facial reanimation surgery

1. Facial Reanimation Surgery

3. ACUTE FACIAL PARALYISIS
(<3WEEKS)
INTERMEDIATE DURATION NERVE
PARALYSIS (3WEEKS – 2YEARS)
CHRONIC FACIAL PARALYSIS (>2
YEARS)
FACIAL NERVE DECOMPRESSION CROSS FACE NERVE GRAFTING REGIONAL MUSCLE TRANSFERS
TRANSMASTOID
MIDDLE FOSSA
TRANSLABYRINTHINE
TEMPORALIS
MASSETER
DIGASTRIC
FACIAL NERVE REPAIR
-PRIMARY
-CABLE GRAFT
NERVE TRANSFERS
-HYPOGLOSSAL
-MESSTERIC
-SPINAL ACCESSORY
FREE MUSCLE TRANFER
- GRACILLIS
- SERATOUS ANTERIOR
- LATISMOUS DORSI
- PEC MINOR

4. Classification
• Neural Methods:
• Facial nerve decompression
• Nerve grafts (to overcome gaps)
• Cross fascial nerve grafting
• Nerve transfers
• Hypoglossal to facial
• Spinal accessory to facial
• Mandibular to facial
• Musculofascial transposition
• Prosthetics

5. DYNAMIC STATIC
NERVE GRAFTING SLINGS
MUSCLE TRANSFER GOLD WEIGHT
- REGIONAL
- FREE FLAP
TARSORRHAPHY
LOWER LID SHORTENING

6. • IMMIDIATE
• WITHIN 3 weeks

7. FACIAL NERVE DECOMPRESSION
• TRANSMASTOID APPROACH : when trauma is localized to tympanic or
mastoid segments, 180 degree.
• MIDDLE FOSSA APPROACH : when injury extends to labyrinthine
segments, may be used with transmastoid approach ,
• Translabyrinthine approach: for entire intratemporal course , where
cochleovestibular function is absent.

8. DIRECT NERVE REPAIR
• best return of facial nerve function
• should be tension free

9. NERVE GRAFTING
GREAT AURICULAR N
SURAL N
when a tension-free primary nerve repair is
not possible
generally accepted that the best possible outcome
is House-Brackmann Grade III facial function

10. Intermediate duration (3 months – 2 years )
• Intermediate duration facial paralysis typically occurs in the setting of
an anatomically intact facial nerve that has not recovered well.
• EG  facial paralysis after acoustic neuroma surgery in which the
nerve is often intact but can have poor recovery due to stretch injury.
• Nerve transfers and nerve crossover procedures are typically the
treatment of choice in this period as the native facial musculature is
still viable

11. • Best outcomes from cross facial nerve grafting are if the period of
denervation is less than 6 months

12. DIRECT NERVE TRANSFER

13. CROSS FACIAL NERVE GRAFTING
• A nerve graft that acts as motor
conduit from the normal side to
opposite side
• Options
• Single contralateral branch to
distal nerve anastomosis
• Multiple anastomosis from
segmental branches to segmental
branches

14. CHRONIC FACIAL PARALYSIS (>2 years )
• In most cases of chronic facial paralysis of greater than 2 yr duration,
the native facial musculature has atrophied and requires the use of
alternative muscles for facial reanimation.

15. Dynamic transfers
• Local muscle transposition
• Free flap

16. Free muscle transfer
• Two steps
• First step – cross face nerve graft
• Second stage – muscle transfer
after 9-12 months

17. STATIC FACIAL REANIMATION
• Used for suspension of forehead, eyelids, nares , oral commisures
• Autologous material
• Tensor fasciae lata
• Temporalis fascia
• Synthetic material

21. Adjuvant procedures
• Soft tissue procedures to improve asymmetry
• Rhytidectomy
• Excision of redundant oral mucosa
• Brow lift
• Procedures for drooling
• Submandibular gland resection with parotid duct ligation
• Modification of normal side to improve symmetry
• Neurectomy
• myectomy