surgical treatment of facial paralysis - hackensack meridian … · 2018-12-13 · peripheral nerve...

Surgical Treatment of Facial Paralysis

Michael Rose, MD, FACS.

Chief, Division of Plastic and Reconstructive Surgery at Jersey Shore University

Medical Center.

Peripheral Nerve Surgery

Peripheral Nerve

Surgery

Disorders of

Peripheral Nerves

Spinal Cord Injury

Stroke

Nerve Regeneration

Peripheral Nerve Surgery Applications

Peripheral Nerve Disorders

• Compression Neuropathy

• Facial Paralysis

• Phantom Limb pain

• Nerve Trauma

Spinal Cord Injury

• Tetraplegic hand

• Pressure sores

• Ventilator dependency

• Bladder dysfunction

Stroke

• Upper extremity paralysis

• Aspiration

Brachial Plexus Repair

Facial Reanimation

Prostate Grafting

Foot Drop Surgery

Nerve Transplantation

Reanimation After Spinal Cord Injury

Reanimation After Stroke

Resensitization of the Buttocks

Primary Repair

Nerve Grafting

Neurotization

Free Muscle Flap

Can Be Fixed

NEURAPRAXIA

Stretching of nerve

Results in nerve dysfunction

Demyelination

Function returns by 3 months

NEUROTMESIS

Significant nerve damage

Nerve division

No recovery

Nerve repair required

Facial Paralysis

Trauma

Cancer

Stroke

Bell’s Palsy

Facial Nerve Function

• Motor Accessory Auditory Accessory Masticatory Facial Expression

• Secretory Lacrimal Parotid Submandibular/Sublingual

• Afferent from Taste Fibers Traumatic Neoplastic Congenital

Examination

• Central Paralysis

movements of the upper face tend to be spared

emotional expression may be present

lacrimation and salvation may be present

involvement of the tongue

• Peripheral Paralysis

less prominent wrinkles/nasolabial fold, brow droop

unable to wrinkle forehead or purse lips

bell phenomenon

Surgical Intervention

• Direct nerve anastomosis

• Interpositional nerve grafts

• Anastomosis to other nerves

• Dynamic musculofascial transpositions

• Static musculofascial transpositions

• Microvascular reanimation

• Other facial corrective procedures

Nothing by EMG or clinically at 3 months

Minimal Progress by EMG

or clinically at 6 months

Not completely improved by 9 months

Muscle transposition

• Temporalis

• Masseter

Crossover Techniques

• Irreversible nerve injury

• Intact motor endplates

• Intact mimetic function

• Intact proximal donor nerve

• Intact distal facial nerve

LATE CROSS-FACIAL NERVE GRAFTING AND

FREE MUSCLE TRANSFER

Summary

1) Many etiologies

2) Many treatment options

3) Etiology often drives treatment decisions

4) Can be a long process with multiple steps

5) Results are variable but can be very rewarding

6) Adjunctive treatments are helpful (biofeedback,

botox injections, static lifts and “tucks”, eyelid

weights etc)

7) Procedures have been refined over the years with

microsurgical advances, but future treatments may

be able to restore function more reliably (Stem

cells, nerve regrowth research, tissue engineering

etc)

THANK YOU Michael Rose, MD, FACS.

Chief, Division of Plastic and Reconstructive Surgery at

Jersey Shore University Medical Center.