Goals of Rehabilitating the Paralyzed Face

Facial paralysis has two major consequences: loss of volitional facial muscle motion and loss of baseline muscle tone. The loss of muscle motion leads to the functional debilities noted with facial paralysis, such as the inability to blink, to purse the lips, and to flare the nostrils. The loss of baseline facial muscle tone is responsible for many of the changes in facial appearance associated with facial paralysis, such as drooping of the ipsilateral face and deviation of the nose to the contralateral side. The ultimate goal of rehabilitating the paralyzed face would be to restore normal facial tone and function. However, it must be recognized by both physician and patient that no single technique (or combination of techniques) will restore normal facial tone and motion. It is the responsibility of the treating physician to be knowledgeable with regard to the various treatment options and to present these options to the patient in such a fashion that an informed decision may be made by the patient. For example, an 80-year-old individual with facial paralysis and multiple medical problems may be very satisfied with simple restoration of eyelid closure alone, whereas a 25-year-old individual may strive to have every nuance of facial motion restored. It remains for the surgeon to weigh the therapeutic options available against what is appropriate for each patient.

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