facial paralysis reconstruction
TRANSCRIPT
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FACIAL PARALYSIS RECONSTRUCTION
BOBBY SWADHARMA PUTRA (BSP)Surabaya, 28 Februari 2011
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
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Klasifikasi
Berdasarkan penyebab :► Kongenital► Trauma► Infeksi ► Neoplasma► Idiopatik► Toxic► Iatrogenik
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Berdasarkan anatomi :• Extratemporal• Intratemporal• Intracranial
Berdasarkan sisi wajah yang terkena : Bilateral Unilateral
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Anatomi
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18 paired muscle animate the face
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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
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Eye symptoms: dryness, excessive tearing, incomplete closure, outdoor discomfort, use of artificial
tears.
Pemeriksaan Fisik
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Snap test
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Nasal airway obstruction :
due to the paralysis muscles and the sagging of the cheek, forced inspiration leading to collapse of the
nostril.
12Oral symptoms: continence problems, speech.
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Psychological status & level of difficulty to communicate (happiness, anger & sadness)
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Examination:Brow, eye, upper, lower
lid, position of the inf.canalicular punctum,
corneal ulcerations, philtrum, depression of commisure, nasolabial
fold, sagging of the cheek.
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Synkinesis: simultaneous
contraction of two or more muscle groups
which should not contract togather
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Pemeriksaan fisik dimulai dengan meminta pasien
mengangkat alis, menutup mata, tersenyum, dan mengerucutkan bibir.
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
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Tatalaksana
► Non surgical
Sering diterapkan untuk kelainan pada mata,
seperti lid taping, eye lubrication, eye patches
Melatih pergerakan otot wajah (rehabilitasi
medik)
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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
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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
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Alis
►Direct Incision►Insisi koronal►Endoscopic Brow Lift
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Direct brow lift
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Direct brow lift
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Coronal Brow lift
Endoscopic Brow lift
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Kelopak Mata Atas
►Lid Loading (gold prothese)►Pemasangan Palpebral Spring►Transfer m. temporalis►Free Platysma transfer
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Lid Loading
Early technique– Incision in the supratarsal crease– Subcutaneous pocket – Insert weight– Close skin
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Gold Weight
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Surgical Procedures
Gold weight implant-placed beneath levator
aponeurosis
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Gold Weight
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Gold Weight Placement
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Combination of Gold Weight and Lower Lid Shortening
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Combination of Gold Weight and Lower Lid Shortening
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Platinum Chain
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Palpebral Spring
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Kelopak Mata Bawah
►Static Sling►Cartilage graft to
tarsal plate jarang dilakukan
►Wedge Incision
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Tendon sling placement
37Horizontal lid shortening
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Lower lid shortening– Wedge excision with
lateral canthopexy– Used in combination
with gold weight implantation
39Temporalis Muscle Transplantation
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Tarsorrhaphy
41Lateral canthorhaphy
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Nasal
►Elevasi ala nasi, kemudian dilakukan pemasangan sling dari tendon.
►Septoplasty bila perlu
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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
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Regional Muscle Transfer
M. temporalis M. masseter
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Free muscle transplantation
Free muscle transplantation
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Cross Facial Nerve Graft
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Bibir Bawah
► Reseksi otot m. depressor labii inferior
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Resection of the depressor labii inferioris of the normal side
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Resection of the depressor labii inferioris of the normal side
Algoritma
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Surgical management
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Tow stage Microneurovascular muscle transplantation
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Dissection of the facial nerve branches on the normal side
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Mapping of the facial nerve branches
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Mapping of the facial nerve branches
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Sural nerve harvesting with a nerve stripper
58Gracilis muscle harvesting
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Placement and
anastomosis of the
pedicle
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Placement and
anastomosis of the
pedicle
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Temporalis & masseter muscle transplantation
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Static tendon slings placement
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
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TERIMA KASIH