Facial expression and musculature is complicated and one of nature’s most delicate functions. Deformities secondary to facial paralysis such as sagging of the face, ectropion, epiphora and drooling, can be distressing to the person afflicted with facial nerve paralysis.
Permanent paralysis of the 7th cranial nerve results in one of the most severe cosmetic or functional deformities of the face, and its correction, which never is perfect is a major challenge for the plastic surgeon.
The reconstructive aim in facial nerve paralysis is to restore first the normal appearance of the face at rest, then symmetry with voluntary motion, controlled ballance in expressing emotion, restoration of oral, nasal, and ocular sphincter control, and to prevent loss of other significant functions.
The reconstructive techniques required to correct facial paralysis are fascial suspensision, masseter and temporalis muscletransfer with carrying insertions, control of spastic antagonistic muscles by neurotomy or selective myom-ectomy, a unilateral uplifting rhytidoplasty with formation of a nasolabial fold, correction of the palpebral deformities by simple canthoplasty or lateral tarsorrhaphy, nerve anastomosis, nerve rerouting, nerve grafting and muscle transplantation with microneurovascular anastomosis, etc.
The choice of procedures was never dependent on the prejudice of the operator but on a detailed analysis of the etiology, degree, status prognosis, and rate of progression of deformity, as well as on the usual evaluation of the patient’s age, sex and general health.
We treated two permanent facial paralysis patients with combined static fascia lata suspension and dynamic muscle transposition, by using portions of the masseter and temporalis muscle to support and reactivate the eyelid and mouth.
By this combined use of divergent muscle action, the facial animation more closely simulates normal facial movement. Postoperatively, electromyographic tracings showed action potentials in transferred muscles.
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