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Nervus facialis parese

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Nervus facialis parese
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nervus facialis parese Qevevux, Wed, May, 16, 2018

The midthird of the face is probably the most challenging region in facial reanimation. In this area, staple static procedures such as slings (either temporalis sling or Gore-tex sling) and cervicofacial rhytidectomy, or more complex reconstruction such as tissue transfers or cross-facial reinnervation procedures, can be performed. Base decision making on the patient's personal needs of restoration and, most importantly, on the patients' general health.

nervus facialis parese Cafetac, Wed, May, 16, 2018

The same decision should be made if the patient is in bad health or at higher risk (eg, diabetes, old age, multimorbid state). In the upper third of the face, a frequent problem is lack of eye closure and ectropic lower eyelid; placement of upper-lid gold weight is performed as a static procedure. 35, for lower-lid ectropion, wedge excision of the lateral lower eyelid and lateral canthopexy are possible static procedures. Cosmetic impairment as found in ptosis of the eyebrow can be corrected with partial forehead and brow lifts.

nervus facialis parese Ucytepiw, Wed, May, 16, 2018

In this case, coapting the stumps is not successful, and innervated free tissue transfer or muscle transposition (temporalis, masseter, gracilis muscle) is indicated. The performance of microneurovascular tissue transfer has 2 major advantages in this scenario; ie, the possibility of voluntary facial musculature movement and volume gain in case of loss of muscle volume after surgery. If the patient is not compliant enough to undergo several operative procedures, as is often necessary in microneurovascular tissue transfer or cross-facial nerve grafting, offer static procedures, such as sling placements (temporalis sling, gore-tex sling) or cervicofacial rhytidectomies to improve static symmetry of the face.

nervus facialis parese Xovys, Wed, May, 16, 2018

If the stumps cannot be approached easily intraoperatively, farther proximal preparation can be performed to gain more length for the coaptation of the facial nerve. Cable grafting (interposition nerve grafting using either the greater auricular nerve or sural nerve) also may be necessary in some patients and is used when the coaptation would be under significant tension. Silence on the emg usually indicates long-term denervation.

nervus facialis parese Ikytys, Wed, May, 16, 2018

21, direct coaptation of the proximal and distal facial nerve stumps or interposition nerve grafting should not be performed at this time. In this case, close follow-up study of nerve regeneration with clinical and technical methods (physical examination, tinel sign, enog, mst) is the therapeutic strategy of choice. Treatment algorithm according to facial region involvement. View Media gallery, emg percutaneous testing can reveal fibrillation potentials. These potentials resemble the permanent denervation of the facial nerve; in this case, coaptation of the distal and proximal stump is indicated.

nervus facialis parese Egypyx, Wed, May, 16, 2018

Clinically, facial nerve paralysis is considered chronic when its onset or the time of injury dates back more than 1 year. Two types of procedures are used in the surgical treatment of chronic facial nerve paralysis: dynamic and static reanimative procedures. Dynamic techniques include all surgical procedures that enable the patient to actively move facial or grafted muscles; static techniques include operations performed to optimize symmetry and reduce complications (eg, lip wedge resection, sling placement, partial cervicofacial rhytidectomy, upper lid blepharoplasty, lateral canthopexy). When considering surgical intervention in chronic facial paralysis, carefully evaluate the patient's remaining potential for spontaneous recovery by electromyography (emg mst, and enog. Emg evaluation, as indicated in the algorithm in the image below, emg testing can reveal polyphasic motor unit potentials (mup which are expressions of regenerative processes of the facial nerve.

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