The mimic function was poorer in patients with longer follow-up time. In conclusion, most of the patients achieved good result in facial reanimation and were satisfied with the functional outcome. In grafted nerve Vascular Endothelial Growth Factor (VEGF) and its receptors were expressed in nervous tissue. A high expression of p75NGFR was often seen with better function of the transplanted muscle. The expression of p75NGFR was lower in older than in younger patients. P75Nerve Growth Factor Receptor (p75NGFR) was expressed in every nerve graft sample. A longer time between cross facial nerve grafting and biopsy sampling correlated with a higher number of viable axons. The grafted nerves characterized by fibrosis and regenerated axons were thinner than in control samples although they were well vascularized. In nerve grafts, the mean number of viable axons amounted to 38% of that in control samples. The good long-term functional outcome correlated with dominance of fast fibers in muscle grafts.
Severe muscle atrophy correlated with prolonged intraoperative ischaemia. All samples showed intramuscular innervation. Proliferative activity of satellite cells was seen in 60% of the samples and it tended to decline with an increase of follow-up time. In muscle biopsies, the mean muscle fiber diameter was diminished to 40% compared to control values. A correlation was found between good functional outcome and normal muscle structure in MRI.
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In MRI study, the free MNV flaps were significantly smaller than originally. A majority of the patients (78%) defined their quality of life improved after surgery. The longer the follow-up time after muscle transfer the weaker was the muscle function. In our studies, we found that almost two-thirds of the patients achieved good result in facial reanimation. The structure of MNV muscles and nerve grafts was evaluated using histological and immunohistochemical methods ( Ki-67, anti-myosin fast, S-100, NF-200, CD-31, p75NGFR, VEGF, Flt-1, Flk-1). Magnetic resonance imaging (MRI) of MNV muscle flaps was done, and nerve graft samples (n=37) were obtained in second stage of the operation and muscle biopsies (n=18) were taken during secondary operations. Twenty-seven out of forty patients operated on were interviewed, and the functional outcome was graded. In this thesis, we recorded the long-term results of MNV surgery in facial paralysis and observed the possible contributing factors to final functional and aesthetic outcome after this procedure. Patients with severe long-term facial paralysis are often reanimated with a two-stage procedure combining cross-facial nerve grafting, and 6 to 8 months later with microneurovascular (MNV) muscle transfer. Microneurovascular free muscle transfer with cross-over nerve grafts in facial reanimation Loss of facial symmetry and mimetic function as seen in facial paralysis has an enormous impact on the psychosocial conditions of the patients. The paper provides an overview of recent advances in facial reanimation, including preoperative assessment, surgical reconstruction options, and postoperative management. Postoperative results can be improved with ancillary soft tissue procedures, as well as botulinum toxin. Microvascular free tissue transfer is a reliable technique with reanimation potential whose results continue to improve as microsurgical expertise increases. In long-standing facial paralysis, temporalis muscle transfer gives a dependable and quick result. The best functional results are obtained with direct facial nerve anastomosis and interpositional nerve grafts. The options for dynamic reanimation of the paralyzed face must be examined in the context of several patient factors, including age, overall health, and patient desires. This review delineates common surgical techniques and reviews state-of-the-art techniques. Along with the myriad of new surgical techniques in managing facial paralysis comes the challenge of selecting the most effective procedure for the patient.
Facial paralysis often has a significant emotional impact on patients.
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