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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.

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