Local flaps in head & neack reconstructionMd Roohia
A flap is a unit of tissue transferred from one site to another while maintaining its own blood supply. Flaps are classified based on their location as local or distant. Local flaps can be random, which rely on subdermal vessels, or axial, relying on named vessels. Flaps are also classified based on their composition, such as skin, muscle, or bone flaps. When planning local flaps, goals include color and thickness match, sensory preservation, and minimal secondary defects. Common local flap techniques include advancement, rotation, and transposition flaps to close facial defects. Complications can be prevented through proper planning to avoid tension and including a flap margin.
The document discusses facial nerve palsy and facial reanimation. It begins with an introduction to the facial nerve and its functions. It then covers anatomy of the facial nerve, classifications and etiologies of facial nerve palsy, presentation and evaluation, non-surgical and surgical management options. For surgical management it discusses various nerve repair techniques including cable grafting and nerve transfers. It also covers approaches to managing specific areas like the eyebrow, eyelids, and lips which may be paralyzed. Both static and dynamic reconstruction techniques are outlined.
This document discusses maxillectomy, which is the surgical removal of part or all of the maxilla bone. It provides a history of maxillectomy and describes the anatomy of the maxilla bone. It also discusses different classifications of maxillectomy procedures based on the extent of bone removed. The common indications for maxillectomy are malignant tumors like squamous cell carcinoma. The approaches used include lateral rhinotomy, Weber-Ferguson, and transoral-transpalatal. Reconstruction options involve dental prosthetics, maxillofacial prosthetics, and titanium implants.
Clinical significance of submental artery island flap. department of oral and maxillofacial surgery. presentation from international science conference 2016-17
This document discusses neck dissection, including:
1. The history and evolution of neck dissection from the late 19th century to modern functional neck dissections.
2. The surgical anatomy of the neck relevant to neck dissection, including lymphatic drainage patterns and the classification of lymph node levels.
3. The technique of neck dissection, including exposure, resection of lymph node levels, and hemostasis.
4. Potential complications of neck dissection like hematoma, wound infections, and neural injuries.
This document discusses techniques for reanimating facial paralysis. It begins by outlining general principles, including reinnervating muscles early, separately reanimating the upper and lower face, and tailoring the procedure to the patient's needs and assessment. Surgical techniques are then described, including neural methods like nerve grafting and transfers, musculofacial transpositions, and static procedures. The timing of different techniques depends on whether the paralysis is acute (<3 weeks), intermediate (3 weeks to 2 years), or chronic (>2 years). Assessment involves evaluating the cause and extent of paralysis along with patient factors. The goal is to restore facial symmetry, competence, protection, and dynamic smile.
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
Head and neck cancer reconstruction is arguably the
most challenging area of reconstruction for the reconstructive
surgeon. A clear understanding of the principles of use of local flaps and a comprehensive understanding of the anatomy of these flaps provides the head and neck surgeon with a plethora of local and regional options for primary and secondary reconstruction.
Local flaps in head & neack reconstructionMd Roohia
A flap is a unit of tissue transferred from one site to another while maintaining its own blood supply. Flaps are classified based on their location as local or distant. Local flaps can be random, which rely on subdermal vessels, or axial, relying on named vessels. Flaps are also classified based on their composition, such as skin, muscle, or bone flaps. When planning local flaps, goals include color and thickness match, sensory preservation, and minimal secondary defects. Common local flap techniques include advancement, rotation, and transposition flaps to close facial defects. Complications can be prevented through proper planning to avoid tension and including a flap margin.
The document discusses facial nerve palsy and facial reanimation. It begins with an introduction to the facial nerve and its functions. It then covers anatomy of the facial nerve, classifications and etiologies of facial nerve palsy, presentation and evaluation, non-surgical and surgical management options. For surgical management it discusses various nerve repair techniques including cable grafting and nerve transfers. It also covers approaches to managing specific areas like the eyebrow, eyelids, and lips which may be paralyzed. Both static and dynamic reconstruction techniques are outlined.
This document discusses maxillectomy, which is the surgical removal of part or all of the maxilla bone. It provides a history of maxillectomy and describes the anatomy of the maxilla bone. It also discusses different classifications of maxillectomy procedures based on the extent of bone removed. The common indications for maxillectomy are malignant tumors like squamous cell carcinoma. The approaches used include lateral rhinotomy, Weber-Ferguson, and transoral-transpalatal. Reconstruction options involve dental prosthetics, maxillofacial prosthetics, and titanium implants.
Clinical significance of submental artery island flap. department of oral and maxillofacial surgery. presentation from international science conference 2016-17
This document discusses neck dissection, including:
1. The history and evolution of neck dissection from the late 19th century to modern functional neck dissections.
2. The surgical anatomy of the neck relevant to neck dissection, including lymphatic drainage patterns and the classification of lymph node levels.
3. The technique of neck dissection, including exposure, resection of lymph node levels, and hemostasis.
4. Potential complications of neck dissection like hematoma, wound infections, and neural injuries.
This document discusses techniques for reanimating facial paralysis. It begins by outlining general principles, including reinnervating muscles early, separately reanimating the upper and lower face, and tailoring the procedure to the patient's needs and assessment. Surgical techniques are then described, including neural methods like nerve grafting and transfers, musculofacial transpositions, and static procedures. The timing of different techniques depends on whether the paralysis is acute (<3 weeks), intermediate (3 weeks to 2 years), or chronic (>2 years). Assessment involves evaluating the cause and extent of paralysis along with patient factors. The goal is to restore facial symmetry, competence, protection, and dynamic smile.
Maxillectomy and craniofacial resection Mamoon Ameen
all maxillectomy types in detail and maxillofacial resection ,indications ,contraindications ,preoperative asssessment and detail techniques and rehabilitations
Head and neck cancer reconstruction is arguably the
most challenging area of reconstruction for the reconstructive
surgeon. A clear understanding of the principles of use of local flaps and a comprehensive understanding of the anatomy of these flaps provides the head and neck surgeon with a plethora of local and regional options for primary and secondary reconstruction.
Reconstruction techniques in head and neckhaseebahmed176
This document provides an overview of reconstruction techniques in head and neck surgery. It discusses Gillie's principles of reconstruction and the reconstructive ladder. It describes various techniques including skin grafts, local flaps such as nasolabial and forehead flaps, distant flaps such as deltopectoral and latissimus dorsi flaps, and free tissue transfers including radial forearm and fibula flaps. It discusses factors to consider for each technique such as blood supply, advantages, disadvantages and appropriate applications in head and neck reconstruction.
This document discusses various techniques for reconstructing skin and soft tissue defects in the head and neck region. It describes different types of grafts, local flaps, regional flaps, and free flaps that can be used including split thickness grafts, full thickness grafts, axial pattern flaps, transposition flaps, pedicled flaps like pectoralis major and latissimus dorsi flaps. Careful preoperative planning is important when using local flaps for head and neck reconstruction.
This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
This document provides an overview of neck anatomy and neck dissection procedures. It describes the boundaries and contents of the neck regions. It then discusses the different types of neck dissections including radical neck dissection, modified radical neck dissection, and selective neck dissections. Key structures such as lymph nodes, muscles, nerves and vessels are identified. Surgical considerations and indications for different procedures are also outlined.
This document discusses various techniques for facelift surgery. It begins by noting that facial aging affects all layers of the face, changing its shape from heart-shaped to rectangular. Various facelift techniques are then described in detail, including subcutaneous facelift, SMAS plication, MACS lift, and deep plane lift. Post-operative care and potential complications are also outlined. The goal of facelift surgery is to reposition ptotic tissue and restore a more youthful facial contour.
The temporoparietal fascial flap (TPF) uses fascia from the scalp which is supplied by the superficial temporal artery. It can be used as a pedicled or free flap for reconstruction of facial, orbital, and skull defects. The relevant anatomy is described including landmarks for incision and dissection. Indications include reconstruction of oral, orbital, and cranial defects. Advantages are an easy harvest with a reliable vascular pedicle and low donor site morbidity. Disadvantages include a short pedicle length and potential scarring or alopecia at the donor site.
The nasolabial flap is used to reconstruct defects of the nose, lower eyelid, cheek, lip, oral commissure and anterior oral cavity. It has a reliable blood supply from the facial and angular arteries. The flap can be raised in a superior or inferior direction and is outlined along the nasolabial fold. The technique involves raising the flap in a supra-muscular plane and transferring it to the defect site through a transoral tunnel. Advantages are a concealed donor site scar and good color and texture match. Complications include infection, necrosis and asymmetry.
The document discusses various types of local flaps used in head and neck reconstruction. Local flaps involve moving tissue from one site to another to repair defects. There are several types of local flaps classified based on how the tissue moves (advancement, pivotal, interpolation) and what tissues are included (skin, muscle, fat). Common examples used to repair facial defects include buccal fat pad flaps, tongue flaps, and various types of advancement and pivotal flaps. Proper planning and design of local flaps is necessary to close wounds and defects with adequate tissue while avoiding dog ears or tension.
Total maxillectomy is a surgical procedure to remove the entire maxilla bone. It was first described in the 1820s and approaches have been refined over time. It is indicated for malignant tumors involving the maxilla, extensive benign tumors, or fungal/granulomatous infections. Contraindications include poor general health, bilateral orbital involvement, or skull base extension. Potential complications include bleeding, infection, epiphora, skin graft breakdown, numbness, and atrophic rhinitis. Careful surgical planning and follow up are required due to significant reconstruction and rehabilitation needs.
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
1. The document discusses the anatomy and classification of neck dissections for oral squamous cell carcinoma. It reviews the history and developments of neck dissection techniques from radical to functional approaches.
2. It describes the important structures and lymph node groups in the neck, including the spinal accessory nerve, internal jugular vein, and lymph node levels IA-III.
3. Performing neck dissection requires knowledge of the cervical lymph node drainage patterns and surgical anatomy to adequately remove metastatic lymph nodes while preserving important structures to minimize morbidity.
Local and regional flaps in head and neck reconstructionSaleh Bakry
Local and regional flaps are used for head and neck reconstruction. There are several types of flaps classified by blood supply, location, configuration, tissue content, and transfer method. Local flaps use adjacent tissue while regional flaps are near but not adjacent. Free flaps completely detach tissue and reconnect blood vessels microsurgically. Examples of local and regional flaps discussed are advancement, rotation, and transposition flaps as well as pedicled and free myocutaneous flaps.
Maxillary sinus carcinoma arises from the maxillary sinus and can spread locally and to lymph nodes. Diagnosis involves physical exam, CT/MRI imaging, and biopsy. Staging evaluates tumor size, lymph node involvement, and distant spread. Treatment depends on stage but may include surgery such as maxillectomy, radiation therapy such as IMRT, and chemotherapy such as cisplatin for locally advanced cases. The goal of treatment is a complete resection with negative margins or effective control with radiation with or without chemotherapy while minimizing side effects to nearby structures like the optic nerves and chiasm. Outcomes depend on stage, with earlier stages having higher survival rates treated with surgery or surgery plus radiation.
This document provides information on facelift procedures. It discusses facial aging changes and facelift anatomy. Several facelift techniques are described including subcutaneous, superficial musculoaponeurotic system (SMAS), extended SMAS, lateral SMAS-ectomy, platysma-SMAS plication, deep plane, short scar, and secondary facelifts. Neck rejuvenation techniques like submental dissection and platysmaplasty are also outlined. Potential complications are noted. The goal of facelifts is to lift tissues while avoiding an operated look through careful surgical planning and technique.
This document provides an overview of rhinoplasty procedures. It discusses the history and anatomy of rhinoplasty. It describes techniques for open and closed rhinoplasty approaches. It covers tip work including tip suturing and grafts. It also discusses nasal augmentation including graft materials and saddle nose repair. Deformities like deviated nose and underprojected tip are reviewed along with surgical correction methods. Key anatomical structures and surgical principles are emphasized.
The document discusses the use of the Hadad-Bassagasteguy (HB) flap in reconstructing anterior skull base defects after endonasal skull base surgery. The HB flap uses the vascularized nasal septal mucoperiosteum to repair defects. In a study of 53 patients who underwent HB flap reconstruction, only 2 patients (3.8%) experienced post-operative cerebrospinal fluid leaks. The study found the HB flap to be effective at preventing post-operative CSF leaks across a variety of patient profiles and skull base surgery types. The HB flap is becoming a standard technique for reconstructing anterior skull base defects due to its high success rate and versatility.
Maxillectomy is a surgical procedure to remove part or all of the maxilla bone. It can be performed for tumors, infections, or other conditions affecting the maxilla. The surgery involves three main stages - soft tissue dissection to expose the bone, resection of the maxilla to the required extent, and closure/reconstruction. Key anatomical structures that must be carefully identified and protected during the procedure include the orbital contents, lacrimal sac, infraorbital nerve, and internal maxillary artery. Comprehensive preoperative evaluation and planning is important to determine the surgical approach and extent of resection required.
1. Flaps are used in reconstructive surgery to repair structural defects following procedures like cancer surgery. They involve transferring tissue from one part of the body to another while maintaining or reconnecting its blood supply.
2. There are many types of flaps classified by their blood supply, tissue type, and location. Common flaps used in head and neck reconstruction include local flaps like nasolabial and advancement flaps as well as regional and distant flaps like pectoralis major and radial forearm flaps.
3. Proper flap selection and design is important to replace tissue "like with like" and adhere to anatomical borders and units for optimal cosmetic and functional outcomes.
Microvascular flaps for reconstruction in head and neck cancermurari washani
(1) The document discusses the history and advances in microvascular surgery, which allows for complex tissue reconstruction through free tissue transfer.
(2) It outlines the key advantages of microvascular free flaps over traditional pedicled flaps, such as the ability to transfer large amounts of composite tissue from a variety of donor sites.
(3) The document provides details on planning microvascular surgery, including patient evaluation, vessel preparation, and anastomosis techniques to successfully reattach blood vessels between the donor tissue and recipient site.
The document discusses the embryology, anatomy, components, causes of injury, grading systems, evaluation, and treatment of the facial nerve. It covers the development of the facial nerve from the embryonic stage through maturity and describes the various parts of the nerve and their functions. The document also outlines different classification systems for nerve injuries, approaches for evaluating facial nerve paralysis, and surgical and non-surgical techniques for treating injuries or reanimating paralysis of the facial nerve.
This document discusses facial paralysis, which can be aesthetically, functionally, and psychologically devastating. It affects the 18 paired and 1 unpaired muscles that animate the face. Symptoms discussed include dry eyes, tearing, eye closure issues, nasal obstruction, oral symptoms like incontinence and speech problems, and psychological and communication difficulties displaying emotions. Examination focuses on areas like the brow, eyes, mouth, and nasolabial fold. Treatment goals are to protect the eye, restore symmetry, and allow facial movements. Surgical management techniques mentioned include brow lifts, gold weight placement, tarsorrhaphy, tendon sling placement, microneurovascular muscle transplantation, and static tendon sling placement. The
This document provides information on facial paralysis (palsy) including its causes, types, treatments, and more. It begins with an introduction to facial function and paralysis. It then covers nerve anatomy and classifications of nerve injuries. Specific topics include facial nerve anatomy, types of facial paralysis (central vs peripheral), common causes like Bell's palsy, and surgical treatment options depending on when paralysis occurred (acute, intermediate, or chronic stages). Evaluation methods and the House-Brackmann grading scale for facial function are also summarized.
Reconstruction techniques in head and neckhaseebahmed176
This document provides an overview of reconstruction techniques in head and neck surgery. It discusses Gillie's principles of reconstruction and the reconstructive ladder. It describes various techniques including skin grafts, local flaps such as nasolabial and forehead flaps, distant flaps such as deltopectoral and latissimus dorsi flaps, and free tissue transfers including radial forearm and fibula flaps. It discusses factors to consider for each technique such as blood supply, advantages, disadvantages and appropriate applications in head and neck reconstruction.
This document discusses various techniques for reconstructing skin and soft tissue defects in the head and neck region. It describes different types of grafts, local flaps, regional flaps, and free flaps that can be used including split thickness grafts, full thickness grafts, axial pattern flaps, transposition flaps, pedicled flaps like pectoralis major and latissimus dorsi flaps. Careful preoperative planning is important when using local flaps for head and neck reconstruction.
This powerpoint describes the types of maxillectomy & operative steps for total maxillectomy. It also enumerates various flaps used for reconstruction of maxillectomy defect.
This document provides an overview of neck anatomy and neck dissection procedures. It describes the boundaries and contents of the neck regions. It then discusses the different types of neck dissections including radical neck dissection, modified radical neck dissection, and selective neck dissections. Key structures such as lymph nodes, muscles, nerves and vessels are identified. Surgical considerations and indications for different procedures are also outlined.
This document discusses various techniques for facelift surgery. It begins by noting that facial aging affects all layers of the face, changing its shape from heart-shaped to rectangular. Various facelift techniques are then described in detail, including subcutaneous facelift, SMAS plication, MACS lift, and deep plane lift. Post-operative care and potential complications are also outlined. The goal of facelift surgery is to reposition ptotic tissue and restore a more youthful facial contour.
The temporoparietal fascial flap (TPF) uses fascia from the scalp which is supplied by the superficial temporal artery. It can be used as a pedicled or free flap for reconstruction of facial, orbital, and skull defects. The relevant anatomy is described including landmarks for incision and dissection. Indications include reconstruction of oral, orbital, and cranial defects. Advantages are an easy harvest with a reliable vascular pedicle and low donor site morbidity. Disadvantages include a short pedicle length and potential scarring or alopecia at the donor site.
The nasolabial flap is used to reconstruct defects of the nose, lower eyelid, cheek, lip, oral commissure and anterior oral cavity. It has a reliable blood supply from the facial and angular arteries. The flap can be raised in a superior or inferior direction and is outlined along the nasolabial fold. The technique involves raising the flap in a supra-muscular plane and transferring it to the defect site through a transoral tunnel. Advantages are a concealed donor site scar and good color and texture match. Complications include infection, necrosis and asymmetry.
The document discusses various types of local flaps used in head and neck reconstruction. Local flaps involve moving tissue from one site to another to repair defects. There are several types of local flaps classified based on how the tissue moves (advancement, pivotal, interpolation) and what tissues are included (skin, muscle, fat). Common examples used to repair facial defects include buccal fat pad flaps, tongue flaps, and various types of advancement and pivotal flaps. Proper planning and design of local flaps is necessary to close wounds and defects with adequate tissue while avoiding dog ears or tension.
Total maxillectomy is a surgical procedure to remove the entire maxilla bone. It was first described in the 1820s and approaches have been refined over time. It is indicated for malignant tumors involving the maxilla, extensive benign tumors, or fungal/granulomatous infections. Contraindications include poor general health, bilateral orbital involvement, or skull base extension. Potential complications include bleeding, infection, epiphora, skin graft breakdown, numbness, and atrophic rhinitis. Careful surgical planning and follow up are required due to significant reconstruction and rehabilitation needs.
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
1. The document discusses the anatomy and classification of neck dissections for oral squamous cell carcinoma. It reviews the history and developments of neck dissection techniques from radical to functional approaches.
2. It describes the important structures and lymph node groups in the neck, including the spinal accessory nerve, internal jugular vein, and lymph node levels IA-III.
3. Performing neck dissection requires knowledge of the cervical lymph node drainage patterns and surgical anatomy to adequately remove metastatic lymph nodes while preserving important structures to minimize morbidity.
Local and regional flaps in head and neck reconstructionSaleh Bakry
Local and regional flaps are used for head and neck reconstruction. There are several types of flaps classified by blood supply, location, configuration, tissue content, and transfer method. Local flaps use adjacent tissue while regional flaps are near but not adjacent. Free flaps completely detach tissue and reconnect blood vessels microsurgically. Examples of local and regional flaps discussed are advancement, rotation, and transposition flaps as well as pedicled and free myocutaneous flaps.
Maxillary sinus carcinoma arises from the maxillary sinus and can spread locally and to lymph nodes. Diagnosis involves physical exam, CT/MRI imaging, and biopsy. Staging evaluates tumor size, lymph node involvement, and distant spread. Treatment depends on stage but may include surgery such as maxillectomy, radiation therapy such as IMRT, and chemotherapy such as cisplatin for locally advanced cases. The goal of treatment is a complete resection with negative margins or effective control with radiation with or without chemotherapy while minimizing side effects to nearby structures like the optic nerves and chiasm. Outcomes depend on stage, with earlier stages having higher survival rates treated with surgery or surgery plus radiation.
This document provides information on facelift procedures. It discusses facial aging changes and facelift anatomy. Several facelift techniques are described including subcutaneous, superficial musculoaponeurotic system (SMAS), extended SMAS, lateral SMAS-ectomy, platysma-SMAS plication, deep plane, short scar, and secondary facelifts. Neck rejuvenation techniques like submental dissection and platysmaplasty are also outlined. Potential complications are noted. The goal of facelifts is to lift tissues while avoiding an operated look through careful surgical planning and technique.
This document provides an overview of rhinoplasty procedures. It discusses the history and anatomy of rhinoplasty. It describes techniques for open and closed rhinoplasty approaches. It covers tip work including tip suturing and grafts. It also discusses nasal augmentation including graft materials and saddle nose repair. Deformities like deviated nose and underprojected tip are reviewed along with surgical correction methods. Key anatomical structures and surgical principles are emphasized.
The document discusses the use of the Hadad-Bassagasteguy (HB) flap in reconstructing anterior skull base defects after endonasal skull base surgery. The HB flap uses the vascularized nasal septal mucoperiosteum to repair defects. In a study of 53 patients who underwent HB flap reconstruction, only 2 patients (3.8%) experienced post-operative cerebrospinal fluid leaks. The study found the HB flap to be effective at preventing post-operative CSF leaks across a variety of patient profiles and skull base surgery types. The HB flap is becoming a standard technique for reconstructing anterior skull base defects due to its high success rate and versatility.
Maxillectomy is a surgical procedure to remove part or all of the maxilla bone. It can be performed for tumors, infections, or other conditions affecting the maxilla. The surgery involves three main stages - soft tissue dissection to expose the bone, resection of the maxilla to the required extent, and closure/reconstruction. Key anatomical structures that must be carefully identified and protected during the procedure include the orbital contents, lacrimal sac, infraorbital nerve, and internal maxillary artery. Comprehensive preoperative evaluation and planning is important to determine the surgical approach and extent of resection required.
1. Flaps are used in reconstructive surgery to repair structural defects following procedures like cancer surgery. They involve transferring tissue from one part of the body to another while maintaining or reconnecting its blood supply.
2. There are many types of flaps classified by their blood supply, tissue type, and location. Common flaps used in head and neck reconstruction include local flaps like nasolabial and advancement flaps as well as regional and distant flaps like pectoralis major and radial forearm flaps.
3. Proper flap selection and design is important to replace tissue "like with like" and adhere to anatomical borders and units for optimal cosmetic and functional outcomes.
Microvascular flaps for reconstruction in head and neck cancermurari washani
(1) The document discusses the history and advances in microvascular surgery, which allows for complex tissue reconstruction through free tissue transfer.
(2) It outlines the key advantages of microvascular free flaps over traditional pedicled flaps, such as the ability to transfer large amounts of composite tissue from a variety of donor sites.
(3) The document provides details on planning microvascular surgery, including patient evaluation, vessel preparation, and anastomosis techniques to successfully reattach blood vessels between the donor tissue and recipient site.
The document discusses the embryology, anatomy, components, causes of injury, grading systems, evaluation, and treatment of the facial nerve. It covers the development of the facial nerve from the embryonic stage through maturity and describes the various parts of the nerve and their functions. The document also outlines different classification systems for nerve injuries, approaches for evaluating facial nerve paralysis, and surgical and non-surgical techniques for treating injuries or reanimating paralysis of the facial nerve.
This document discusses facial paralysis, which can be aesthetically, functionally, and psychologically devastating. It affects the 18 paired and 1 unpaired muscles that animate the face. Symptoms discussed include dry eyes, tearing, eye closure issues, nasal obstruction, oral symptoms like incontinence and speech problems, and psychological and communication difficulties displaying emotions. Examination focuses on areas like the brow, eyes, mouth, and nasolabial fold. Treatment goals are to protect the eye, restore symmetry, and allow facial movements. Surgical management techniques mentioned include brow lifts, gold weight placement, tarsorrhaphy, tendon sling placement, microneurovascular muscle transplantation, and static tendon sling placement. The
This document provides information on facial paralysis (palsy) including its causes, types, treatments, and more. It begins with an introduction to facial function and paralysis. It then covers nerve anatomy and classifications of nerve injuries. Specific topics include facial nerve anatomy, types of facial paralysis (central vs peripheral), common causes like Bell's palsy, and surgical treatment options depending on when paralysis occurred (acute, intermediate, or chronic stages). Evaluation methods and the House-Brackmann grading scale for facial function are also summarized.
The facial nerve is a mixed nerve that carries motor, sensory and parasympathetic fibers. It has several branches that innervate the muscles of facial expression. Facial nerve palsy can result from a variety of causes including Bell's palsy (idiopathic, viral), Ramsay Hunt syndrome (herpes zoster virus), tumors, trauma, infections and other conditions. Clinical testing assesses for signs of facial asymmetry, eye problems and inability to move facial muscles. Treatment depends on the underlying cause but may include eye protection, steroids, antivirals, surgery and other approaches.
This document discusses the management of Bell's palsy, which is an acute, unilateral paralysis of the facial nerve. It describes the causes, symptoms, diagnosis, and various treatment options for Bell's palsy. For initial treatment, oral steroids and antiviral drugs are often prescribed within 72 hours. Surgical options are also discussed, including nerve grafts and transfers to restore facial function. Prognosis depends on factors like age and severity, with about 71% recovering fully within 6 months. Residual effects may include muscle contractures or synkinesis that can sometimes require additional surgery.
Bell's palsy is a facial paralysis caused by inflammation of the facial nerve as it passes through the stylomastoid foramen. It affects the muscles of facial expression on one side of the face. Causes include trauma, infection, tumors, and idiopathic. Symptoms include pain behind the ear, inability to close the eye, and drooping of the mouth corner on the affected side. Treatment involves corticosteroids to reduce swelling, vitamin B, physical therapy like massage and electrical stimulation to prevent muscle atrophy, and heat/cold for increased blood flow and muscle contraction.
Bell's Palsy is a sudden paralysis of the facial nerve that causes unilateral facial weakness or paralysis. It is the most common cause of acute facial nerve paralysis. The exact cause is unknown but is believed to sometimes involve reactivation of the herpes simplex virus. Symptoms include facial drooping, weakness of muscles on one side of the face, and impaired taste sensation on the affected side. Most patients recover fully within 3-6 months through treatment with corticosteroids or antiviral drugs. A small percentage of patients may experience long-term sequelae such as incomplete recovery or facial spasms.
The document discusses the anatomy and embryology of the facial nerve. It begins with an introduction stating that the facial nerve is the seventh cranial nerve and is mixed with both motor and sensory components. It then covers the embryological development of the facial nerve from the second branchial arch. The document outlines the course of the facial nerve from its nuclei of origin in the brainstem through its intracranial, intratemporal, and extracranial segments. It details the branches and functional components of the facial nerve as well as associated ganglia. Variations and blood supply of the facial nerve are also mentioned.
This document discusses facial reanimation techniques for chronic unilateral facial palsy, including one-stage, two-stage, and three-stage procedures. It notes that two-stage and three-stage procedures often involve nerve grafts such as the hypoglossal nerve and muscle grafts such as the pectoralis minor muscle. The document also examines using a single sural nerve to provide three grafts, finding the nerve contains an average of 6.3 fascicles proximally and 6.7 distally that can be used individually as grafts.
This document discusses various techniques for facial reanimation in patients with facial nerve paralysis. It begins by describing candidate patients and goals of treatment. Dynamic reanimation techniques are preferred and include primary nerve repair, grafting, and nerve transfers within the first 2 years after injury. For longer-standing paralysis or congenital cases, static procedures like muscle transfers or free flaps are used. Assessment involves evaluating the cause, extent of paralysis, and likelihood of recovery. Electromyography can assess muscle viability. The document then outlines specific procedures for different anatomical areas and management of complications like synkinesis.
This document provides an overview and update on facial palsy. It discusses the functions of the face, including displaying emotions, communication, sensory functions, and physical roles. Facial nerve lesions can be central or peripheral. Bell's palsy is described as an idiopathic peripheral facial paralysis. Treatment options discussed include steroids, antivirals, physical therapy techniques like exercises and mime therapy, and a functional training program. Chronic facial palsy can cause issues like synkinesis, asymmetry, and psychological impacts that rehabilitation aims to address.
Clinical anatomy of facial nerve and facial nerve palsy Ramesh Parajuli
The facial nerve is a mixed nerve that originates in the brainstem and has motor, sensory, and parasympathetic functions. It has several segments as it exits the brainstem and travels through the skull and internal auditory canal before exiting behind the ear. It gives off several branches and terminates in branches that innervate the muscles of facial expression. Facial nerve palsy can result from various causes like Bell's palsy, trauma, infection, tumors, or iatrogenic injuries. Clinical assessment and electrical tests can localize the site of injury which guides management including medications, physical therapy, or surgical interventions like decompression or repair.
The document discusses Bell's palsy, which causes sudden weakness or paralysis of the muscles on one side of the face. It is caused by inflammation and swelling of the 7th cranial nerve, which controls facial muscle movement. Symptoms include an inability to smile or close one eye fully. Treatment involves corticosteroids to reduce swelling along with antiviral medications, as herpes simplex virus is a common cause. Most people fully recover facial function within a few months, though symptoms may persist in rare cases.
BELL'S PALSY IS AN IDIOPATHIC LMN TYPE FACIAL PALSY..THE SEMINAR TELLS YOU OF COURSE OF NERVE..FACIAL MUSCLES THEIR ACTION..HOW TO EXAMINE..THE SEQUELAE OF FACIAL PALSY...LOOK AT IT..
ClickHotel's business intelligence tools are more advanced than the conventional reporting tools. Hotel managers are able to view a more detailed data reports of their operations in a much shorter time frame. This enables managers to make faster and more accurate decisions.
MICROS POS integrated ClickRest, is a cloud-based affordable business intelligence solution specialized for restaurants. It is suitable for operations of all sizes from single to multi-chain food locations. You can monitor your business' real-time performance from any device without the need for IT support.
This document discusses techniques for rehabilitating facial paralysis. It begins with an overview of causes of facial paralysis and basics about nerve regeneration. It then describes several cranial nerve techniques used for rehabilitation, including hypoglossal-facial anastomosis and hypoglossal-facial nerve jump grafting. Factors for selecting surgical techniques are outlined. Muscle transposition techniques using the temporalis, masseter, and digastric muscles are also summarized. Post-operative care and expected results are briefly mentioned.
This document summarizes a technique for performing local/regional anesthesia for thyroid surgery. It begins by describing the patient who will undergo a parathyroidectomy due to hypercalcemia from hyperparathyroidism. It then provides background on the history and development of performing thyroid surgery under local/regional anesthesia. It proceeds to describe the relevant anatomy of the cervical plexus and its branches. It concludes by outlining the technique for performing a superficial cervical plexus block, including patient position, landmarks, local anesthetic used, and injection points along the posterior border of the sternocleidomastoid muscle at the level of the external jugular vein. The summary is provided in 3 sentences or less as requested.
This study evaluated surgical treatment of spinal tuberculosis in 25 patients over a period of 15 months on average. Microbiological testing confirmed tuberculosis in all cases. Patients underwent anterior, posterior, or combined surgical procedures along with 12 months of antitubercular drug therapy. Neurological function improved in all patients. Bony fusion was achieved within 6 months on average. For dorsolumbar lesions, the average kyphosis angle improved from 36 to 17 degrees. The authors concluded that early surgical intervention along with chemotherapy can effectively treat spinal tuberculosis by stabilizing the spine and preventing kyphosis progression.
This document summarizes 4 journal articles related to pediatric neurosurgery. The first article describes a technique using an endoscopic transnasal approach for odontoid resection in children with Chiari malformation Type I and ventral brainstem compression, presenting 2 case reports. The second article describes the presentation and outcomes of Chiari malformation Type I in children under 6 years old. The third article discusses using MRI to distinguish between progressive and compensated hydrocephalus in infants. The fourth article proposes a method to reduce infection rates for ventriculoperitoneal shunts.
Post-Thyroidectomy Laryngeal Diplegia in Mali: What Therapeutic Challenge? by Kone Fatogoma Issa in Experiments in Rhinology & Otolaryngology
Post-thyroidectomy laryngeal diplegia is the most common and most feared complication [1]. It occurs following a recurrent nerve lesion in 26 to 59% of cases [1,2]. Tracheotomy was considered until 1922 as the only reference treatment [3,4]. Therapeutic approaches have evolved over time, ranging from convention altranslaryngeal or extralaryngeal therapy to endoscopic laser approaches [5]. These endoscopic methods emphasized endoscopicary tenoidectomy and posterior transverse cordotomy [4,6]. Laser transverse posterior cordotomy has proved its efficacy, illustrated by the work of Denis and Kashima and Laccoureye & Merite Drancy [4,7].
COMPARISON OF OPEN LICHTENSTEINE UNDER LOCAL AGAINST LAP.TEP UNDER GENERAL AN...chinmay gandhi
This document describes a study comparing open Lichtenstein hernioplasty under local anesthesia to laparoscopic extraperitoneal inguinal hernioplasty under general anesthesia.
For the open procedure, 25 patients underwent Lichtenstein repair with local anesthesia. Post-operative pain was well controlled with oral analgesics. At 3 months, there were no recurrences and only mild chronic pain in a few patients.
For the laparoscopic procedure, 25 patients underwent TEP repair with selective mesh fixation. Operative times were longer for bilateral cases. Post-operative pain was well controlled and patients were discharged on post-op day 2. At 3 months, there were no recurrences or chronic pain.
The
Distraction osteogenesis was performed on 15 patients with retrognathia and obstructive sleep apnea secondary to temporomandibular joint ankylosis. This study evaluated the effects of mandibular advancement using distraction osteogenesis to increase the posterior airway space. Results found significant improvements in sleep apnea symptoms and polysomnography outcomes after distraction, including reduced apnea-hypopnea index and increased lowest blood oxygen saturation. The authors concluded that distraction osteogenesis is an effective treatment for obstructive sleep apnea in patients with severe acquired retrognathia.
EPSiT study copy Pilonidal sinussss.pptxcsxbbk85tx
This journal article presents the results of a prospective study evaluating endoscopic pilonidal sinus treatment (EPSiT) on 77 patients over 2 years. EPSiT uses a fistuloscope to ablate the sinus cavity and tracts endoscopically under local anesthesia. The study found EPSiT resulted in a 92% healing rate with low postoperative pain and quick recovery time, returning to work in 6 days on average. Recurrence rate was low at 8%. EPSiT provides promising minimally invasive results for pilonidal sinus treatment with short healing times, low complications and high patient satisfaction compared to open surgical techniques.
Anesthesia consideration for parotidectomyTayyab_khanoo9
This document summarizes anesthesia considerations for parotidectomy surgery. It discusses the anatomy of the parotid gland and facial nerve. Parotidectomy is usually indicated for parotid tumors and may require facial nerve monitoring. The document presents a case of performing parotidectomy under local anesthesia in a high-risk patient with hypertension. It describes blocking the maxillary and cervical plexus nerves along with local infiltration to anesthetize the area. The surgery was performed successfully without complications under local anesthesia. Advantages of this technique include avoiding risks of general anesthesia and facilitating identification and protection of the facial nerve.
Liposuction used to treat deep vascular accesses for hemodialysis.pptxGierelma J.T.
This study evaluated the use of liposuction to superficialize deep arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in 14 hemodialysis patients. Liposuction was performed to remove excess fat overlying the access to allow for cannulation. Following liposuction, the mean access depth decreased from 7mm to 5.3mm after 4 weeks of healing. For patients who previously could not use their deep access, 2 out of 3 were able to remove their tunneled catheters. For other patients, the length of accessible access increased on average from 5cm to 12.7cm. The procedure was well-tolerated with only minor bleeding in one case.
1) The DECRA trial investigated whether early decompressive craniectomy improved outcomes for patients with severe traumatic brain injury and refractory intracranial hypertension compared to standard care.
2) Patients who underwent early craniectomy had decreased intracranial pressure and shorter time on ventilators and in the ICU compared to standard care.
3) However, patients who received early craniectomy were more likely to have an unfavorable outcome, with 70% having functional disability or death, compared to 51% of patients receiving standard care.
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasSean M. Fox
Drs. Faith Meyers, Madison Watts and Steven Perry are Emergency Medicine Residents at Carolinas Medical Center who are interested in medical education. Along with the guidance of Dr. Michael Gibbs (Chair of Emergency Medicine), Dr. Jonathan Clemente (Chief of the Department of Radiology and Neuroradiology specialist), Dr. Christa Swisher (Neurocritcal Care Intensivist), and Dr. Scott Wait (Chief of Pediatric Neurosurgery) they aim to help educate us on Neuroimaging. In this presentation they will address Atraumatic Neurosurgical Intracranial Infections. Follow along with the EMGuideWire.com team as they post the CMC Neuroimaging Case Studies.
- Acute Epidural Hematomas
Genioglossus muscle advancement and simultaneous sliding genioplasty in the m...Dibya Falgoon Sarkar
This study describes a technique that combines genioglossus muscle advancement and sliding genioplasty to treat obstructive sleep apnea. The technique was performed on 14 patients with OSA and retrognathia. It resulted in advancement of the genioglossus muscle to help keep the airway open during sleep. Only 3 patients underwent follow-up sleep studies, which showed improvement in 2 patients. While this technique provides both functional and aesthetic benefits, larger studies are still needed to fully evaluate its effectiveness in treating OSA.
This document describes the case of an 8-year-old boy who presented with 6 months of headaches and 1 month of gait disturbance. After examination, MRI revealed a posterior fossa midline neoplastic lesion involving the right cerebellum and compressing the fourth ventricle, causing hydrocephalus. The diagnosis was medulloblastoma with hydrocephalus. The patient underwent VP shunt placement for hydrocephalus and then midline suboccipital craniectomy for tumor resection. Outcomes and complications of the surgery are discussed.
Planning for Awake Brain Surgery: In Light of Research Regarding Language Loc...Allina Health
This document discusses the evolution of surgical management of brain tumors at Abbott Northwestern Hospital over the past two decades. It describes how the integration of neuronavigation, functional MRI, and intraoperative MRI has allowed surgeons to remove more of tumors while avoiding injury to eloquent brain areas. Over 1700 patients with various brain tumors have undergone surgery using these techniques. The document also presents four case examples and discusses how awake brain mapping during surgery helps identify language areas of the brain to further aid in maximal tumor resection.
The document discusses cervical spine injuries and cervical spondylotic myelopathy. It presents early experience with anterior decompression, fusion and plating for cervical spine injuries in Abuja, Nigeria. It describes surgical techniques used including anterior cervical discectomy and fusion. It highlights the importance of early referral for surgery and discusses challenges including lack of intensive care and rehabilitation facilities.
This document discusses the management of penile carcinoma. Surgery is the mainstay of treatment and may involve circumcision, laser ablation, Mohs micrographic surgery, or penectomy depending on the location, size, and stage of the tumor. Radiotherapy options include brachytherapy and external beam radiation therapy. Chemotherapy has a limited role and is mainly used perioperatively for unresectable disease. Treatment aims to balance tumor control with organ preservation and minimizing psychosocial and sexual morbidity. Close multidisciplinary care and discussion of treatment expectations is important.
- This document describes a rare case of right hemidiaphragm paralysis following repair of esophageal atresia and tracheoesophageal fistula.
- The infant underwent an extrapleural ligation of the fistula with primary anastomosis and was discharged after two weeks. However, at two months he presented with shortness of breath and pneumonia.
- After conservative management failed, the infant underwent a right-sided thoracotomy with plication of the paralyzed diaphragm. Post-operatively his symptoms resolved.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
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3. H&P
Background: 72 yo female referred to Dr. Gooi on 7/25/16 from ENT at OSH for evaluation of a
right parotid mass
HPI: Right lip weakness in 4/2015
◦ Progressed over next few months to entire right face
◦ No taste on right by 12/2015
◦ Diagnosed with Bell’s palsy
◦ Followed with Neurology
◦ Serial MRI’s all read as negative
◦ MRI in June 2016 significant for a right parotid mass
*Modified from documentation by Dr. Zhen Gooi
4. H&P
HPI Continued
◦ CT Neck: partially calcified 9 mm mass along the posterior inferior deep aspect of the right parotid gland
◦ FNA and core-needle biopsy
◦ Malignant epithelial cells present, further classification pending surgical excision
◦ 8/2016: fullness of right side of face and tenderness to deep palpation in addition to facial weakness
PMH: Blepharospasm, benign intention tremor, hypertension
PSH: Knee and shoulder arthroplasty, tonsillectomy with pre-op radiation
FH: No family history of cancer
SH: Former smoker quit 1986, no EtOH
ROS: Denies fevers chills, rash, dysphagia, dyspnea, odynophagia, unintentional weight loss,
sialorrhea or mouth dryness. Denies vision loss, hearing loss or tinnitus
* Modified from documentation by Dr. Zhen Gooi
5. H&P
Exam
◦ Vitals: WNL
◦ General: NAD, strong voice breathing comfortably
◦ Ears: TMs clear and mobile; no effusions noted
◦ Nose: No external deformity
◦ Oral Cavity: Mucosa unremarkable without suspicious lesions or asymmetry; floor of mouth/tongue soft.
◦ Oropharynx: Mucosa unremarkable without suspicious lesions or asymmetry
◦ Parotid gland: No palpable parotid mass
◦ Neck: No masses or lymphadenopathy
*Modified from documentation by Dr. Zhen Gooi
6. H&P
Exam continued
◦ Neuro: Cranial Nerve VII Exam
◦ Forehead: House Brackmann 6.
◦ Eye opening: House Brackmann 4, inability to close, scleral show, Bell's phenomenon
◦ Buccal region: House Brackmann 1, full movement
◦ Lips: House Brackmann 6
◦ Video
◦ Laryngoscopy positive for left vocal cord paralysis
*Modified from documentation by Dr. Zhen Gooi
7. Workup
CT Chest: No evidence of metastases, or other significant
abnormality
MRI Brain: Unremarkable
MRI Neck:
◦ Deep parotid mass with abnormal extension extending cranially
along the entire right facial nerve into the fundus of the internal
auditory canal along a span of 3 mm of the distal meatal segment,
consistent with perineural spread of tumor
◦ Prominent cervical lymph nodes
PET CT: parotid mass and right level 1B lymph node
Patient was presented at tumor board
15. Facial Reanimation Approach
Nonsurgical Management
Surgical Management
◦ Dynamic
◦ Facial nerve neurorrhaphy
◦ Cable graft
◦ Nerve transposition
◦ Muscle transposition
◦ Microneurovascular transfer
◦ Static procedures 1
Two-system method can be utilized when deciding which procedure is best 2
Proximal system: facial nerve nucleus and proximal facial nerve
Distal system: distal nerve branches and facial musculature
16. Facial Reanimation Techniques
Direct Anastomosis: proximal and distal systems intact
◦ Indicated when defect is ≤18 mm 3
◦ Best if done within 72 hours of nerve transection (no Wallerian
degeneration)
◦ Often not needed if branch is transected medial to lateral canthus 4
Repair with nerve graft: proximal and distal systems intact
◦ Indicated when CN VII cannot be re-approximated without tension
◦ Great auricular, sural and medial or lateral antebrachial cutaneous
nerves are most commonly used
◦ Benefit seen in 6 mo; max at 12-18 mo ; likely no better than HB 3
17. Facial Reanimation Techniques
Nerve Transfer: proximal system compromised, distal system intact
◦ Hypoglossal nerve transfer
◦ Most popular and commonly used
◦ Study of 53 patients over 10 years found no statistically significant difference in outcome between primary neurorrhapy, cable
graft or nerve transposition 5
◦ Masseteric nerve transposition
◦ Convenient position
◦ Minimal morbidity from transection
◦ Minimal synkinesis with speech 6
◦ Cross-facial Technique
◦ Distal branches from unaffected side are connected to branches of affected side by separate tunneled sural grafts
◦ Potential for preserved emotional animation
◦ Only 9/23 patients in one study and 1/10 patients in another developed movement rated as “good” 7,8
18. Facial Reanimation Techniques
Muscle Transposition: distal and proximal systems
compromised
◦ Temporalis Tendon Transfer
◦ Primary goals are to restore symmetry of the smile and improve oral function.
◦ Dynamic muscle transfer is improved by means of activity-based therapy
◦ Smile retains natural vector pull
◦ Coronoid process and attached temporalis are mobilized inferiorly and secured
to oral commissure and subcutaneous tissue in the region of the nasolabial fold
19. Facial Reanimation Techniques
◦ Masseter muscle transposition
◦ Generally used when temporalis muscle transfer or
temporalis tendon transfer are not viable options
◦ Vector pull is more horizontal 24
◦ Two slips of masseter are attached to the dermal layers of
the skin at oral commissure for overcorrection of the smile
20. Facial Reanimation Techniques
Microneurovascular muscle transfer: distal and proximal systems compromised
◦ Gracilis, latissimus dorsi, and pectoralis minor
◦ One or two stages
◦ Conflicting data on which achieves better results 23
◦ One study in pediatric patients showed single stage procedure with masseteric nerve allowed better excursion but only two-stage
procedure led to spontaneous facial movement 20
◦ Large 655 patient study concluded that for the restoration of both truly spontaneous smile and facial muscle
movement, free muscle transfer neurotized by the contralateral healthy facial nerve is best 9
21. Facial Reanimation Techniques
Static Procedures
◦ Indicated in debilitated patients or those without muscle or nerve to use
for dynamic reconstruction
◦ Benefit is immediate restoration of facial symmetry
◦ Often performed for interim support in conjunction with facial nerve
repair or grafting
◦ Alloderm typically used; also Gor-Tex
Facial Plastics: Upper eyelid gold weight
◦ Closure is sufficient to cover the cornea is reported in 78% of cases
◦ Resolution of keratitis in 62 to 100% of cases 10
22. Considerations
2010 study of 105 patients supported dynamic reconstruction even with malignant pathology,
prolonged preoperative palsy, proximal nerve injury site, radiotherapy or long graft length 11
Planned postoperative adjuvant radiation therapy should not affect decision as studies have
shown no detrimental effects from radiation 21
Age over 60 related to worse outcome 6
Failure of nerve repairs or grafts may be attributed to 22
◦ Nerve fibrosis
◦ Muscle fibrosis
◦ Infection
◦ Tension and separation at anastomosis
23. Hypoglossal Nerve Transfer
Most common nerve transfer because anatomic and functional
relationship to CN VII
◦ Course, caliber and anatomic location
◦ Less donor morbidity than other nerves which have been used including
CN XI and phrenic
Very good option when paralysis has been present for >12 months or
there is uncertainty of viability of proximal facial nerve stump 12
◦ Other authors report it is indicated within two years of onset 13
B: one year after
hypoglossal nerve transfer
24. Hypoglossal Nerve Transfer
In 1979 Conley et al described end-to-end suture of CN XII
to proximal trunk of facial nerve (b) 14
End (CN VII) to side (CN XII) suture with interpositional
nerve graft was introduced (f)
◦ CN XII is incised 30% for side anastomosis
◦ Great auricular or sural nerve often used
◦ Less ipsilateral tongue atrophy- less dysphagia and dysarthria
Dissecting CN VII intratemporally and connecting end to a
partially sectioned CN XII without graft has regained
popularity (d)
25. Hypoglossal Nerve Transfer
Efficacy
◦ Average of 5.5 months to appearance of first facial movements 12
◦ A study of 20 patients after interpositional jump graft, all had “good” facial tone and symmetry 15
◦ 13/20 had “excellent” restoration of facial movement
◦ Only 3/20 had CN XII deficits
◦ Other studies recommend avoiding interpositional grafts if alternative direct nerve transfer option exists
◦ Physical therapy after procedure is critical so patients can learn to activate the hypoglossal nerve during
planned facial movement 12
Drawbacks
◦ No cortical adaptation resulting in spontaneous smile in any of 26 patients studied in a 655 patient review
◦ 15% of patients in a 137 patient study developed hypertonia of middle 1/3 of face
◦ Often successfully treated with Botox 16
26. Outcome
Functional outcome two weeks post-op
◦ Active at home and is independent in all her ADL's
◦ Reports dizziness but improving
◦ Trismus: only eating soft foods currently
Pathology: 1.3 x 0.9 x 0.8 cm salivary duct carcinoma ex
pleomorphic adenoma of high grade with associated
positive LVI, PNI, extraparenchymal extension and a close
margin of 1 mm. PT3N0. Positive margin at geniculate
ganglion
Carcinoma Ex-Pleomorphic Adenoma:
◦ One of three malignant mixed tumors along with
carcinosarcoma and metastasizing pleomorphic adenoma
◦ Most common presentation is patient in 6th or 7th decade
with long-standing mass that undergoes rapid growth over a
few months
27. Outcome
Now receiving adjuvant chemoradiation and PT
◦ Postoperative radiotherapy improves locoregional control from 50% to 80% in patients with advanced
disease and close margins or perineural invasion 17
◦ University of Chicago study showed 5 year survival of 59% when adding chemotherapy as opposed to
10-15% with adjuvant radiation alone 18
◦ Planning on right upper lid gold weight implantation and right lower lid ectropion repair with
Oculoplastics
28. Take-home
Bell’s Palsy 19
◦ Diffuse CN VII involvement with or without loss of taste anterior 2/3
◦ Onset is acute over 1-2 days; progressive reaching max within three weeks
◦ Slowly progressive course with discrete distal branch involvement more indicative of tumor
Reconstruction Ladder
◦ Many different ways to breakdown the numerous procedures for facial
◦ Non-surgical vs Surgical
◦ Dynamic vs Static
◦ Degree of surgical intervention
◦ Duration of paralysis
29. References
1: Flint, Paul W., and Charles William Cummings. Cummings Otolaryngology: Head & Neck Surgery. Philadelphia, PA: Mosby Elsevier, 2010. Print.
2:Ridley, Ryan. "Facial Reanimation." UTMB Grand Rounds (2014): n. pag. Facial Reanimation 2010. UTMB. Web.
3: Humphrey CD, Kriet JD. Nerve repair and cable grafting for facial paralysis.Facial Plast Surg. 2008 May;24(2):170
4: Parnes, Steven. "Dynamic Reanimation for Facial Paralysis Treatment & Management." Dynamic Reanimation for Facial Paralysis Treatment & Management: Medical Therapy, Surgical
Therapy, Intraoperative Details. Medscape, n.d. Web. 25 Aug. 2016.
5:Guntinas-Lichius, Orlando, Michael Streppel, and Eberhard Stennert. "Postoperative Functional Evaluation of Different Reanimation Techniques for Facial Nerve Repair." The American Journal
of Surgery 191.1 (2006): 61-67. Web.
6: Socolovsky, Mariano, Roberto S. Martins, Gilda Di Masi, Gonzalo Bonilla, and Mario Siqueira. "Treatment of Complete Facial Palsy in Adults: Comparative Study between Direct
Hemihypoglossal-facial Neurorrhaphy, Hemihipoglossal-facial Neurorrhaphy with Grafts, and Masseter to Facial Nerve Transfer." Acta Neurochir Acta Neurochirurgica 158.5 (2016): 945-57
7:Anderl H: Cross-face nerve transplant. Clin Plast Surg 1973; 6: pp. 433
8: :Samii M: Nerves of the head and neck: management of peripheral nerve problems. In Omer G, and Spinner M (eds): Management of Peripheral Nerve Problems. Philadelphia: WB Saunders,
1970.
9: Gousheh J, Arasteh E. Treatment of facial paralysis: dynamic reanimation of spontaneous facial expression-apropos of 655 patients. Plast Reconstr Surg. 2011 Dec. 128(6):693e-703e
10: Levine R E, Shapiro J P. Reanimation of the paralyzed eyelid with the enhanced palpebral spring or the gold weight: modern replacements for tarsorrhaphy. Facial Plast Surg . 2000; 16 325-
336
11: Iseli TA, Harris G, Dean NR, Iseli CE, Rosenthal EL. Outcomes of static and dynamic facial nerve repair in head and neck cancer. Laryngoscope
12: Gidley P W, Gantz B W, Rubinstein J T. Facial nerve grafts: from cerebellopontine angle and beyond. Am J Otol. 1999; 20 781-788
30. References
13 Beutner, Dirk, Jan C. Luers, and Maria Grosheva. "Hypoglossal-facial-jump-anastomosis without an Interposition Nerve Graft." The Laryngoscope (2013): n. pag. Web.
14: Conley J., Baker D. Hypoglossal-facial nerve anastomosis for reinnervation of the paralyzed face. Plast Reconst Surg 1979; 63:63–72.
15: May, Mark, Steven M. Sobol, and Sara J. Mester. "Hypoglossal-Facial Nerve Interpositional-Jump Graft for Facial Reanimation without Tongue Atrophy." Otolaryngology -- Head and Neck Surgery 104.6 (1991): 818-25.
16: Dressler, D., and P.w. Schonle. "Botulinum Toxin to Suppress Hyperkinesias after Hypoglossal-facial Nerve Anastomosis." Eur Arch Otorhinolaryngol European Archives of Oto-Rhino-Laryngology 247.6 (1990)
17: Terhaard, Chris H.j., Herman Lubsen, Coen R.n. Rasch, Peter C. Levendag, Hans H.à.m. Kaanders, Reineke E. Tjho-Heslinga, Piet L.a. Van Den Ende, and Fred Burlage. "The Role of Radiotherapy in the Treatment of Malignant Salivary Gland
Tumors." International Journal of Radiation Oncology*Biology*Physics 61.1 (2005): 103-11.
18: Pederson, Aaron W., Joseph K. Salama, Daniel J. Haraf, Mary Ellen Witt, Kerstin M. Stenson, Louis Portugal, Tanguy Seiwert, Victoria M. Villaflor, Ezra Ew Cohen, Everett E. Vokes, and Elizabeth A. Blair. "Adjuvant Chemoradiotherapy for
Locoregionally Advanced and High-risk Salivary Gland Malignancies." Head Neck Oncol Head & Neck Oncology 3.1 (2011): 31.
19: Ronthal, Michael. "Bell's Palsy: Pathogenesis, Clinical Features, and Diagnosis in Adults." Bell's Palsy: Pathogenesis, Clinical Features, and Diagnosis in Adults. Up To Date, n.d. Web. 22 Aug. 2016.
20: Snyder-Warwick AK, Fattah AY, Zive L, Halliday W, Borschel GH, Zuker RM. The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density. Plast
Reconstr Surg. 2015 Feb. 135 (2):370e-81e
21: McGuirt W F, McCabe B F. Effect of radiation therapy on facial nerve cable autografts. Laryngoscope. 1977; 87 415-428
22: Gousheh, Jamal, and Ehsan Arasteh. "Treatment of Facial Paralysis." Plastic and Reconstructive Surgery 128.6 (2011): n. pag. Web.
23: Kumar PA, and Hassan KM: Cross-face nerve graft with free-muscle transfer for reanimation of the paralyzed face: a comparative study of the single-stage and two-stage procedures. Plast Reconstr Surg 2002; 109: pp. 451
24: Hontanilla B, Qiu SS. Transposition of the hemimasseteric muscle for dynamic rehabilitation of facial paralysis. J Craniofac Surg. 2012 Jan. 23(1):203-5.