facial paralysis reconstruction

64
FACIAL PARALYSIS RECONSTRUCTION BOBBY SWADHARMA PUTRA (BSP) Surabaya, 28 Februari 2011 1

Upload: bobbykayla

Post on 24-Oct-2014

60 views

Category:

Documents


10 download

TRANSCRIPT

Page 1: Facial Paralysis Reconstruction

1

FACIAL PARALYSIS RECONSTRUCTION

BOBBY SWADHARMA PUTRA (BSP)Surabaya, 28 Februari 2011

Page 2: Facial Paralysis Reconstruction

Pendahuluan

► Facial paralysis adalah kondisi dimana terjadi deformitas disebabkan paralisis struktur pada wajah yang diinervasi oleh n. facialis.

► Not an aesthetic issue Functional disability

► Pada otot wajah fungsi yang bisa terganggu adalah proteksi mata, jalan nafas, fungsi makan dan berbicara

2

Page 3: Facial Paralysis Reconstruction

Klasifikasi

Berdasarkan penyebab :► Kongenital► Trauma► Infeksi ► Neoplasma► Idiopatik► Toxic► Iatrogenik

3

Berdasarkan anatomi :• Extratemporal• Intratemporal• Intracranial

Berdasarkan sisi wajah yang terkena : Bilateral Unilateral

Page 4: Facial Paralysis Reconstruction

4

Anatomi

Page 5: Facial Paralysis Reconstruction

5

Page 6: Facial Paralysis Reconstruction

6

18 paired muscle animate the face

18

Page 7: Facial Paralysis Reconstruction

7

Page 8: Facial Paralysis Reconstruction

Pemeriksaan Klinis► Anamnesa

Keluhan pada mata seperti mata kering atau air

mata berlebihan, kelopak mata tidak bisa menutup

Keluhan pada nasal airway

Bentuk mulut yang tidak simetris, gangguan bicara

8

Page 9: Facial Paralysis Reconstruction

9

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

tears.

Pemeriksaan Fisik

Page 10: Facial Paralysis Reconstruction

10

Snap test

Page 11: Facial Paralysis Reconstruction

11

Nasal airway obstruction :

due to the paralysis muscles and the sagging of the cheek, forced inspiration leading to collapse of the

nostril.

Page 12: Facial Paralysis Reconstruction

12Oral symptoms: continence problems, speech.

Page 13: Facial Paralysis Reconstruction

13

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

Page 14: Facial Paralysis Reconstruction

14

Examination:Brow, eye, upper, lower

lid, position of the inf.canalicular punctum,

corneal ulcerations, philtrum, depression of commisure, nasolabial

fold, sagging of the cheek.

Page 15: Facial Paralysis Reconstruction

15

Synkinesis: simultaneous

contraction of two or more muscle groups

which should not contract togather

Page 16: Facial Paralysis Reconstruction

16

Pemeriksaan fisik dimulai dengan meminta pasien

mengangkat alis, menutup mata, tersenyum, dan mengerucutkan bibir.

Page 17: Facial Paralysis Reconstruction

Tatalaksana►Secara umum bertujuan :

Proteksi mata

Mengembalikan posisi simetri wajah

Mengembalikan fungsi gerakan wajahEkspresi wajah ( senyum )

Konseling pasien diperlukan oleh karena

sulit mengembalikan semua fungsi dan

bentuk wajah seperti semula

17

Page 18: Facial Paralysis Reconstruction

Tatalaksana

► Non surgical

Sering diterapkan untuk kelainan pada mata,

seperti lid taping, eye lubrication, eye patches

Melatih pergerakan otot wajah (rehabilitasi

medik)

18

Page 19: Facial Paralysis Reconstruction

Tatalaksana► Surgical Treatment

Alis : Direct brow lift, coronal brow lift, endoscopic brow lift

Kelopak mata atas (lagophtalmus) : Gold weight, temporalis transplantation, spring, tarsoraphy

Kelopak mata bawah (ektropion) : Tendon sling, lateral canthoplasty, horizontal lid shortening, termporalis lid transplatation, cartilage graft

19

Page 20: Facial Paralysis Reconstruction

20

Surgical Treatment

Nasal airway : Static sling, alar base elevation, septoplasty

Bibir atas & pipi:Muscle transplantation with use of ipsilateral 7th nerve, cross facial nerve graft, or other cranial nerve for motor inervation, temporalis transplantation with or without masseter transplantation, static sling, soft tissue balancing procedure

Bibir bawah :Depressor labii inferioris resection, muscle transplantation (digastric platysma ), wedge excision

Page 21: Facial Paralysis Reconstruction

21

Alis

►Direct Incision►Insisi koronal►Endoscopic Brow Lift

Page 22: Facial Paralysis Reconstruction

22

Direct brow lift

Page 23: Facial Paralysis Reconstruction

23

Direct brow lift

Page 24: Facial Paralysis Reconstruction

24

Coronal Brow lift

Endoscopic Brow lift

Page 25: Facial Paralysis Reconstruction

25

Kelopak Mata Atas

►Lid Loading (gold prothese)►Pemasangan Palpebral Spring►Transfer m. temporalis►Free Platysma transfer

Page 26: Facial Paralysis Reconstruction

26

Lid Loading

Early technique– Incision in the supratarsal crease– Subcutaneous pocket – Insert weight– Close skin

Page 27: Facial Paralysis Reconstruction

27

Gold Weight

Page 28: Facial Paralysis Reconstruction

28

Surgical Procedures

Gold weight implant-placed beneath levator

aponeurosis

Page 29: Facial Paralysis Reconstruction

29

Gold Weight

Page 30: Facial Paralysis Reconstruction

30

Gold Weight Placement

Page 31: Facial Paralysis Reconstruction

31

Combination of Gold Weight and Lower Lid Shortening

Page 32: Facial Paralysis Reconstruction

32

Combination of Gold Weight and Lower Lid Shortening

Page 33: Facial Paralysis Reconstruction

33

Platinum Chain

Page 34: Facial Paralysis Reconstruction

34

Palpebral Spring

Page 35: Facial Paralysis Reconstruction

35

Kelopak Mata Bawah

►Static Sling►Cartilage graft to

tarsal plate jarang dilakukan

►Wedge Incision

Page 36: Facial Paralysis Reconstruction

36

Tendon sling placement

Page 37: Facial Paralysis Reconstruction

37Horizontal lid shortening

Page 38: Facial Paralysis Reconstruction

38

Lower lid shortening– Wedge excision with

lateral canthopexy– Used in combination

with gold weight implantation

Page 39: Facial Paralysis Reconstruction

39Temporalis Muscle Transplantation

Page 40: Facial Paralysis Reconstruction

40

Tarsorrhaphy

Page 41: Facial Paralysis Reconstruction

41Lateral canthorhaphy

Page 42: Facial Paralysis Reconstruction

42

Nasal

►Elevasi ala nasi, kemudian dilakukan pemasangan sling dari tendon.

►Septoplasty bila perlu

Page 43: Facial Paralysis Reconstruction

43

Bibir & PipiRekonstruksi dibagi 2 : Static pemasangan sling (fascia, tendon,

goretex) Dynamic pemindahan otot :

Regional : temporalis, masseterCross facial nerve graftcoaptation to masseter motor

branch

- Free muscle transplantation

Page 44: Facial Paralysis Reconstruction

44

Regional Muscle Transfer

M. temporalis M. masseter

Page 45: Facial Paralysis Reconstruction

45

Free muscle transplantation

Page 46: Facial Paralysis Reconstruction

Free muscle transplantation

46

Page 47: Facial Paralysis Reconstruction

Cross Facial Nerve Graft

47

Page 48: Facial Paralysis Reconstruction

48

Bibir Bawah

► Reseksi otot m. depressor labii inferior

Page 49: Facial Paralysis Reconstruction

49

Resection of the depressor labii inferioris of the normal side

Page 50: Facial Paralysis Reconstruction

50

Resection of the depressor labii inferioris of the normal side

Page 51: Facial Paralysis Reconstruction

Algoritma

51

Page 52: Facial Paralysis Reconstruction

52

Surgical management

Page 53: Facial Paralysis Reconstruction

53

Tow stage Microneurovascular muscle transplantation

Page 54: Facial Paralysis Reconstruction

54

Dissection of the facial nerve branches on the normal side

Page 55: Facial Paralysis Reconstruction

55

Mapping of the facial nerve branches

Page 56: Facial Paralysis Reconstruction

56

Mapping of the facial nerve branches

Page 57: Facial Paralysis Reconstruction

57

Sural nerve harvesting with a nerve stripper

Page 58: Facial Paralysis Reconstruction

58Gracilis muscle harvesting

Page 59: Facial Paralysis Reconstruction

59

Placement and

anastomosis of the

pedicle

Page 60: Facial Paralysis Reconstruction

60

Placement and

anastomosis of the

pedicle

Page 61: Facial Paralysis Reconstruction

61

Temporalis & masseter muscle transplantation

Page 62: Facial Paralysis Reconstruction

62

Static tendon slings placement

Page 63: Facial Paralysis Reconstruction

Daftar Pustaka

Leedy, E. Jason : Facial Reanimation. Essentials of Plastic Surgery. QMP Publishing. 2007; 347-361

Neligan, C. Peter; Zuker, M.Ronald : Facial Paralysis Reconstruction. Grabb & Smith’s Plastic Surgery 6th edition. Lippincott Williams & Wilkins. 2007; 417-427

Zuker, M.Ronald ; Manktelow, T. Ralph; Hussain, Gazi : Facial Paralysis. Mathes’ Plastic Surgery Volume 3. 2006; 883-915

63

Page 64: Facial Paralysis Reconstruction

64

TERIMA KASIH