SLIDE 1
Surgical Treatment of Facial Paralysis
Michael Rose, MD, FACS. Chief, Division of Plastic and Reconstructive Surgery at Jersey Shore University Medical Center.
Peripheral Nerve Surgery
Peripheral Nerve Surgery
Disorders
- f
Surgical Treatment of Facial Paralysis Michael Rose, MD, FACS. - - PowerPoint PPT Presentation
Surgical Treatment of Facial Paralysis Michael Rose, MD, FACS. - - PowerPoint PPT Presentation
Surgical Treatment of Facial Paralysis Michael Rose, MD, FACS. Chief, Division of Plastic and Reconstructive Surgery at Jersey Shore University Medical Center. Peripheral Nerve Surgery Spinal Cord Injury Disorders of Stroke Peripheral
SLIDE 2
SLIDE 3
Peripheral Nerve Surgery
Applications
Peripheral Nerve Disorders
- Compression
Neuropathy
- Facial Paralysis
- Phantom Limb
pain
- Nerve Trauma
Spinal Cord Injury
- Tetraplegic hand
- Pressure sores
- Ventilator
dependency
- Bladder
dysfunction Stroke
- Upper extremity
paralysis
- Aspiration
SLIDE 4
- Brachial Plexus Repair
- Facial Reanimation
- Prostate Grafting
- Foot Drop Surgery
- Nerve Transplantation
- Reanimation After Spinal Cord Injury
- Reanimation After Stroke
- Resensitization of the Buttocks
SLIDE 5
- Primary Repair
- Nerve Grafting
- Neurotization
- Free Muscle Flap
Can Be Fixed
SLIDE 6
- NEURAPRAXIA
- Stretching of nerve
- Results in nerve dysfunction
- Demyelination
- Function returns by 3 months
- NEUROTMESIS
- Significant nerve damage
- Nerve division
- No recovery
- Nerve repair required
SLIDE 7
SLIDE 8
- Facial Paralysis
- Trauma
- Cancer
- Stroke
- Bell’s Palsy
SLIDE 9
Facial Nerve Function
- Motor
Accessory Auditory Accessory Masticatory Facial Expression
- Secretory
Lacrimal Parotid Submandibular/Sublingual
- Afferent from Taste Fibers
Traumatic Neoplastic Congenital
SLIDE 10
Examination
- Central Paralysis
movements of the upper face tend to be spared
emotional expression may be present lacrimation and salvation may be present involvement of the tongue
- Peripheral Paralysis
less prominent wrinkles/nasolabial fold, brow droop unable to wrinkle forehead or purse lips bell phenomenon
SLIDE 11
Surgical Intervention
- Direct nerve anastomosis
- Interpositional nerve grafts
- Anastomosis to other nerves
- Dynamic musculofascial transpositions
- Static musculofascial transpositions
- Microvascular reanimation
- Other facial corrective procedures
SLIDE 12
Nothing by EMG or clinically at 3 months
SLIDE 13
Minimal Progress by EMG
- r clinically at 6 months
SLIDE 14
Not completely improved by 9 months
SLIDE 15
SLIDE 16
SLIDE 17
SLIDE 18
SLIDE 19
SLIDE 20
SLIDE 21
Muscle transposition
- Temporalis
- Masseter
SLIDE 22
Crossover Techniques
- Irreversible nerve injury
- Intact motor endplates
- Intact mimetic function
- Intact proximal donor
nerve
- Intact distal facial nerve
SLIDE 23
SLIDE 24
SLIDE 25
SLIDE 26
SLIDE 27
SLIDE 28
SLIDE 29
SLIDE 30
LATE CROSS-FACIAL NERVE GRAFTING AND FREE MUSCLE TRANSFER
SLIDE 31
SLIDE 32
SLIDE 33
SLIDE 34
Summary 1) Many etiologies 2) Many treatment options 3) Etiology often drives treatment decisions 4) Can be a long process with multiple steps 5) Results are variable but can be very rewarding 6) Adjunctive treatments are helpful (biofeedback, botox injections, static lifts and “tucks”, eyelid weights etc) 7) Procedures have been refined over the years with microsurgical advances, but future treatments may be able to restore function more reliably (Stem cells, nerve regrowth research, tissue engineering etc)
SLIDE 35