Dynamische Verfahren zur Gesichtsnervenrekonstruktion

Zu den chirurgischen Behandlungsmöglichkeiten von Patienten mit Gesichtsnervenlähmung gehören statische und dynamische OP-Verfahren. Für eine Wiederherstellung der Lidschlussfunktion sind statische Rekonstruktionen ausreichend; soll das Lächeln rekonstruiert werden, das für das psychosoziale Leben des Patienten wichtig ist, kommen dynamische Verfahren zum Einsatz wie verschiedene Nervenanastomosen, die Labbé-Prozedur und der Grazilis-Lappen.

Abstract

In this article the indications and surgical treatment options for patients with facial nerve palsy are discussed. A distinction is made between static and dynamic surgical procedures. Static reconstructions for example are used to restore the eyelid closure function. For smile reconstruction, which is important for the psychosocial life of the patient, dynamic procedures are used. Depending on the duration of the facial nerve paralysis, there are several possibilities to restore the smile. In this work the masseteric branch transposition to the buccal branch, the hypoglossal-facial nerve anastomosis, the Labbé procedure and the gracilis flap as a free muscle transplant are discussed. The surgical procedures are compared and the advantages and disadvantages of the intervention are presented. A spontaneous smile is aimed, this cannot always be achieved. With the masseteric branch transposition to the buccal branch and the Labbé procedure the smile is initially triggered by chewing. A spontaneous smile is possible through cortical adaptation. With the gracilis flap, however, a nerve anastomosis with the contralateral ‘healthy’ facial nerve is possible, either directly or via a so-called cross facial nerve grafting, whereby a spontaneous smile can be achieved.

Schlüsselwörter

Fazialisparese - dynamische Gesichtsnervenrekonstruktion - Nervus facialis - Massetericus-Fazialis-Nervenanastomose - Labbé-Prozedur - Grazilis-Lappen

Key words

facial palsy - dynamic facial reanimation - facial nerve - nV-nVII-jump - Labbé procedure - gracilis flap

Publication History

Article published online:
30 August 2021

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