The outcomes of dynamic procedures for blink restoration in pediatric facial paralysis. 2010

Julia K Terzis, and Dimitrios Karypidis
Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Microsurgery Program, Eastern Virginia Medical School.

BACKGROUND Surgical planning aims to restore coordinated eyelid function. Although achieving voluntary eye closure is one of the primary goals, it cannot guarantee return of involuntary blink. Restoration of the afferent pathway of the reflex is a prerequisite, but successful coordination of the reflex components and restoration of their time-related function are also required. METHODS A retrospective review of 49 patients who underwent dynamic procedures for blink restoration was performed. The patients were divided into two groups. Group A (n = 42) included patients who underwent nerve transfers: cross-facial nerve grafting and subsequent microcoaptations, mini-hypoglossal nerve transfers, and direct orbicularis oculi neurotization. Group B (n = 14) included patients who underwent eye sphincter substitution techniques: pedicled frontalis, free platysma, mini-temporalis, and a slip of free pectoralis minor transfers. Seven of the patients included in the groups underwent both nerve and muscle transfer procedures. Objective blink ratios were measured according to an established protocol by the senior author (J.K.T.). RESULTS Thirty patients were girls and 19 were boys. The age of the patients ranged from 1 to 17 years, with a mean +/- SD age of 7.5 +/- 3.2 years. Denervation time ranged from 76 months to 15.25 years. Blink improvement was noted in all of the patients. Blink scores and ratios were consistently better in group A than in group B. CONCLUSIONS Dynamic procedures provide the functional potential on which subsequent static procedures can be performed to aid blink return, taking into account the future needs of the still growing patient.

UI MeSH Term Description Entries
D007002 Hypoglossal Nerve The 12th cranial nerve. The hypoglossal nerve originates in the hypoglossal nucleus of the medulla and supplies motor innervation to all of the muscles of the tongue except the palatoglossus (which is supplied by the vagus). This nerve also contains proprioceptive afferents from the tongue muscles. Cranial Nerve XII,Twelfth Cranial Nerve,Nerve XII,Nervus Hypoglossus,Cranial Nerve XIIs,Cranial Nerve, Twelfth,Cranial Nerves, Twelfth,Hypoglossal Nerves,Hypoglossus, Nervus,Nerve XII, Cranial,Nerve XIIs,Nerve XIIs, Cranial,Nerve, Hypoglossal,Nerve, Twelfth Cranial,Nerves, Hypoglossal,Nerves, Twelfth Cranial,Twelfth Cranial Nerves,XII, Nerve,XIIs, Nerve
D007223 Infant A child between 1 and 23 months of age. Infants
D008297 Male Males
D010369 Pectoralis Muscles The pectoralis major and pectoralis minor muscles that make up the upper and fore part of the chest in front of the AXILLA. Pectoralis Major,Pectoralis Major Muscle,Pectoralis Minor,Pectoralis Minor Muscle,Pectoral Muscle,Muscle, Pectoral,Muscle, Pectoralis,Muscle, Pectoralis Major,Muscle, Pectoralis Minor,Muscles, Pectoralis Major,Pectoral Muscles,Pectoralis Major Muscles,Pectoralis Majors,Pectoralis Minor Muscles,Pectoralis Minors,Pectoralis Muscle
D001767 Blinking Brief closing of the eyelids by involuntary normal periodic closing, as a protective measure, or by voluntary action. Orbicularis Oculi Reflex,Reflex, Blink,Reflex, Corneal,Reflex, Orbicularis Oculi,Winking,Blink Reflexes,Corneal Reflexes,Orbicularis Oculi Reflexes,Blink Reflex,Reflexes, Blink,Reflexes, Orbicularis Oculi
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005143 Eyelids Each of the upper and lower folds of SKIN which cover the EYE when closed. Eyelid
D005152 Facial Muscles Muscles of facial expression or mimetic muscles that include the numerous muscles supplied by the facial nerve that are attached to and move the skin of the face. (From Stedman, 25th ed) Mimetic Muscles,Facial Muscle,Mimetic Muscle,Muscle, Facial,Muscle, Mimetic,Muscles, Facial,Muscles, Mimetic
D005154 Facial Nerve The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and SALIVARY GLANDS, and convey afferent information for TASTE from the anterior two-thirds of the TONGUE and for TOUCH from the EXTERNAL EAR. Cranial Nerve VII,Marginal Mandibular Branch,Marginal Mandibular Nerve,Seventh Cranial Nerve,Nerve VII,Nerve of Wrisberg,Nervus Facialis,Nervus Intermedius,Nervus Intermedius of Wrisberg,Cranial Nerve VIIs,Cranial Nerve, Seventh,Facial Nerves,Mandibular Nerve, Marginal,Mandibular Nerves, Marginal,Marginal Mandibular Nerves,Nerve VIIs,Nerve, Facial,Nerve, Marginal Mandibular,Nerve, Seventh Cranial,Nerves, Marginal Mandibular,Nervus Faciali,Seventh Cranial Nerves,Wrisberg Nerve,Wrisberg Nervus Intermedius

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