顔面神経麻痺治療におけるface－liftingの役割 異常共同運動の治療を中心に

摘要

Acute unilateral facial paralysis such as Bell's palsy and Hunt syndrome is mostly a benign neurologic condition that mostly resolves in a few months. However, incomplete return of facial motor function continues to he long-term sequela in a percentage of patients. Patients with incomplete facial paralysis sometimes endure and adapt to cosmetic sequelae rather than functional problems such as lagophthal-mos. There is a narrow palpebral fissure and deep nasolabial fold at rest, both of which are probably-caused by muscle contracture producing facial asymmetry. Synkinesis, which mainly includes involuntary closure of the eyes while whistling or smiling, is always a big annoyance to patients. To overcome these problems, we employ face lifting to acquire facial symmetry. Furthermore, to reduce aberrant movements of the facial muscles, we use selective neurectomy and myectomy. The purpose of this paper is to present our surgical techniques and results of treatment of incompletely paralyzed face.By a face lift incision, a cheek pocket is created and the pars orbitalis of the orbicularis oculi muscle in the lateral orbital rim region where the zygomatic branches run through is dissected. A small volume of orbicularis oculi muscle including the zygomatic branches is then resected. Since a slight drooping of the cheek is seen in most patients, cheek skin is lifted up by fixing the SMAS plane upwards. In case of patients whose nasolabial fold is rather deep, a subcutaneous plane is cut by a steel wire with lipoinjection to make the nasolabial fold shallow and inconspicuous.Synkinetic movement was reduced in most cases, and an additional face lift operation and the use of steel wire improved the cosmetic results.