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.

Avaliação neurologica completa na neuropatia hanseniana / Complete neurologica assessment in Hansen´s disease

Dada a importância da afectação neurológica da Doença de Hansen, os autores tentam descrever neste artigo a forma de realizar uma exploração neurológica completa. Para efeito, são focados os pontos fundamentais desta prática, como a palpação e identificação dos nervos periféricos engrossados, o estudo da sensibilidade superficial e profunda, a exploração da mobilidade voluntária, o exame dos reflexos e a avaliação dos processos neutróficos secundários ao trauma. Devemos destacar que, na maioria das situações, para o diagnóstico da doença e fundamentalmente no trabalho de campo, realizaremos uma exploração baseada em todos estes pontos, embora muito mais simplificada. Como anexo do artigo serão apresentados os resultados obtidos com a exploração neurológica de 71 doentes controlados no Sanatório Fontilles.

Leprosy affects facial nerves at the main trunk: neurolysis can possibly avoid transfer procedures.

The predilective sites of lesions in leprous peripheral nerves are well established, and their surgical decompression is common practice when sensorimotor disorders persist after medication. By contrast, the precise localization of leprous facial neuropathy still remains unclear, and musculofascial transfers have been the only type of surgical treatment. The goal of this study was to clarify where leprosy affects facial nerves and to determine whether neurolysis might suffice to restore facial function. In five Indian and two Egyptian patients suffering from leprous facial neuritis, the nerves were stimulated transcranially at the brainstem to evoke efferent motor nerve action potentials, which were recorded from the exposed nerves. Lesions were detected at the main trunk proximally from the first bifurcation in all cases. Epineuriotomy revealed fibrosis of the interfascicular epineurium in all instances, as an indication for interfascicular neurolysis. One patient was able to close his eye and showed a better smile soon after surgery. After 16 and 21 months, respectively, one patient had improved distinctly, two patients slightly, two patients showing no progress, and two patients were lost to follow-up. It is concluded that (1) leprous facial neuropathy is located at the main trunk close to the first bifurcation and not exclusively at the peripheral zygomatic branches, (2) microsurgical neurolysis can be considered in leprous facial neuropathy before transfer procedures as long as voluntary or spontaneous activity is present in the affected muscles, and (3) intraoperative transcranial electrical stimulation is an effective means of localizing the site and proximal extent of leprous facial neuropathy.