If the injured facial nerve does not heal after 1 to 1.5 years, or if the nerve is not surgically repaired within this period, the mimetic musculature is usually so weakened that it cannot be restored. However, these cases are not hopeless: in older patients from about 75 years, static suspensions and muscle replacement operations can achieve considerable improvements in function and aesthetics.

Surgical procedures to restore the dynamics of the face can be performed simultaneously by rearranging still functioning muscle groups in the face. This can be used to successfully reconstruct partial functions of the facial expression of a completely or partially paralyzed half of the face.

Temporalis muscle transfer

With muscle rearrangements of certain muscle groups of the masticatory musculature, for example, functionally significant facial movements such as closing of the eyes and controlling the corner of the mouth to laugh and smile can be restored without impairing the masticatory function. The success of regained dynamic function and symmetry is already noticeable for the patient immediately after the operation.

Prior to surgery, this 85-year-old patient demonstrated massive asymmetry with a completely paralyzed right eye closure. In addition, a strongly drooping lower eyelid on the right and flaccid cheek tissue are visible. A loss of the facial nerve after tumor resection (acoustic neuroma surgery) led to chronic facial paralysis due to the loss of the entire mimetic musculature on the right side (left picture). Middle picture: Immediately after the reconstruction operation with a muscle rearrangement of the masticatory musculature (Gillies-McLaughlin or Labbe operation), the patient is able to close the right eye completely arbitrarily. Right picture: In addition to a clear gain in symmetry, the patient can produce an active smile after the operation and is strengthened in her social function.

Temporalis muscle (temporal muscle, musculus temporalis)

Source: www.anatomynext.com

The temporal muscle is one of four essential masticatory muscles. It is a strong muscle. When chewing, as seen here in a good friend of the author, its contours are sometimes clearly visible. Parts of the Temporalis muscle are suitable for the restoration of an spontaneous eye closure (modified Gillies operation). The tendon of the entire muscle is used in the modified McLaughlin or Labbé operation to control the corner of the mouth. However, the patient does not have to expect reduced chewing function on this side, as the remaining chewing muscles compensate the function very well.