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In Reply.—We thank Dr Ekstrand for his comments on our article. His review of 470 patients with Bell's palsy gives an excellent perspective on the natural course of the disease. Our philosophy regarding the timing of reanimation surgery in Bell's palsy is in complete accord with Ekstrand's recommendations.
There were three patients with Bell's palsy in our series. Unfortunately, they were not referred to us until 5, 7, and 13 years, respectively, after the onset of their condition. All three patients did achieve adequate reanimation.
Waiting at least 1 year before performing surgery allows patients to gain the maximal degree of spontaneous recovery. Surgery performed shortly after the maximal recovery has been achieved spares the patient with fixed paralysis the agony of waiting years for return of neuromuscular function that is unlikely to occur.
CASLER MJD. Treatment of Facial Paralysis-Reply. Arch Otolaryngol Head Neck Surg. 1991;117(11):1309. doi:10.1001/archotol.1991.01870230125026
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