MİCROSURGİCAL PROCEDURES İN FACİAL

PARALYSİS

Repair with Microsurgical Techniques in Facial Paralysis; Facial paralysis is a deformity caused by paralysis of the facial nerve that causes both aesthetic and functional problems on the face. Facial paralysis is a deformity caused by paralysis of the facial nerve that causes both aesthetic and functional problems on the face. The most common cause is sudden exposure to cold or sudden facial paralysis of unknown cause (Bell’s paralysis). These patients recover completely by 80% with appropriate medication. However, the first 3 weeks are very critical. This period should be spent under doctor’s control. Because if there is no recovery period for 3 weeks and there is no positive development in the paralyzed muscles, the canal in the temporal bone where the nerve enters the face should be loosened immediately. Otherwise, the possibility of permanent facial paralysis is very high. In chronic facial paralysis, the most common causes are congenital facial paralysis, after surgery of tumors adjacent to the cerebellum called corner tumors and trauma.

Therefore, in my clinical opinion, how to treat facial paralysis is as follows.

In sudden facial paralysis;

  • Steroid therapy
  • Anti-inflammatory drug
  • Hot application and protection from cold

As I said before here, the critical period is 3 weeks. If there is no positive development in the paralysis during this period, the channel through which the facial nerve moves through the bone should be loosened immediately.

Cases that have not been caught by doctor in the first acute period, but are less than 6 months old.

If each muscle cannot receive an electrical stimulation from a self-stimulating nerve due to nerve damage for approximately 6 months, permanent damage to this muscle occurs. Even if the nerve is repaired after this period, this muscle has no chance to work. For this reason, I try to help my patients to save the muscles in this period by stitching a nerve that works the tongue nerve or neck muscles with a facial nerve, with a technique called babysitter, to save these muscles and to work them normally. This technique is, in my opinion, the most appropriate surgical procedure to give me a chance to save those muscles.

 

Late facial paralysis over 6 months to 1 year;

Here, the muscles are irreversibly damaged. For this reason, a muscle transplant is needed to replace facial muscles. Although there are many methods, I will tell you about your choice.

While many methods require a two-stage surgery, the method I chose is a one-stage surgical procedure. While I had chosen the two-step method before, I now choose the one-step method because of some disadvantages of these methods. In the surgical procedure I chose, the muscle taken from the inner leg (grasillis muscle) is thinned and placed on the lips and nose edges on the face. However, before this procedure, I thin the muscle considerably for an aesthetic result. I then stitch the muscle nerve to the masticatory muscle nerve. It has been reported in recent scientific publications and according to my clinical experience, this nerve works very strongly on the transplanted muscle. When it is successful at the end of approximately 6-8 months, this transplanted muscle adapts to the face enough to allow normal laughter, speech and easy presence in social situations without attracting attention.

 

 

Grasillis Muscle Removal and Moving to Face

Even if the person makes the laughing movement by thinking about the chewing at the beginning, the brain can learn this process quite well over time and the person can laugh when it progresses spontaneously. Especially in children, this development is at a very high level.

Below you will see photos and videos of a pediatric patient before and after surgery.

+In addition, patients with facial paralysis also have problems closing their eyes. In his treatment, the two methods that I use most frequently are to gain weight by placing a gold plate on the upper eyelid, which I will call static, and the other method, which I will call dynamic, is the method of opening and closing the eye by voluntarily turning the chewing muscle to the upper and lower eyelids.

As I explained at the beginning of my article, I recommend free muscle transplants to provide lip movements as the first option for my patients in late facial paralysis cases. However, if my patients do not want this method, this time I try to make lip movements by turning the masseter muscle, one of the chewing muscles, towards the lip edge. In this technique, the muscle is separated from the place where it attaches to the jawbone and turned into the lip edge as shown in the following figure. According to the anatomical characteristics of the patient, all or part of this muscle is turned into the lip edge. Even if it is turned completely, the chewing function of the patient is not impaired.

Attempts for Closing the Eyelid in Facial Paralysis

There are two methods I apply to patients who cannot close their eyelids due to facial paralysis.

Gold Plate Application

I use two methods to provide this function in patients who cannot close their eyes due to f+-acial paralysis. One of these is the placement of a gold plate on the upper eyelid. After the appropriate weight is calculated and a special gold plate is made for the patient, this gold plate is placed under the skin with the incision made in the upper eyelid. Thus, the patient can easily close his eyes, especially while sleeping. It will help to provide a comfortable life by reducing the opening of the eye during the day.

Converting the Temporal or Masseter Muscle to the Eyelid

In this method, I turn any of these two muscles, which are the masticatory muscles, towards the upper and lower eyelids. Thus, the patient can voluntarily close the eyelids besides the reduction of the eyelid opening due to the mass of the muscle.

Our Facial Paralysis Patients:

 

 

Video of the postoperative 1st year of our pediatric patient
The 1st month of our next patient after surgery:

 

2nd month after surgery:

8 months after surgery:

Pre-operative image. The patient cannot pull the corner of the lip on
 the paralyzed side while at rest while laughing.

8th month after surgery. The lip corner of our patient has started to pull, 
but swelling continues on her face due to edema.

In the postoperative 1st year of our facial paralysis patient, symmetrical laughing was achieved on the other side.

 

 

In the postoperative 1st year of our facial paralysis patient, 
symmetrical laughing was achieved on the other side.

The preoperative image of our patient, 
who we performed facial paralysis reanimation at adult age.
 There are scars related to previous surgery
 in the part of the patient with facial paralysis.
 Although there has been surgery for facial paralysis before, 
there is no pulling in the corner of the mouth.

The 5th month of our patient after surgery. Although he was an adult, the patient smiled symmetrically with the healthy side in the 5th month.

 

The 5th month of our patient after surgery. Although he was an adult, 
the patient smiled symmetrically with the healthy side in the 5th month.

 

Tumor detection in the auditory nerves is a very common pathological condition. Facial paralysis is a very common complication, as the facial nerve will be damaged on the tumor side following the formation of the tumor during surgery. Following the tumor formation during surgery, the facial nerve can be adapted to the tongue nerve (babysitter procedure), and the movements of the facial muscles can be achieved without facial paralysis.

Although the results vary from patient to patient, it should be known by the doctors who perform this surgery that there is such a treatment. Our patient was operated in this way and a satisfactory movement of the facial muscles was achieved before a complete facial paralysis developed in the postoperative 1st year.

The 3rd Month After Surgery For Another Of Our Facial Paralysis Patient. Lip Movements Begins.

 

Facial Paralysis Surgery, 1.5 Years Later

What Causes Facial Paralysis?

Idiopathic peripheral facial paralysis (a unilateral facial paralysis that starts suddenly for no apparent reason)

Take a blow to the head

Staying in the cold or wind

Skull fracture or similar facial blows

Head or neck tumor

Middle ear infection or other ear damage

Lyme disease (It is a bacterial disease caused by the tick animal caused by the bacterium Borrelia burgdorferi, which is transmitted as a result of ticks adhering to humans.)

Ramsay-Hunt Syndrome

Diseases that negatively affect the immune system, such as MS disease and Guillain-Barré syndrome

 

Is Facial Paralysis Passed?

You can easily get rid of this disease when you apply facial paralysis treatments with the right treatment methods with early diagnosis without being permanent. The critical point here is early diagnosis is an important factor.

 

How Is Facial Paralysis Treatment?

Microsurgery (Surgical Treatment)

Botox

Physical Therapy (Acupuncture)

 

How to Understand Facial Paralysis?

The symptoms of facial paralysis are generally not known clearly. The disease may also begin with pain in the neck or behind the ear. On one side of the person’s face, all the muscles that give expression to the face become weak or the muscles become completely ineffective, that is, they become unable to perform their duties. The patient begins to be unable to control his facial gestures. With the first symptom of facial paralysis, the patient begins to have difficulty in closing the eyelids, it is very difficult to wrinkle his forehead, and the lip edges fall abnormally.

 

What are the Healing Symptoms in Facial Paralysis?

After the doctor’s treatments are applied, tests are made as time passes, and as a result of these tests, the movement strength of the muscles begins to be regained. As a result of the treatment, the muscles are stretched again and the patient can move according to his own request.

 

What Should People With Facial Paralysis Do?

Facial paralysis, which also negatively affects the muscles and brain functions in the mouth, reaches its maximum level within a few hours or days. It is very important to intervene in the first 24 hours so that facial paralysis is not permanent.

 

 

How Should Facial Paralysis Exercises Be Done?

 

Moving the eyebrows up and down.

Drinking liquid beverages with the help of a straw.

Puckering lips.

Trying to whistle.

Close and open eyes.

Chewing gum.

Massaging the chin, lips and cheeks with a soft toothbrush or cheek brush.

 

A button that is put on a thread is taken between the lips and the button is tried to be held by the lips while pulling the rope. Shrunken mouth smiling, holding the sides of the mouth, giving resistance to the movement with the index and thumb tried to open. (The same exercise is also done by trying to move from the smile position to the receding position.) A button that is put on a thread is taken between the lips and the button is tried to be held by the lips while pulling the rope. The chin tries to be extended forward. Laughing without showing teeth first, then laughing with teeth showing.

 

Comments of Patients with Facial Paralysis

“It was after my tumor surgery. I was 12 then and now I am 23 years old. Because it is permanent, unfortunately, it did not pass, but do not worry, be careful about the cold and see the emergency neurologist, classical facial paralysis passes in a couple of months, maybe cortisone treatment may be required. With the right treatment, you will recover quickly, don’t worry too much. ”

 

What Are Facial Paralysis Medications?

Medications used in the treatment of facial paralysis are generally in the form of tablets. These are oral cortisone drugs for 2-3 weeks. Since they contain cortisone, they reduce edema around the facial nerve and prevent further damage to the facial nerve. Because facial paralysis progresses rapidly. While 85% of the patients recover completely with treatment, 10% partial recovery and 5% may not improve. Drug treatment should be started between 24-48 hours after facial paralysis develops. The results obtained in this way will be more successful.

 

Causes Facial Paralysis?

The reason why facial paralysis is out of diseases is due to the exposure of the face to cold and wind. Apart from these; Infections such as herpes, traumatic causes, upper respiratory tract diseases such as otitis media, cold, flu are among the causes of facial paralysis.