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LEPROSY AFFECTS FACIAL NERVES IN A SCATTERED DISTRIBUTION FROM THE MAIN TRUNK TO ALL PERIPHERAL BRANCHES AND NEUROLYSIS IMPROVES MUSCLE FUNCTION OF THE FACE

Current literature rejects nerve release in leprous facial neuropathy and states that lesions are restricted to the peripheral zygomatic branches. Since there are approximately 500,000 patients with this disease throughout the world, we wanted to clarify the precise location of facial nerve’s affection and the benefit of neurolysis. Our study showed that in patients with leprosy, the facial nerve’s main trunk, the peripheral zygomatic branches, and all other branches were affected. Follow-up showed improvement in lagophthalmos and in misreinnervation, with no improvement in the control cohort. Nerve release improves muscle function in leprous facial neuropathy, provided surgery is performed on all affected segments. Intraoperative electroneurodiagnostics is an effective tool for detecting the most proximal site of lesion and ensuring effective surgery.

Received April 28, 2002. Accepted for publication August 5, 2002.

Acknowledgments: We thank Dr. G. Cruccu (Rome, Italy) who helped us develop the new stimulation technique, and Professor Suresh Tambwekar (Bombay, India) for his suggestions, which led to the implementation of the study. We also thank Professor T. Lion (Vienna) and Professor M. Rotter (Vienna) for carefully revising the manuscript.

Financial support: The study was supported by the Medical School of Vienna, Austria, Zeneca, Inc., EMS (Nicolett), Inc., Smith-Kline Beecham, Inc., Novartis, Inc., KCI-Medicus Inc., Immuno, Inc., and an International Nepal Fellowship.

Authors’ addresses: Edvin Turkof, Abteilung für Plastische Chirurgie, Universitätsklinik für Chirurgie, AKH Wien, Währinger Gürtel 18-20, A-1090 Vienna, Austria, Telephone: 43-1-40400-5620, Fax: 43-1-409-1057, E-mail: edvin{at}turkof.com. Bruce Richard and Bharat Khatri, Green Pasture Hospital, Pokhara, Nepal. Ojan Assadian, Division for Clinical Microbiology, Clinical Institute of Hygiene and Medical Microbiology of the University of Vienna, Vienna General Hospital, Vienna, Austria. Erich Knolle, Division of Anesthesia B, Department of Anesthesiology, Vienna General Hospital, Vienna, Austria. Sebastian Lucas, Department of Histopathology, Division of Clinical Laboratory Sciences, Guy’s, King’s and St. Thomas School of Medicine, London, United Kingdom.