Conclusion

Surgical planning for reanimation of the chronically paralyzed face continues to be a challenge. This is related to the fact that even the most advanced reanimation techniques in the best hands often yield disappointing cosmetic or functional results.

We have outlined our specific approach as it has evolved over the past decade (Fig. 24-1) and have defined clinical scenarios that deviate from the dogma that reinnervation techniques come first, followed by dynamic muscle transfer, leaving static techniques as a last resort. These procedures are not mutually exclusive; specific clinical goals must dictate therapy. For example, there is a role for muscle transfer even in the setting of expected nerve recovery, and there is a role for static procedures even in patients who are a good anesthesia risk, who have isolated functional complaints relative to their facial palsy.

As more techniques for both static and dynamic reanimation of the paralyzed face are developed, a growing number of tools will be at our disposal for the treatment of what continues to be a suboptimally managed problem.

REFERENCES

Hadlock and Cheney—CHAPTER 24

1. Cheney M, ed. Facial Surgery, Plastic and Reconstructive. Baltimore: Williams & Wilkins; 1997:665-684

2. Baker D, Conley J. Regional muscle transposition of rehabilitation of the paralyzed face. Clin Plast Surg 1979;6:317-331

3. May M. Muscle transposition for facial reanimation: indications and results. Otolaryngol Head Neck Surg 1984;92:85-87

Cheney M, McKenna M, Megerian C, Ojemann R. Early temporalis transposition for the management of facial paralysis. Laryngoscope 1995;105:993-1000

O'Brien B, Franklin J, Morrison W. Cross-facial nerve grafts and microneurovascular free muscle transfer for long established facial palsy. Br J Plast Surg 1980;33:202-215

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