Comparison of Modalities for Rehabilitation of the Paralyzed Face




Restores neuronal input

Significant synkinesis;

Good choice for young

to facial muscles, with

movement of face with

motivated patients who

resulting strong resting

eating and speaking;

can accept donor site

facial tone

excessive resting tone;

morbidity and

hemitongue paralysis;


requires fairly involved

surgery; forehead rarely


Uses contiguous muscle,

Temporal depression;

May be a reasonable

not nerve; low donor site

bulk of muscle

choice for patients who

morbidity; provides

overlying the zygoma

want some movement of

elevation of the oral

may be apparent;

oral commissure, but

commissure; and allows

movement of corner of

should be reserved for

some conscious (but not

mouth is not

young motivated

spontaneous) movement

spontaneous and may

patients; amount of

of the corner of the

not be very strong;

successful movement


surgery requires general

obtained is variable

anesthesia and 2-3 hours

operating time; forehead

not improved

No donor site morbidity;

No movement of face

Nice alternative to other

simple procedure with

possible; possibility of

procedures with few

local anesthesia on an

implant extrusion;

down sides; when

outpatient basis; can

possibility of loosening

combined with upper

improve both oral

of suspension

eyelid gold weights, a

commissure and brow;

very acceptable

improves facial

rehabilitation of the

symmetry, function, and

paralyzed face may be

appearance at rest

Hypoglossal to facial nerve transfer

Temporalis muscle transfer

Gore-Tex suspension

The disadvantages of Gore-Tex suspension are the fact that it is a static procedure with no chance of facial movement. There is the additional disadvantage of potential loosening of the suspension and extrusion of the Gore-Tex implant, both of which have been very uncommon in our experience.

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