Contemporary Management of the Patient with Facial Paralysis

Abstract

Program Description: Patients with facial nerve paralysis suffer significant cosmetic and functional morbidity. These effects socially isolate the patient and may cause devastating complications, including corneal ulceration and poor oral intake requiring nutritional supplementation. Most of these patients eventually require the attention of the facial plastic reconstructive surgeon. Management of the eye involves both loading the upper eyelid and tightening the lower eyelid. Gold weight versus platinum weight for the upper lid, shortening, tarsal strip or wedge excision of the lower lid will be compared and contrasted. Mid face reconstruction can be addressed by mid face lifting or by nasal valve repair. Rehabilitation of the nasal valve is straightforward and well received by patients. The lower face functions to allow for proper articulation and deglutition. Without oral competence, drooling and social isolation will occur. Reconstructive options are either dynamic using a temporalis muscle sling or adynamic with acellular suspension. The advantages and risks associated with the procedures and the operative results of these techniques will be discussed by the panel. Each panelist in this multidisciplinary presentation will present his preferred method of rehabilitation and then case scenarios will be used to explore subtleties of each surgical approach. Educational Objectives: 1) Be able to discuss the different possible management options for the paralyzed eye. 2) Understand the different approaches to the lower face and choose between a dynamic and an adynamic reconstruction. 3) Know when to offer nasal rehabilitation to patients with facial paralysis.