Facial Plastic and Reconstructive Surgery

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Program Description: Patients with facial nerve paralysis suffer significant cosmetic and functional morbidity due to lack of eye protection, ectropion, and lack of muscular control of the lower face. These effects can not only socially isolate the patient but may cause devastating complications to the affected organ including corneal ulceration and poor oral intake requiring nutritional supplementation. While the etiology of facial paralysis can be multifactorial, most of these patients eventually require the attention of the facial plastic reconstructive surgeon. Management of the eye involves not only loading the upper eyelid but tightening the lower eyelid. Many procedures are available for this rehabilitation, and these will be discussed. 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. The high incidence of nasal obstruction following facial nerve paralysis often is not recognized and should not be neglected. Rehabilitation of the nasal valve is straight forward 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. The reconstructive options for the lower face can be considered as either dynamic using a temporalis muscle sling or as dynamic with just some form of 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 their preferred method of rehabilitation and then case scenarios will be used to explore subtleties of each surgical approach. This miniseminar will consist of a short presentation by each panelist with a focus on individual case management presentations. Audience participation will be encouraged. Educational Objectives: 1) Be able to manage the acute and chronic effects of paralysis of the upper eye. 2) Add tarsal strip to their management paradigm of the lower lid. 3) Discuss the benefits and disadvantages of lower face reanimation with dynamic vs adynamic reconstruction.