Facial Paralysis, Modification to Labbé Technique

Abstract

Background: Facial paralysis is one of the conditions that affect functionally, emotionally and aesthetically to patients greatly. Multiple techniques have been described for its treatment, and we consider that Labbé's technique is the one that most surprises with its results.

Materials and methods: In the Specialty Hospital "Dr. Bernardo Sepúlveda" National Medical Center Century XXI (CMN SXXI), Mexican Institute of Social Security (IMSS), three cases are presented: patients with facial paralysis due to trauma, surgical damage on the VII cranial nerve and conditions due to otological and idiopathic infections. Four modifications to the original Labbé technique are proposed to execute it more easily: trans-zygomatic oblique osteotomy, to reach directly the coronoid process; osteotomy of the descending coronoid; radiated suture fixation at 180° for temporary muscle replacement with positional replacement of the sutures trans-operatively; and the next day of the intervention with the patient awake, fixation of the orbicularis muscle of the lips, to the temporal tendon previously referenced. The modifications and results obtained are shown.

Results: The modifications offer a better surgical technique and very favorable results.

Conclusions: The modification to Labbé technique gives excellent results in the treatment of permanent facial paralysis, improving facial symmetry, salivary incontinence, facial tone, improving speech, giving the patient movement on the affected side and the ability to smile again.

Keywords: Facial paralysis; Labbé; Modification to Labbé technique; Modifications; Paralysis; Technique; Temporal.

Fig. 1

Multiple treated patient with different surgical alternatives

Fig. 2

a Coronal approach. b Exposure of the malar and zygomatic arch

Fig. 3

The modification of the Labbé technique, an enlarged osteotomy of the malar to directly access the coronoid process

Fig. 4

a Temporal muscle dissection. b Thanks to the wide osteotomy of the malar, the coronoid process is easily reached, resulting in access to the temporal tendon

Fig. 5

a Coronoids with the tendon toward the oral commissure. b Placing interlaced sutures between the tendon of the temporal muscle and the orbicularis muscle of the lips. c Referenced sutures

Fig. 6

Sutures radially toward the pericranium, the zygomatic and frontal process. Note also the anterior and posterior osteosynthesis of the zygoma

Fig. 7

a Postoperative result with excellent correction and adequate lip competence. b Complete consolidation of the malar osteotomy

Fig. 8

a Presurgical view of the patient, b 6-month postoperative patient, c placement of the gold eyelid weight to correct the lagoftalm, d right eyelid closure after the weight is placed, e 1-year postsurgical control tomography

Fig. 9

a Patient presurgical view and b postsurgical control