Post on 15-Dec-2014
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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