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Facial paralysis reconstruction
 

Facial paralysis reconstruction

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facial paralysis in functionally, aesthetically and psychologically devastating condition.

facial paralysis in functionally, aesthetically and psychologically devastating condition.

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    Facial paralysis reconstruction Facial paralysis reconstruction Presentation Transcript

    • Plastic & Reconstructive Surgery, HMC, Peshawar
      2011
      Mansoor Khan M.B.B.S
    • Facial paralysis: aesthetically, functionally & psychologically a devastating condition
    • 18
      17 paired & one unpaired muscle animate the face
    • 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.canalicularpunctum, 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 labiiinferioris of the normal side
    • Resection of the depressor labiiinferioris of the normal side