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Rehabilitation of the Paralyzed Face

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Rehabilitation of the Paralyzed Face

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    1. Rehabilitation of the Paralyzed Face Elizabeth J. Rosen, MD Karen H. Calhoun, MD 10/30/02

    2. Rehabilitation of the Paralyzed Face Personally devastating Cosmetic deformity Psychological distress Functional deficits Lagopthalmos and ectropion Oral incompetence Nasal obstruction Mastication difficulties Articulation difficulties

    3. Rehabilitation of the Paralyzed Face Goals Functional EYE PROTECTION Oral competence Cosmetic Symmetry at rest Volitional movement Facial expressions

    4. Rehabilitation of the Paralyzed Face Static Slings Gold weight Tarsorrhaphy Lower lid shortening Brow lift Face lift Dynamic Nerve grafting Direct Interposition Crossover Muscle transfer Regional Free flap

    5. Rehabilitation of the Facial Nerve Restore neural input Replace nonfunctional facial neuromuscular units Statically resuspend facial tissues Adjunctive procedures to address specific defects

    6. Patient Evaluation History Etiology Prognosis Duration Past medical history Neurological disease Physical examination General appearance Complete head and neck exam Donor tissues

    7. Rehabilitation of the Facial Nerve Restore neural input Replace nonfunctional facial neuromuscular units Statically resuspend facial tissues Adjunctive procedures to address specific defects

    8. Rehabilitation of the Facial Nerve Restore neural input Procedure of Choice Distal facial nerve available Within 3 years of injury Best outcome Options End-to-end anastomosis Interposition graft crossover

    9. Rehabilitation of the Facial Nerve Replace nonfunctional facial neuromuscular units 2nd choice Long standing paralysis Lack of normal neuromuscular units Patient contraindications to nerve crossover Dynamic function Options Regional muscle transfer Free muscle transfer

    10. Rehabilitation of the Facial Nerve Statically resuspend facial tissues 3rd choice Patient factors Temporizing measure Symmetry at rest Options Fascia or synthetic slings

    11. Rehabilitation of the Facial Nerve Adjunctive procedures to address specific defects Options Gold weight implants/lid springs Lid shortening procedures Lower lip wedge resection Brow/face lift botox

    12. Restoration of Neural Input Primary anastomosis Interposition graft Crossover graft Cross-facial graft

    13. Restoration of Neural Input Primary anastomosis Procedure of choice Performed immediately/ASAP Technique Magnification Epineural/perineural 8-0, 9-0, 10-0 nylon suture Must have no tension Rerouting if necessary

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