Outcomes of direct muscle neurotisation in adult facial paralysis.

Fifty-seven adult patients with facial paralysis, who underwent direct muscle neurotisation, were reviewed and divided into three categories depending on the function that direct neurotisation was aiming to augment. Group 1 included 30 patients who underwent direct neurotisation for eye closure and blink, group 2 consisted of 23 patients for smile augmentation, and group 3 comprised 31 patients for depressor. The age of the patients ranged from 21 to 74 years. Denervation time (Dt) ranged from 8 months to 42 years. Eight patients had partial facial paralysis, and 49 patients had complete facial paralysis. The results were based on the functional and electromyography (EMG) scoring of the neurotised muscles showing an overall EMG mean improvement of 26.56% in eye closure, 34.47% in smile restoration and 32.67% in depressor function by the procedure. Median improvement in all facial functions was one grade (25%) in theTerzis grading systems regarding the respective facial functions. The prerequisites are Dt less than 6 months and a functional contralateral facial nerve. In cases where Dt is more than 27 months and preoperative EMG's are silent, a free or pedicled muscle should be used to substitute the denervated native facial muscle. Promoting expressivity and augmenting facial muscle function using direct muscle neurotisation are important components in facial reanimation.