facial paralysis reconstruction

Mansoor Khan M.B.B.S

Plastic & Reconstructive Surgery, HMC, Peshawar

2011

Facial paralysis: aesthetically, functionally &

psychologically a devastating condition

17 paired & one unpaired muscle animate the face

18

Eye symptoms: dryness, excessive tearing, incomplete closure, outdoor discomfort, use of artificial

tears.

Nasal airway obstruction :

due to the paralysis of N & LN muscles and

the sagging of the cheek, forced

inspiration leading to collapse of the

nostril.

Oral symptoms: continence problems, speech.

Psychological status & level of difficulty to communicate (happiness, anger & sadness)

Examination:Brow, eye, upper, lower

lid, position of the inf.canalicular punctum,

corneal ulcerations, philtrum, depression of commisure, nasolabial

fold, sagging of the cheek.

Bells Phenomena

Snap test

Synkinesis: simultaneous

contraction of two or more muscle groups

which should not contract togather

Patients’ expectations/concerns: sort out the problem of the patients’ concern,

if you don’t correct that then the treatment is a failure

Aims: protect the eye, rest symmetry, provision of facial

movements (involuntary, independent & spontaneous facial

expression).

Goals of Eye Treatment:

maintain vision, protection, functional eyelids, cosmesis improvement, expression of

emotions

Goals of Mouth Treatment:

correction of the asymmetry, oral continence, speech improvement, provision of balance symmetrical

smile

The complete accomplishment of the

goals is difficult: the patient should be counseled

what are achievable expectations, the well informed patients are more likely to be satisfied what is achieved

Surgical management

Direct brow lift

Direct brow lift

Coronal Brow lift

Endoscopic Brow lift

Gold weight placement

Gold weight placement

Gold weight placement

Palpebral spring placement

Temporalis Muscle Transplantation

Tarsorrhaphy

Tendon sling placement

Horizontal lid shortening

Lateral canthorhaphy

Tow stage Microneurovascular muscle transplantation

Dissection of the facial nerve branches on the normal side

Mapping of the facial nerve branches

Mapping of the facial nerve branches

Sural nerve harvesting with a nerve stripper

Gracilis muscle harvesting

Placement and

anastomosis of the

pedicle

Placement and

anastomosis of the

pedicle

Temporalis & masseter muscle transplantation

Static tendon slings placement

Resection of the depressor labii inferioris of the normal side

Resection of the depressor labii inferioris of the normal side