Reanimation of the middle and lower face in facial paralysis: review of the literature and personal approach.
Facial paralysis refers to a condition in which all or portions of the facial nerve are paralysed. The facial nerve controls the muscles of facial expression, paralysis which results in a lack of facial expression which is not only an aesthetic issue, but has functional consequences as the patient cannot communicate effectively. The treatment of long-standing facial paralysis has challenged plastic surgeons for centuries, and still the ultimate goal of normality of the paralysed hemi-face with symmetry at rest as well as the generation of a spontaneous symmetrical smile with corneal protection has not yet fully been reached. Until the end of the 19th century, the treatment of this condition involved non-surgical means such as ointments, medicines and electrotherapy. With the advent and refinement of microvascular surgical techniques in the latter half of the 20th century, vascularised free muscle transfers coupled with cross-facial nerve grafts were introduced, allowing the possibility of spontaneous emotion being restored to the paralysed face became reality. The aim of this article is to revisit the surgical evolution and current options available as well as outcomes for patients suffering from facial paralysis concentrating on middle and lower face reanimation.
Ghali
Shadi
S
Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK. shadighali100@yahoo.co.uk
MacQuillan
Anthony
A
Grobbelaar
Adriaan O
AO
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D005154:Facial Nerve / Q000033:anatomy & histology / Q000601:surgery; D005158:Facial Paralysis / Q000209:etiology / Q000628:therapy*; D005206:Fascia Lata / Q000637:transplantation; D006801:Humans; D008487:Medical History Taking; D008866:Microsurgery; D018482:Muscle, Skeletal / Q000294:innervation / Q000637:transplantation; D009416:Nerve Regeneration; D016067:Nerve Transfer; D009460:Neurologic Examination; D009465:Neuromuscular Agents / Q000627:therapeutic use; D019651:Plastic Surgery Procedures; D013710:Tendons / Q000637:transplantation
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A