Our facial expressions are extremely complex. Smiling, closing our eyes, and lifting our eyebrows are such natural expressions of our emotions. For patients who experience facial paralysis, the loss of some or all of these abilities can be life-altering. They often suffer from a drooping mouth, an inability to close one or both eyes, and a significant change in their appearance. The condition can not only have a debilitating effect on the functionality of facial features but can also severely impact one’s self-esteem.
Although there are conditions where facial paralysis has resolved over time, and normal form and function of facial features progressively restore themselves, therapy or surgical treatment is often needed to reanimate the face. Facial paralysis reanimation surgery primarily seeks to restore symmetry to the smile. Associated procedures can also be performed to establish eyelid closure and to fill areas were affected muscle atrophy has occurred. In facial reanimation surgery, our reconstructive surgeon will attempt to rebalance the smile by restoring function in the paralyzed area. In cases of partial or complete paralysis, functioning muscles may be moved into those regions with the goal of restoring balance and form.
- Muscle Transfer
- Nerve Grafting
- Neural Techniques
- Eyelid Surgery
- Other Procedures
Reanimation In Depth
Eyelid reanimation for the treatment of paralytic lagophthalmos: Historical perspectives and current applications of the gold weight implant
Upper eyelid and eyebrow position may both be affected by facial nerve paralysis due to innervation of the frontalis and orbicularis muscles by branches of the facial nerve. The two are interconnected and function as a complex; consequently, brow position has mechanical effects on eyelid position. For example, descent and deflation of tissues may lead to brow ptosis, exacerbating underlying dermatochalasis, or eyelid ptosis. In cases of facial nerve paralysis, management of eyebrow ptosis should be weighed against underlying lagophthalmos due to weakness of eyelid closure, and brow elevation be titrated so as not to worsen underlying lagophthalmos.
Various facial reanimation procedures can be performed for treating patients with chronic facial nerve paralysis. The radiologic imaging features of static and dynamic techniques are reviewed in this article with clinical correlation, including brow lift, eyelid weights and springs, gracilis free flaps, fascia lata grafts, temporalis flaps, and Gore-Tex suspension slings. Although the anatomic alterations resulting from facial reanimation surgery may not necessarily be the focus of the imaging examination, it is important to recognize such changes and be familiar with MR imaging compatibility of the associated implanted materials. Furthermore, imaging is sometimes used to specifically evaluate the postoperative results, such as vessel patency following free gracilis transfer.