Temporalis Muscle Transposition in Irreversible Facial Nerve Palsy: A Vestibular Approach.

Background The facial nerve plays a crucial role in innervating the motor supply of facial muscles, enabling essential facial expressions that facilitate human communication. Defects or damages to this nerve can have significant consequences, leading to functional, emotional, and social difficulties caused by the immobility of facial muscles. Patients suffering from irreversible facial nerve palsy often experience functional symptoms such as eyelid closure defects, mouth deviation, and limited movement. Methods This study aims to address these challenges and offer potential solutions for patients with irreversible facial nerve palsy. In this study, 18 patients (three males and 15 females) underwent temporalis transfer with an intraoral approach in the cranio-orbito-palpebral unity. Preoperative facial reanimation planning involved evaluating the smile's appearance on the unaffected side. Photographs were captured in various positions, and facial expressions were examined. Following this, botulinum toxin was injected into the normal side of the face seven days before the procedure to address the hyperactive condition of the mimic muscles. Results Temporalis transfer with an intraoral approach for oral commissure reanimation in the context of irreversible facial nerve palsy was performed. The surgical procedure combined coronal and orbital approaches and achieved the desired outcomes. Postoperative complications observed included hematomas and ossification. Functional outcomes, assessed using the House-Brackmann grading system, indicated a mean improvement of 2.5, signifying moderate dysfunction with normal tone and facial symmetry. Conclusion This intervention represents an alternative approach to actual techniques of facial palsy reanimation, especially in selected patients who can benefit from the absence of visible scars, such as young patients and those prone to hypertrophic and keloid scarring, as well as patients with non-prominent nasolabial folds.

Orbitofrontal monobloc advancement for Crouzon syndrome.

INTRODUCTION: Usually, patients suffering from Crouzon syndrome have synostosis of coronal sutures, exophthalmia, hypertelorism, and hypoplasia of the middle third of face. Sometimes maxillary retrusion is absent, so these patients have class I or II relationship. In these cases, frontofacial monobloc advancement, which is the gold standard, increases the maxillo-mandibular dysmorphia. Therefore we propose orbitofrontal monobloc advancement minus dental arch, without splits of the pterygoid plates. CASE REPORT: A 12-year-old girl with Crouzon syndrome had intracranial hypertension, exophthalmia, a middle third retrusion and a class II occlusion. We achieved orbitofrontal monobloc advancement which is frontofacial monobloc advancement minus maxillary dental arch. Four distractors KLS Martin were used. After 20 days of distraction, the final advancement was 10.2 mm for cranial distractors and 10.5 mm at fronto-zygomatic. Distractors were removed after 8 months. DISCUSSION: We offer patients suffering from Crouzon syndrome with class I or II relationship a change from the classic frontofacial monobloc advancement leaving the maxillary dental arch in place, thus avoiding the worsening of the maxillo-mandibular dysmorphia related to surgery. The idea of associating Le Fort I osteotomy with a frontofacial monobloc advancement or Le Fort III osteotomy has already been described, mainly by Tessier and Obwegeser, however they probably achieved a complete Le Fort I osteotomy while we don't split the pterygoid plates. The patient's morphology and his surgical history determine the choice between Le Fort III and monobloc advancement. Dental occlusion needs to be taken into account for surgical indication.

Silent sinus syndrome: a mechanical theory.

We present the case of a progressive enophthalmos, 23 years after an orbital floor fracture treated conservatively. Imaging demonstrated orbital fat herniation into the pterygopalatine fossa and a collapse of the maxillary sinus walls. We hypothesise that some "silent sinus syndrome" might be caused by an aspiration phenomenon resulting from masticatory muscle movements.

Orbital morphology in exophthalmos and exorbitism.

BACKGROUND: Exophthalmos is a protrusion of the eyeball due to an increase in orbital contents in a normal bony orbit. Exorbitism is a protrusion of the eyeball due to a decrease in capacity of the orbital container, with a normal orbital content volume such as seen in a congenital form termed nonsyndromic exorbitism. High myopia can enhance proptosis. The purpose of this study was to provide values for orbital measurements from computed tomography and to suggest computed tomography criteria for nonsyndromic exorbitism. METHODS: Seventy-three computed tomography scans were collected (57 of Graves' ophthalmopathy and 16 of nonsyndromic exorbitism). Thirty-two scans from nonproptotic patients constituted a control series. Nine measurements and two indexes, performed on a reference axial computed tomography slice transecting the neuro-ocular plane, were obtained from each scan. RESULTS: The angle between the sagittal axis and the lateral orbital wall, as well as the width of the ethmoid bone (midinterorbital distance), was found to be more open in the nonsyndromic exorbitism population. A lateral orbital wall angle greater than or equal to 42 degrees and a midinterorbital distance greater than 30 mm were chosen as cutpoints. The association of these two criteria allowed the authors to obtain a sensitivity of 62 percent, a specificity of 78 percent, a positive predictive value of 80 percent, and a negative predictive value of 86 percent for nonsyndromic exorbitism. CONCLUSIONS: The different mechanisms of globe protrusion have to be taken into account before an orbital expansion/decompression procedure is planned. Only a preoperative morphological analysis of the orbital shape permits a precise analysis of the relative position of the ocular globe and orbital structures, in addition to clinical examination.

Orbitoblepharophimosis syndrome: a 16-year perspective.

The orbitoblepharophimosis syndrome is a congenital malformation of the orbitopalpebral region. It is an autosomal-dominant condition typified by palpebral and orbital phimosis, ptosis, epicanthus inversus with telecanthus, and enophthalmia. It has three forms: minor, major, and extreme. It is a rare malformation affecting both sexes. The gene responsible is 3q21-24. Surgical treatment involves three to four operations: orbital remodeling by burring and grafting (intraorbital and extraorbital), epicanthus correction, and ptosis operation. Results varied depending on the severity of the form and the quality of the tissues. The authors present a series of 50 patients who were treated for this syndrome over the past 16 years.