Methods for treating established facial paralysis

Takushima Akihiko, Harii Kiyonori

doi:10.5981/jjhnc.34.275

In the treatment of established facial paralysis, reconstruction for total facial reanimation requires several kinds of operative procedures. Main targets for reconstruction are the eyebrows, eyes, cheeks, and lower lips. For the eyebrows, direct skin excision above the paralyzed eyebrow, which is mainly indicated in the elderly patients, is the most reliable method, although an endoscopic eyebrow lift should be used in young patients. Lid loading is good for patients with a slight lagophthalmos. However, contour of the plate is conspicuous in some patients and the technique cannot be used for patients who are allergic to gold. Conversely, temporary muscle transfer should be employed for complete eye closure. The Kuhnt-Szymanowski method should be employed as an ancillary approach for patients with severe ectropion. For the cheeks, face lift is a good procedure for incomplete paralysis. However, patients with slight or no movement of the cheek when smiling need a neurovascular free muscle transfer. For the lower lips, selective neurectomy or myectomy should be employed for symmetry of the lower lip. Neurovascular free muscle transfer is recently employed for dynamic reconstruction. With these operative techniques, symptoms of established facial paralysis should be treated comprehensively.

Methods for treating established facial paralysis

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