Download - Facial paralysis reconstruction
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Mansoor Khan M.B.B.S
Plastic & Reconstructive Surgery, HMC, Peshawar
2011
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Facial paralysis: aesthetically, functionally &
psychologically a devastating condition
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17 paired & one unpaired muscle animate the face
18
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Eye symptoms: dryness, excessive tearing, incomplete closure, outdoor discomfort, use of artificial
tears.
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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.
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Oral symptoms: continence problems, speech.
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Psychological status & level of difficulty to communicate (happiness, anger & sadness)
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Examination:Brow, eye, upper, lower
lid, position of the inf.canalicular punctum,
corneal ulcerations, philtrum, depression of commisure, nasolabial
fold, sagging of the cheek.
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Bells Phenomena
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Snap test
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Synkinesis: simultaneous
contraction of two or more muscle groups
which should not contract togather
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Patients’ expectations/concerns: sort out the problem of the patients’ concern,
if you don’t correct that then the treatment is a failure
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Aims: protect the eye, rest symmetry, provision of facial
movements (involuntary, independent & spontaneous facial
expression).
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Goals of Eye Treatment:
maintain vision, protection, functional eyelids, cosmesis improvement, expression of
emotions
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Goals of Mouth Treatment:
correction of the asymmetry, oral continence, speech improvement, provision of balance symmetrical
smile
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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
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Surgical management
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Direct brow lift
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Direct brow lift
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Coronal Brow lift
Endoscopic Brow lift
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Gold weight placement
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Gold weight placement
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Gold weight placement
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Palpebral spring placement
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Temporalis Muscle Transplantation
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Tarsorrhaphy
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Tendon sling placement
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Horizontal lid shortening
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Lateral canthorhaphy
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Tow stage Microneurovascular muscle transplantation
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Dissection of the facial nerve branches on the normal side
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Mapping of the facial nerve branches
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Mapping of the facial nerve branches
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Sural nerve harvesting with a nerve stripper
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Gracilis muscle harvesting
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Placement and
anastomosis of the
pedicle
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Placement and
anastomosis of the
pedicle
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Temporalis & masseter muscle transplantation
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Static tendon slings placement
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Resection of the depressor labii inferioris of the normal side
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Resection of the depressor labii inferioris of the normal side
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