Professional Documents
Culture Documents
Summary 13 Facial Paralysis
Summary 13 Facial Paralysis
F9giglyhe.r.ve
K
mixednerve motor fibers
f sensoryfibersfibers
sti c facialnervepathway parasympathetic
st i
Pla Pla
intracranialpart
e
intratemporalpart
extratemporalpart
@T y
facial nervebranches orbicularisoculim
frontal temporal branch 3 4Sr
noconnection btwfrontalbr
ffrontalism m
Corrugators
otherbrofthefacialnerve
Is
nervea superficialnoteinuwuzygomaticarchTaooiosisno'msuperficial deep
temporal fasa
Zygomatic 4Buccalbranch 58br overlapMinnervation
supply lowerorbicularisoculi lipelevator
U U
obicularisoris buccinator
KK
pesanserinus plexiformarrangementwithinparotid
c g
i
offacial n
st lip
Marginalmandibularbranch
la
supply depressorgrmental
themandible
relationshipwithinferiorborderof
y e
410
P
facial
9 NumbHis
ant tofacial9
Posttofacial9
I
T
1814passabove
@ @
700Ipassabovetheborder alg 19 passbelow
lootpassonthesuperficialsurfaceoftheantifacialvein
cervicalbranch i br tosubplatysmaplanesupplyplatysm
f steroids 9th24hriisno.tn
surgicaldecompression
woot 760mgId xsd 7 t to5mgIdbythetenthdayoftreatment
K U
facialparalysis earpain varicelliformrashinexternalauditorycanal
c
Pred 1Mk Dannishi
stiMobiussyndrome syndromiccongenital
s t i
Pla Pla
mostcommon bilateral 1zooooolivebirths Plan freefunctioningm transfer
involveCNH VIl IXX X
T y e
@
K
F9C
K U i protection oftheeye
c
i ofthemusclesvital forthe 2 Maintenanceofthenasalairway
i i
Function
st t
3 oralcontinence andspeech
Pla
Eyes i distancebtwupper lowereyelids 9 nmm normallynosclerashowing
in
Pla s
e
morecommon neutralgazeposition upperlidcover23mmofsuperiorcorneallimbus
y
Problem
upperlid movement lowerlidstatic1insquinting1smiling lower 92mm lid
@T
Appearanceoftheparalyzedeye widened palpebral aperture
lowerliddevelopsanectropion causingtheinfo
lacrimalpuncturetopullawayfromthe
eye
exacerbatestearing 9riskofcornealexposure
i
Lips affectsthepatient'sabilitytospeak eat adrink
inability tosmile Paralysisoflipelevatorgr
drooling 1difficultyin controllingthemouth 1Paralysisoftheobicularis oris
MII Patten hownormsTx is nooionWnwTritorsoodromoodwailodog partialorcompleteparalysis
risingonsetofparalysisdegreeimprovementtrinketscause congenital acquired unilateral bilateral otheranomalysyn
Patientsheptomy Eyes drynessexcessivetearing incompleteclosurediscomfortwhenptisoutdoorsuseartificialtears
nuff
mworn doin Nasal iairwayobstruction psychosocialfunctioning
0B work oral oralcontinencedrooling speechsmile socialinteraction
o pglienttsconcern_oioomsiioisymmetmatrest.m onstirair risooidosnomnquiina.si our
nunectropionworndroopingofthecheek
Levelofinjury Extra cranialtraumatumorcongenital
U U
Intratemporal trauma tumorinfectlinflamidiopathicBell congenital
IntracranialCIatrogenic
KK
injtumor congenitalsyndromic1hemifacialmicrosomig Mobiussyndrome
c
t i
PIysicalexgmn
s
jEye.si Positionatrestofthebrow movement upwardgazevisualfield palpebralaperturelagophthalmos Bellreflex
Pla
lowerlidpositionatone snaptestpullingtheeyelidawayfromtheglobe release
e
Positionof inft canalicularpunctum
y
ectropion
a nasal
oral
EIeeadinisrpriirtaaf.in
IIntranasalexam @T
amptiemanostrin
drooping ofthecheer
deviationpresenceabsencehasolabialfold commissuredepressiondeviation upper droops @
Inspectionphiltral 1 lip
II
pretenseofvermilioninversion bilateralcommissuremovement upperincisorshowwhen smiling
therefor
alexam dentalhygiene evidenceofcheekbiting
the preserveofsynkinesis oftwoormoremusclegr occurfromamisdirectedsproutingofaxons
simultaneouscontraction
most ofsynkinesisareeye
commontypes with
closure smilingbrowbrinkiingwhenmouthmoved mouthgrimacingwhen
eyesareclosed
Assessmentof
theothercranialn particularlyon I
Treatment protectioncosmetic
maintainvisionprovide
Theaimsoftreatmentareto n protecttheeye maintainA ofeyelidsfteyeexpressemotion
2 providesymmetry atrest Correctasym ofmouth improve speech
Idealgoal 3 providemovement provideoralcontinence g
Balancesymmetricsmile
U
involuntary
µ
independent facialexpression
KK
ofspontaneous
c
sti s t i
Pla Pla
Nonsurgical and surgicaltreatment
Nonsurgical a'outerinduisoooooeyeprotection
1maintaining lubrication
balancingfacialasymmetry
eye
T y e
selftraining Botox
@
KK USurgicalmanagement concideration ageofpatient
i c i
durationofthefacial paralysis
st st
conditionoffacialmusculature1Soft
tissue
Pla Pla
statusofthepotentialdonornerves emuscles
Brow Browptosis 7limitupward gaze of visualfield
surgically Browlift Directbrowliftoiaskinsubbrowria
y e
@T
frontalis
f
openbrowlift coronalbrowliftcstaticsuspens
Endoscopicbrowlift frontaln
transect
t weakeningcontra I
latefrontalis stripofmuscle
contralateralBotoxinj
directbrowlift Kalaivo
correct discrepancyIoimn
too agog
Uppereyelid lagophthalmos
upperhattarsalplate Ba lid loading withgoldprosthesis isthemostpopulartechnique
24Kgold inexposeeyelidskin25mm Mountwon goldweight0Wowwoot
wootsineUuou voirskin75mm n'odonorturnouta
weightrangingfrom 0.8 1.8gm Adequateimprovement in eye
mouldisin oooHou Sizer1N in closure 0.8 7.2gm
outa adequateBellphenomenon qinduswo
U U
bycausingvisiblelump irritationeye
complication extrusion capsuleformation
c KK
i
Bd Palpebralspring wireloop I 2 arms
st
onearm suturedalongtheupperlidmargin
a
Pl
otherarm fixed totheinneraspectofthelateorbitalrim
e
Advantage notdependent on gravity
T y
Problems i malposition Springbreakage orweakening
@
pseudoptosisdueto excessivespringforce
room1109Nukumedial Be
skinerosion
@
canthallig Temporalismuscletransposition
t
useless
autogenoustissue Isionnunnilatuedentulous 7muscleatop
e 7.5cmwide oftemporalism basedinferiorly
flap
flappasssubcu tolateralcanthusnoontunnel w oh
95
ovonnurlurturiumedialcanthalligament
activationmuscle fascialpulltight eyelidclosure
preferuse2mmstripoftendon
disadvanges abnormallidaperture 1oval shapetoslitshape bulkinglateralorbitalmargin
movementofeyelidduringchewing
lustowobioaoooo noisottionairnrioting excellentstatic
supporteyeclosureoncommand
Book Microneurovascularmuscletransplantation platysma transplantation
riotusuperficialtemporala a v udo reinnervation nu crossfacialnervegraft
KK U
BG Lateraltarsorrhaphy iosiousio horizontallidlengthEuro
nutfindanestheticcorneaseverecornealexposure f
Mclaughlin
c
4959W
sti t i
fold
odd
µ galairwayMod
s
tower
Pla Pla
lidsuspension tighten roundweakeningofnasalis
eyeliditylateralcanthoplasty 1 elevatoralaequenasi muscles
horizontal lidshortening
cartilagegraft spacer
y e
droopingcheek nasalseptaldeviate
Sx tendonsling
T
@
ooviltonhointobHiectropionthink Bell
mwoisusoniaulist phenomenon urinilowerlidrowupperlid cartilages
in laxityvisions
onproceduren'suspensionHigtheninglplexyHendonslim HoinimulVowmiddlelaminacontractisviriollombindiusRacer
KK U
Uppertip a cheek reconstruction
correctionofasymmetricalrest
c
smilereconstruction stahilaynamic
stismileanalysis
st i
Pla Pla
1 Directionofmovementofthecommissure4upperlip
2 Howverticalisthemovement estimatemuscle size
3 Wherearoundthemouthistheforcemoststronglyfocused9 directionof movement
y e
@T
4 whatisthepositionofthenasolabialfoldwithsmiling tension
5 Istherea labialmentalfold9 placement
hymammio Procedure or
keyfactors faIInmp.o nhafudai
491918
partial orcomplete 7 Adequalenenefe9 fY
NOO crossfaceotherCN
presenteroftheproximalstump directrepair or
t
ifwsistatfaieieoFueEIutLateO
IYe9Iaee.m.itimatifTwea
U U free transfer
M
c KK facial
cross
i
presenseof motorendplate orother CN
a st
y e Pl
@T @
KK U
sti c s t i
Pla y e Pla
@T
KK U to FFacigal
IParrahyysisg.IO
sti c t
st i
Pla Pla
unilateral Completelpartial
e
congenitillacquire
Bilateral
V
taking
History
dcheil
111Patientsymptoms complaint
Patientassessment
other
t
Bilateralfacialexamination's
Functional Aesthetic @T y
lowhatistheproblemeexpectation
K
op
Managementoffacialparalysis99
K f
involuntary
st ic
Fortheidealgoal Protectionofthevitalfa symmetryatrestmovementwith independent
Eyes Maintainvisionafhofeyelidsprotection cosmeticseyeexpressemotion
e P io
a
spontaneous
P l
Mouth Provideoralcontinenceprevent droolingimprove speechcorrectasymmetryrebalancesymmetricsmile
F
T y e Palients
@ ftp @
toNonsurgicaltreatment Duralionoi
paralysis tosurgicaltreatment
globeprotection factors facialmusculaturesofttissuestatus static staticsling
lidtapingso contactlenspatch Abilityofproximalfacialnerve Dynamic Directrepair
f
moisturechamberslubrication statusofpotentialdonor
nerve restoration Nervegrafting
Nerve
prancing selfdirectmirrorexercise q
f
Nene.FI
cross
agYue
ifneM neuromuscular
training Musclerestoration
frgeegeionma.lff.us
if Surgicaltreatment
Lowerlip'M Hasalairway EyeskBrown
Jh
Commissure Hdepressorlabii
tostaticsling MBrowptosis Browlifting
uppe.FI
Highlight ptZtyinferiorisresectionlaAlarbaseelevation CDirectcoronalendoscopic
K U WTVW
Smilereconstruction lonnormalsidel IIlagophthalmos
Haseptoplasty
K
19muscle
c
transfer IGoldweightispringitarsorrha
ti to
t i
Platysma
digastric
of rest
s s
correction asymmetrical temoporalistransfert
Pla Pla
balancesymmetricsmile 11Wedgeexcision theectropion
mostpatientprefergdynamicrecon
e
tendonsting.la canthopiasty
IS'on Nerve
y
Horizontallidshortening.car.org
K
app
sti t i
mile
Pla Nerveinput
1
Muscle motor
I
Propermuscle
Pla s
or source unit positioning
y e
@T
HousecNVItipsilatorcontralate Moriginalfacialmuscle smileanalysisfrom
11UsenonCNMI7CNVXI IPtransferredmuscle maltedside
H CN H
selectthenemeinputtotherau themuscleunit
Select
determine
by determine duration
by
usableofavia duration
NOT 72
m
1 I FE9niaofral.fiIfanmster
mu've
f
ipsilateral contralateral n orig
T t facialm transform lemporalismmasseterm
determineby Newetr9nsfer atrophy
timing1durationfacialn.s
lump
facial
indication needBabysitting
Preventfacialmatrophy
Musseleettransplantationf
4 1 unavailable nstump during
ingraftingregenerating
Infiniti
iii i
U n'repair
innovator U
K
nenere9enemim4direotrepgir1n
mown.im.se c.m
unnaturalaction
Babysitters
K
immldayalterimo
ic
Nervetomasseter
t
ggapiian.gro.HN temporary
by
monitor advancing
s
inipsilatibituo cnn.CN12 Tina'ssign
a
IPpfeevseenmtemmffceeatfopnhec
z z.no
l
CN rootofbrachialplexus
P
Hulacontralat
T y e 1 stage 2 stage
@ @
Minnervatedbyipsilateral stagel
fhoomsuralngralt
facialncifavailable facial mapping
vi
m.ciongn.seg.c Om.withlongn.segmenlinnervated Crossfacialngraft
LDirectusabdo gracilis bycontralateralfacialn.br reversedirection
MinnervatedbycNYXI stage
IXMobiussyndrome microneurovascularm
KK U
sti c s t i
Pla y e Pla
@T
KK U
airfog thaEw 1
c
a
sti st i
Pla Pla
facial palsy
smile reconstruction
y e
innervation
motor unit
@T
Nerveselection
nerve to masseter CNI
MsoofaoSinaDw
coin coaptiviru facial distal stump niriowinn'um it awords Br
Moominliarsmile in'owinismiles
Unaids nerve to masseter too 4 mo Nw recovery
U U
cross face nerve graH
c KK
ATNOON 75 20 Cm from Oi JoU N lo Cotow
un un Niro b uDinhmasseter n cws1 crossface br hiis710727JU 9
i
hi
t
0
P la s
T y e
Baby sitter wiownicross
face
@ @
moi babysitter una.lucoaptrosproximal ro
facial n stumpIou nounsstageWoo in
h graH arrionvoicesmilebr lov Sino riababysitter
vousviaEArinkounwisauliansrovoirmounrinlivo
vivoviebabysitterVario n'adonorn minio aahmm'srole
DuointuwWontsousafurecovery Io howill doharm5070
Tooutcausewinuriafacialpalsy Monsieururo_0intoa
why inOisinSxNov6 mo Ino Sasrooo 2NDyr7 low
dominionFMr rib atactionpotentialarrovisxrov
KK U
sti c s t i
Pla y e Pla
@T
dull
KK U identified
zuger point 7 home to masseter
sti c st i
Pla Pla
3.7cm anti to tragus intraop
91M
zygomatic and bony
e
0.8cm
deep 1 I am
@T y
U KK U
st ic
Pla
T y e
@ @
KK U
sti c s t i
Pla y e Pla
@T
KK U
sti c st i
Pla y e Pla
@T
U KK U
st ic
Pla
T y e
@ @
KK U
sti c s t i
Pla y ePla
@T