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 Nerves Peripheral Nerve Surgery Nerve Regeneration

Peripheral Nerve Surgery Applications Peripheral Nerve Spinal Cord Stroke Disorders Injury • Compression • Tetraplegic hand • Upper extremity Neuropathy • Pressure sores paralysis • Facial Paralysis • Aspiration • Ventilator • Phantom Limb dependency pain • Bladder • Nerve Trauma dysfunction

 Brachial Plexus Repair  Facial Reanimation  Prostate Grafting  Foot Drop Surgery  Nerve Transplantation  Reanimation After Spinal Cord Injury  Reanimation After Stroke  Resensitization of the Buttocks

Can Be Fixed  Primary Repair  Nerve Grafting  Neurotization  Free Muscle Flap

 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

 Facial Paralysis  Trauma  Cancer  Stroke  Bell’s Palsy

Facial Nerve Function • Motor Accessory Auditory Accessory Masticatory Facial Expression • Secretory Lacrimal Parotid Submandibular/Sublingual • Afferent from Taste Fibers Traumatic Neoplastic Congenital

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

Surgical Intervention • Direct nerve anastomosis • Interpositional nerve grafts • Anastomosis to other nerves • Dynamic musculofascial transpositions • Static musculofascial transpositions • Microvascular reanimation • Other facial corrective procedures

Nothing by EMG or clinically at 3 months

Minimal Progress by EMG or clinically at 6 months

Not completely improved by 9 months

Muscle transposition • Temporalis • Masseter

Crossover Techniques • Irreversible nerve injury • Intact motor endplates • Intact mimetic function • Intact proximal donor nerve • Intact distal facial nerve

LATE CROSS-FACIAL NERVE GRAFTING AND FREE MUSCLE TRANSFER

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)

THANK YOU Michael Rose, MD, FACS. Chief, Division of Plastic and Reconstructive Surgery at Jersey Shore University Medical Center.