The etiology of facial paralysis varies and the treatment must be chosen according to etiology (trauma, ablative operation, Bell's Palsy etc)
(3,10,20). There are two critical periods in the course of facial paralysis, in which the exact information on the pathologic state of the nerve is obtained: the first seven days and three months afterwards. For those cases with prolonged facial paralysis which have no clinical progress and clinical squeals become permanent within the first year of paralysis, should be considered as “Permanent Paralysis”
(21,23). .Facial paralysis may have a significant impact on the patient's emotional status, because of facial disfigurement and difficulties with eating and drinking in a social setting. Therefore, when this devastating situation occurs, early intervention and rehabilitation is important for these patients
(28).
Muscle Transfers:
Patients with prolonged paralysis, in whom the innervations of paralyzed musculature cannot be restored by nerve grafting, cross-face nerve transplantation etc(5) ; should be offered some form of reconstructive static and dynamic aid. Latter reconstructive techniques can be named as follows: static suspensions by fascia, dermis or silastic rubbers, stabilizations by dermal flaps, bone fixation or Marlex; facial or temporal lifting, surgical formations of folds and wrinkles (forehead, furrows, nasolabial folds)(15,24,27); control of antagonist muscles by neurectomy or myoectomy or Botox injections etc.(6,28).
Long- Standing facial paralysis requires the introduction of viable, innervated dynamic muscle to restore facial movement. The option include regional muscle transfer and microvascular free tissue transfer(5,17).
In prolonged Paralysis treatment with muscle transfer dynamic techniques make it possible to regain the lost movements. In 1908, Lexer defined muscle transposition for the first time. Since then, numerous variations of muscle transfer have been reported. In 1934 Gillies had the idea of lengthening the middle third of temporalis muscle by using a strip of the fascia lata(17). In 1949, McLaughlin described a method, using the whole muscle after sectioning the coronoid process and still using a strip of the fascia lata. Edgerton's technique utilized the anterior belly of the digastric muscle in 1967(9). In 1971, Horton transplanted sternocleidomastoid muscle(13). This historical progress revealed that the masseter muscle is best used to give motion to the lower half of the face and temporalis muscle transfer for the motion of upper half of the face(17).
Electrical Stimulation
Electrical stimulation, is used as an adjunct in the management of many disorders including neuromuscular, musculoskeletal, vascular and soft tissue injuries(12). Neuromuscular electrical stimulation of an area with deficits increases of contractile motions by providing proprioceptive, kinesthetic and sensory input. This modality can be used in the management of peripheral nervous system injuries such as Bell's palsy and other conditions that cause pain, weakness and immobility(7).
The goals of treatment are to reeducate a muscle to gain its normal function and to facilitate motion Studies in animal models have indicated that electrical stimulation of denervated muscles retards atrophy. Somia et. al. compared the effectiveness of single and cosmetically accepted eye blink. They established bilateral orbicularis oculi muscle paralysis in eight dog(25). Electrical stimulation has been used for gracilis muscle reeducation for reconstruction of neonatal sphincter(1). There is no study, electrical stimulation using in facial paralysis after muscle transfer.
From all these aspects of view, facial paralysis is a devastating disaster that turn ones face to a no mimic puppet and it should be treated by using any means of the management options. In this study, our aim was to assess the success of electrical stimulation that was administered at different stages of the course of the paralysis as a mean of co-treatment to functional muscle transfer surgery.
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