Static Rehabilitation Procedures

A static sling procedure is generally indicated when the patient does not desire restoration of facial motion or is not medically fit to undergo a more extensive procedure under general anesthesia. Although static sling procedures do not restore facial motion, they do improve facial aesthetics for the patient by providing facial symmetry at rest and often will improve oral incompetence. Traditionally, a fascial graft, such as fascia lata from the thigh, is harvested and anchored from the zygomatic arch to the orbicularis oris, using the same techniques described for muscle transfer. In recent years, availability of highly biocompatible alloplastic implants has obviated the need for harvesting autologous fascia, which eliminates donor site scar and morbidity as well minimize operative time. The most commonly used alloplastic material for midfacial suspension is Gore-Tex,7 although Alloderm is also currently being used. The procedure is simple and easy to perform. A sheet of the implant, either Gore-Tex or Allo-Derm is trimmed to an estimated appropriate size, and a vertical slit is made in the lower part of the implant. Small incisions are made in the melolabial crease and preauricularly over the root of the zygoma. A subcutaneous tunnel is dissected connecting the two incisions. The implant is placed in the subcutaneous pocket and brought out through both incisions. The inferior edge of the implant is sutured to the orbicularis oris muscle as described previously. The other end of the implant is pulled superiorly to achieve the desired elevation of the cheek and upper lip and then anchored to the zygomatic arch with permanent sutures. Some overcorrection is necessary, although not as much as the muscle flaps.

Face lift, performed either alone or in conjuction with a static sling, is also very helpful in reanimation of the paralyzed midface. A deep plane face lift generally yields superior results over the standard superficial lift by SMAS suspension or plication for rehabilitation of the paralyzed face.

Rehabilitation of the Lower Lip

With paralysis of the marginal mandibular nerve, the lower lip may drift in a downward and/or medial direction, which can result in oral incompetence, drooling, and difficulties with annunciation. These functional difficulties usually occur when the paralytic lip drifts down and medially. Correction of this deformity requires static suspension with a sling from the lateral lip to the zygomatic arch and/or a deep plane face lift to pull the corner of the lower lip up. If a midfacial paralytic deformity is being corrected at the same time, the muscle flap or alloplastic sling can be sutured to the lateral lower lip to correct this deformity. For an isolated marginal mandibular nerve paralysis that results in a medial and downward drift of the lower lip, a static sling can be performed. The sling should be tunneled superficially along the cheek to prevent injury to the intact buccal and zygomatic branches. If the lip is only deviated medially, it is primarily a cosmetic problem and can generally be corrected with a lateral lower lip wedge excision.8 However, wedge resection alone will not correct a medial and downward deviation. As previously mentioned, this type of deformity requires a combination of static suspension, such as a sling or deep plane face lift, and wedge resection. Coneley9 also described cheiloplasty for this deformity, where a wedge resection is performed in conjunction with transposition of a viable por tion of the contralateral lip to create a smaller mouth opening and establish a dynamic sphincteric lip.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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