utilized. However, if the lesion is an old one, conjunctive surgical reconstruction with fascia and muscle transplants may be necessary. For, as Blair1 pointed out, it requires six months to a year to obtain all or almost all of the innervation that can be obtained by anastomosis or nerve graft, but it requires a much longer period to learn to use this innervation to the greatest advantage. Consequently, in the presence of muscle atrophy, nerve graft or anastomosis alone will not affect a mechanical recovery.
ANATOMY OF THE SEVENTH NERVE
LAMONT ES. PLASTIC SURGERY IN FACIAL PARALYSIS: WITH MODIFICATIONS IN TECHNIC. Arch Otolaryngol. 1944;39(2):155–163. doi:10.1001/archotol.1944.00680010166006
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