Facial paralysis reconstruction

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facial paralysis in functionally, aesthetically and psychologically devastating condition.

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Facial paralysis reconstruction

  1. 1. Plastic & Reconstructive Surgery, HMC, Peshawar<br />2011<br />Mansoor Khan M.B.B.S<br />
  2. 2. Facial paralysis: aesthetically, functionally & psychologically a devastating condition<br />
  3. 3. 18<br />17 paired & one unpaired muscle animate the face<br />
  4. 4.
  5. 5.
  6. 6.
  7. 7. Eye symptoms: dryness, excessive tearing, incomplete closure, outdoor discomfort, use of artificial tears.<br />
  8. 8. 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.<br />
  9. 9. Oral symptoms:continence problems, speech.<br />
  10. 10. Psychological status & level of difficulty to communicate (happiness, anger & sadness)<br />
  11. 11. Examination:<br />Brow, eye, upper, lower lid, position of the inf.canalicularpunctum, corneal ulcerations, philtrum, depression of commisure, nasolabial fold, sagging of the cheek. <br />
  12. 12. Bells Phenomena<br />
  13. 13. Snap test<br />
  14. 14. Synkinesis: simultaneous contraction of two or more muscle groups which should not contract togather<br />
  15. 15. Patients’ expectations/concerns: sort out the problem of the patients’ concern, if you don’t correct that then the treatment is a failure <br />
  16. 16. Aims:protect the eye, rest symmetry, provision of facial movements (involuntary, independent & spontaneous facial expression). <br />
  17. 17. Goals of Eye Treatment:maintain vision, protection, functional eyelids, cosmesis improvement, expression of emotions <br />
  18. 18. Goals of Mouth Treatment:correction of the asymmetry, oral continence, speech improvement, provision of balance symmetrical smile<br />
  19. 19. 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 <br />
  20. 20. Surgical management <br />
  21. 21. Direct brow lift<br />
  22. 22. Direct brow lift<br />
  23. 23. Coronal Brow lift<br />Endoscopic Brow lift<br />
  24. 24. Gold weight placement<br />
  25. 25. Gold weight placement<br />
  26. 26. Gold weight placement<br />
  27. 27. Palpebral spring placement<br />
  28. 28. Temporalis Muscle Transplantation<br />
  29. 29. Tarsorrhaphy<br />
  30. 30. Tendon sling placement<br />
  31. 31. Horizontal lid shortening<br />
  32. 32. Lateral canthorhaphy<br />
  33. 33. Tow stage Microneurovascular muscle transplantation<br />
  34. 34. Dissection of the facial nerve branches on the normal side<br />
  35. 35. Mapping of the facial nerve branches<br />
  36. 36. Mapping of the facial nerve branches<br />
  37. 37. Sural nerve harvesting with a nerve stripper<br />
  38. 38. Gracilis muscle harvesting<br />
  39. 39. Placement and anastomosis of the pedicle<br />
  40. 40. Placement and anastomosis of the pedicle<br />
  41. 41. Temporalis & masseter muscle transplantation<br />
  42. 42. Static tendon slings placement <br />
  43. 43. Resection of the depressor labiiinferioris of the normal side<br />
  44. 44. Resection of the depressor labiiinferioris of the normal side<br />

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