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Facial Reanimation
Is surgery to correct facial paralysis due to congenital (from birth) deformity, following Bell’s palsy, after trauma or cancer surgery which damage to the facial nerve.
This can be a devastating condition affecting the patient functionally and psychologically. There might be problems with eye closure and protection of the eyes, asymmetry of the eye brows, significant asymmetry of the cheek and with crooked smile, and deformity of the lower lip. The patient van have functional drooling, redness of the eye on the affected side. This can have major effects on their social interactions.
There is lots of progress in the reconstruction of the facial paralysis with nerve and muscle transfers. These procedures can be one or two staged and occasional further minor corrections may be required.
The aim of reconstructive surgery is to restore symmetry and coordinated dynamic animation. The reconstructive strategy is tailored to each patient’s needs. Normal appearance at repose, and symmetry during voluntary and involuntary expression, competent ocular and oral sphincters, preservation of existing facial function, and minimal loss of function in other donor motor nerves should be the goal.
During Consulation:
- Factors that should be considered include:
- patient’s age
- etiology of facial paralysis
- the patient’s life general medical and psychological status
- facial muscle denervation time
- if the paralysis is complete or incomplete
- specific functional deficits
- prospects of any recovery of facial nerve function
- previous facial reanimation operations
- patient’s expectations and priorities
- the surgeon’s experience, and comfort with different procedures.
Operations:
Depending on each individual case, in order to restore facial symmetry and/or movements there might be a need for different procedures and measures that should address deformities and functional problems involving the upper, middle and lower face. Such techniques could involve the use of Botulinum Toxin Type A injections, and performance of brow lift or facelift procedures. Reconstructive options include the transfer of regional muscles from the head and neck area or distant muscle as free neurovascular transfers. These operations are usually combined with use of donor sensory nerves often taken from the legs, with no loss of motor function at donor site. The advent of microsurgery allowed more sophisticated and effective procedures, making free microneurovascular muscle transfer the gold standard method of management for the long standing facial paralysis.
Postoperative Care
Immediate Care: An external splint is applied at the angle of the mouth on the operated side, to prevent the free muscle from detaching from fixation points.
If a muscle is transferred as free flap, monitoring with Doppler takes place for
the first 72 hours, along with other observations on the face. A rhytidectomy-
Long term care: Increased resting tone is the first sign of reinnervation, and appears
around four months postoperatively, while return of motion in adults starts appearing
from six months onwards, with improvement noted for up to two years. There have
been occasions in the pediatric population, that full contractions were prominent
at four months with full smile restoration at six months. There might be a need for
the patient to have some slow-
Additional Website Resources
The article titled Smile Surgery on Wikipedia will provide some additional insight into the procedure.
