Modified procedure for secondary facial rehabilitation following total bilateral irreversible peripheral facial palsy.

We present the case of a middle-aged gentleman who developed total bilateral irreversible peripheral facial palsy over a period of 10 years, starting with palsy of the marginal mandibular and buccal branches of the facial nerve and progressing to the zygomatic and temporal branches. The patient did not develop any other neurological symptoms, and all neurological and other tests have remained negative over the last 10 years. Dripping of saliva and inability to close the mouth necessitated reanimation of the perioral region with the help of a fascia lata graft fixed to the fascia of the masseter muscles. The increasing lagophthalmos and associated eye problems were alleviated with a temporal muscle transposition combined with a lengthening procedure using the temporal fascia, passed through the upper and lower eyelids and hooked around the medial canthal ligament. The fascia strips were sutured not to the canthal ligament itself, but to each other, thereby placing equal self-adjusted tension on the upper and lower eyelids. Both operations were successful and improved eating and eye closure functions, allowing resolution of the eye symptoms.

[Parotid gland Warthin's tumor combined with actinomycosis]. / Actinomycosissal kombinált, parotisban elhelyezkedo Warthin-tumor ritka esete.

The authors describe the diagnostic problems and difficulties of treatment of Warthin's tumor combined with actinomycosis. A 48-year-old woman was presented with a mass in the left parotid region and paresis of the lower left palpebra. The CT, echography, parotid X-ray findings supposed a neoplasm of the left parotid gland which was proved by intraoperative freezing histology. The ramus of the mandible was involved in the process. Total parotidectomy and partial mandiblectomy were performed, with sacrifice of the facial nerve, followed by nerve reconstruction. The final histological evaluation was Warthin's tumor with actinomycosis. Eight years after treatment the patient is free of disease.