- 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.
