Facial reanimation by muscle-nerve neurotization after facial nerve sacrifice. Case report.

INTRODUCTION: Recovering a certain degree of mimicry after sacrifice of the facial nerve is a clinically recognized finding. The authors report a case of hemifacial reanimation suggesting a phenomenon of neurotization from muscle-to-nerve. CLINICAL CASE: A woman benefited from a parotidectomy with sacrifice of the left facial nerve indicated for recurrent tumor in the gland. The distal branches of the facial nerve, isolated at the time of resection, were buried in the masseter muscle underneath. The patient recovered a voluntary hémifacial motricity. The electromyographic analysis of the motor activity of the zygomaticus major before and after block of the masseter nerve showed a dependence between mimic muscles and the masseter muscle. DISCUSSION: Several hypotheses have been advanced to explain the spontaneous reanimation of facial paralysis. The clinical case makes it possible to argue in favor of muscle-to-nerve neurotization from masseter muscle to distal branches of the facial nerve. It illustrates the quality of motricity that can be obtained thanks to this procedure. CONCLUSION: The authors describe a simple implantation technique of distal branches of the facial nerve in the masseter muscle during a radical parotidectomy with facial nerve sacrifice and recovery of resting tone but also a quality voluntary mimicry.

[Painful peripheral neuropathy associated with voriconazole during the treatment of chronic cavitary pulmonary aspergillosis]. / Neuropathie périphérique sous voriconazole au cours d'une aspergillose pulmonaire cavitaire chronique.

Chronic cavitary pulmonary aspergillosis requires a first-line prolonged treatment with itraconazole or voriconazole. We report a 71-year-old immunocompetent man with polyarteritis and history of multiple lung surgery procedures, who developed a peripheral axonal neuropathy 1 month after voriconazole therapy was started for a chronic cavitary pulmonary aspergillosis. After discontinuation of the treatment and a switch to posaconazole, the neuropathy partly improved. Three other cases of peripheral neuropathy with voriconazole have been already published, all reversible after voriconazole discontinuation.