md-medicaldata

Authors

 

Saša Jović¹, Miroslav Broćić¹, Srboljub Stošić¹, Denis Brajković², Milan Tešić¹, Gordana Anđelić <sup>3

1</sup>Military Medical Academy, Clinic for Maxillofacial surgery
²University Clinical Centar of Vojvodina, Clinic for Maxillofacial surgery
³Military Medical Academy, Institute of Medical Research

 

UDK: 616.833.17-009.11

The paper was received / Rad primljen: 03.02.2020.

Accepted / Rad prihvaćen: 07.02.2020.

 

Correspondence to:

Dr Milan Tešić
Vojno Medicinska Akademija
Crnotravska 17, 11000 Beograd
e-mail: dr.milantesic@gmail.com

 

Conflicts of interest
The authors declare that there are no conflicts of interest.

 

Abstract

 

Introduction: Traumatic injuries of the peripheral facial nerve fibers result in the paralysis of the mimic muscles which could be devastating to the patients. The clinical presentation of the facial nerve injury depends on the portion of the injured nerve. During the first 72 hours after the trauma, direct neurosutura of the identified nerve ends results in the best overall restoration of the nerve function. Case report: The male patient was admitted to the Emergency room for the cutting wound in the right parotidomasseteric area. Clinical examination revealed the impaired facial expression due to the palsy of the marginal and buccal branches of the right facial nerve. The patient was submitted to the urgent surgery in general anesthesia. The wound was surgically explored, proximal and distal ends of the cut off main buccal branches and the marginal branch of the right facial nerve were detected, and end-to-end facial nerve anastomosis was admitted using 8-0 polyglactin sutures under microscopic or direct visualization. Five months after the trauma function of the right facial nerve was almost completely restored, and just discrete paresis of the right marginal branch was monitored Conclusion: A direct end-to-end anastomosis of the transected proximal and distal ends of facial nerve, provide the best overall opportunity for restoration of facial expression.

 

 

Key words:

facial nerve injury, Post-traumatic facial palsy, House–Brackmann grading, nerve transaction, neurosuture

 

 

Sažetak

 

Uvod: Traumatske povrede perifernih vlakna facijalnog nerva rezultuju paralizom mimičnih mišića koja je zbog uloge mimike u svakodnevnoj komunikaciji jako teška po pacijente. Klinička slika povrede facijalnog nerva zavisi od mesta povređenog nerva. U prvih 72 sata nakon traume, identifikacija nervnih krajeva i direktna neurosutura rezultuje optimalnom rehabilitacijom nervne funkcije. Prikaz slučaja: Muški pacijent je primljen u Centar za hitnu pomoć zbog rasekotine u desnom parotidomasetičkom području. Klinički pregled pokazao je poremećaj mimike usled paralize marginalnih i bukalnih grana desnog facijalnog živca. Pacijent je hitno operisan u opštoj anesteziji. Rana je hirurški eksplorisana, a detektovani su i proksimalni i distalni završeci rasečenih bukalnih i marginalnih grana facijalnog nerva nakon čega je učinjena direktna neurosutura. Pet meseci nakon traume, funkcija desnog facijalnog nerva je gotovo potpuno rehabilitovana uz prisutnu diskretnu parezu desne marginalne grane. Zaključak: Direktna anastomoza presečenih proksimalnih i distalnih krajeva facijalnog nerva obezbeđuje najbolju opštu šansu za rehabilitaciju funkcije nerva.

 

 

Ključne reči:

povreda ličnog živca, posttraumatska paraliza lica, House-Brackmann skala, transekcija nerva, neurosutura

 

 

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PDF Jović S. et al • MD-Medical Data 2020;12(1): 037-039