Facial reanimations: part II--long-standing paralyses

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Facial Nerve Surgery

Background:

• Long-standing facial paralysis, typically over 18-24 months post-onset, involves fibroadipose metaplasia of facial muscles.
• Nerve input alone is insufficient; surgical muscle transfer is necessary for functional restoration.

Purpose of the Study:

• To review surgical strategies for long-standing facial paralysis.
• To discuss methods for correcting facial asymmetry and restoring movement, focusing on smiling and eyelid closure.

Main Methods:

• Surgical techniques are categorized into free-flap transplantations and masticatory muscle transpositions.
• Static correction methods (e.g., deep-lifting, fascia lata suspension) address asymmetry.
• Dynamic restoration focuses on eyelid closure (temporalis flap, lid plates) and smiling (temporalis flap rotation, gracilis free flap).

Main Results:

• Eyelid closure is commonly achieved with temporalis flaps or lid plates; blinking restoration remains challenging.
• Smiling restoration often involves temporalis flap rotation or gracilis free flap transfer, each with distinct advantages and disadvantages.
• Lower lip palsy management focuses on limiting upward drag, with contralateral paralysis as a symmetry option.
• Forehead movement reconstruction is possible but often requires extensive intervention.

Conclusions:

• Treatment for long-standing facial paralysis necessitates advanced reconstructive techniques beyond neural stimulation.
• A combination of static and dynamic surgical approaches is crucial for optimal facial symmetry and function.
• Ancillary procedures and fine-tuning are frequently required to achieve satisfactory aesthetic and functional outcomes.