FACIAL REANIMATION

• Facial reanimation is done in cases of Facial nerve palsy.
• It is done by restoration of nerve continuity.
• It works best within 6 months of onset of paralysis.
• It can be done by following methods:

Facial nerve decompression( using transmastoid sublabyrinthine approach)

Neurorrhaphy:

• direct anastomosis with or without reroutement
• cable grafting with help of greater auricular nerve or sural nerve
• Nerve transposition (crossover) with help of hypoglossal nerve, spinal accessory nerve, trigeminal nerve or phrenic nerve.

Dynamic rehabilitation

• Regional muscle transposition (Temporalis, Masseter)
• Microneurovascular muscle transfer
• Free muscle grafts
• Nerve muscle pedicle (ansa cervicalis with strap muscle for oral commisure, temporal muscle with pedicle for palpebral commisure.

Static rehabilitation

• Fascia lata sling
• Dermal transplant
• Alloplastic implants (using silastic, Dacron mesh, tantalum, silk)

Surgery for paralysed eyelid

• Laterla tarsorraphy
• Canthoplasty (medial or lateral)
• Gold weight implants
• Palpebral spring
• Silastic encircling prosthesis
• Lid  magnets
• Lower lid tightening

Control of agonist muscle

• selective neurectomy ( chemical or surgical)
• selective myectomy

Selection of procedure depends on time since surgery:

<3 weeks: nerve repair

3 weeks- 2years: nerve repair or nerve crossover

2 years: nerve repair or nerve crossover if EMG shows fibrillation

Dynamic rehabilitation for young and static rehabilitation for old age group.