The device, designed by STT Engineering & Systems of Donostia-San Sebastian and adapted for use by the Plastic Surgery service at the Hospital for facial applications, has received the 2004 Award in the Innovative Projects Competition for Young Entrepreneurs for Transference of Research Results (Ideactiva Gaztempresa). The device captures and quantifies facial movement in three dimensions by means of three infrared cameras and software that processes facial movements before and after reconstruction. In this way, an exact method for measuring and evaluating the various parameters has been devised: angles, the speed of the spreading movement by facial muscles at the corners of the mouth, etc. Moreover, apart from analysing the outcome of surgery, this image-capturing system for facial movements also helps in programming the actual surgical operation. The parameters for the angle and the spreading movement of the risorious muscle that provokes the normal smile are chosen. On carrying out the muscular transplant, the surgeons have to follow the criteria calculated for the facial parameters in such a way that symmetry is established with the healthy side of the face. All this data is studied with this device and provides information for planning the treatment.
Apart from its clinical application, this system provides a highly important tool in the legal field. It can be used as very useful tool in investigations to quantify damage caused by workplace and traffic accidents, given that the degree of injury and muscular contraction can be quantified objectively and with exactitude.
Facial Paralysis is a relatively frequent pathology (each year there are nine new cases per 100,000 inhabitants), its origin being diverse such as, for example, obstetric, congenital, pharmacological, auto-immune, traumatic, surgical, and so on.
Its surgical repair treatment can be carried out by static or dynamic techniques. A static technique is suitable for patients over 70. In general it consists of re-suspending the fallen part of the face with the patient's own tendons or aloplastic material. The patient cannot move the face but has the benefit of very acceptable results in rest mode situations as well as improving nasal respiration, ocular closing and buccal closing.
Novel microsurgical programme
Since Navarre University Hospital designed this novel therapeutic microsurgical programme for treating facial paralysis through dynamic techniques with cruciate facial inserts and muscle transplants, some fifty patients have been treated, the largest series in the state. If the face muscles have been enervated due to the injury, their movement may be recovered over a period of two years maximum, without atrophying. If more time transpires, the facial musculature atrophies and other reconstruction techniques are necessary. Over periods less than 24 months nerve transfers of the healthy contralateral facial nerve are used by means of nerve inserts. With this system, the patient can move the face at will.
Facial paralysis frequently lasts for more than two years and, thus, healthy facial musculature does not exist. In these cases new techniques are applied. These involve the implanting into the face of a muscle from another part of the body. Normally the leg recto interno or the wide dorsal muscle is used as these have considerable contractile power and achieve a highly acceptable spreading movement at the mouth corners. The patient may move her or his face spontaneously with highly acceptable symmetry, despite having been affected by the paralysis over a long period.