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Rehabilitation of Facial Paralysis
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
9 sections · 74 slides
Overview
- Scope of this topic
Burden and epidemiology
- Functional deficits of facial paralysis
- Psychosocial consequences
- Incidence of iatrogenic facial nerve injury
Timing of intervention
- Immediate management of a recognised injury
- Management of complete transection
- Decision pathway at the moment of injury
- Role of static repair in the acute setting
- Delayed management and the six-month window
- Assessment of facial nerve function
Static reconstruction
- Definition and rationale of static techniques
- Static reconstruction by facial third
- Functional anatomy of the upper face
- Brow ptosis correction precedes eyelid surgery
- Upper eyelid weight placement
- Weight sizing and choice of material
- Lateral tarsal strip procedure
- Functional deficits of the paralysed midface
- Tensor fascia lata suspension technique
- Static suspension of the midface and lower lip
- Outcomes of fascial suspension
- Contralateral chemodenervation with BoNT-A
- Chemodenervation and re-innervation of the paralysed side
Principles of nerve repair
- Dynamic reconstruction and the timing of repair
- Instrumentation and microsurgical handling
- Requirements of a sound nerve coaptation
- The repair gap and growth factor transduction
- Bridging long segmental nerve defects
- Allograft repair of a sacrificed zygomatic branch
- Biologic and pharmacologic repair adjuncts
Nerve substitution and selective re-innervation
- Premise of nerve substitution
- Applications and donor options
- Donor nerves for facial re-innervation
- Historic hypoglossal-facial transfer and its morbidity
- Refinements of hypoglossal transfer
- Masseteric nerve transfer
- Selective masseteric re-innervation of buccal branches
- Masseteric versus hypoglossal outcomes
- Cross-face nerve grafting
- Babysitter procedures
Muscle transfer
- Indications for microvascular free tissue transfer
- Donor muscle and innervation options
- Gracilis inset and vector
- Cross-face graft with neurotized gracilis reconstruction
- Temporalis tendon transfer: rationale
- Evolution of the temporalis transfer technique
- Orthodromic temporalis tendon transfer
- Safety profile and comparative outcomes of TTT
- Choice of dynamic technique by time and tissue
Synkinesis and retraining
- Definition and mechanism of synkinesis
- Chemodenervation for synkinesis
- Surgical management of synkinesis
- Facial retraining therapy
- Timing and duration of retraining
Summary
- Immediate primary repair of complete transection
- Principles of facial rehabilitation
- Practice points to carry forward
- References
- References (continued)
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- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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