FPRS facial reanimation Flashcards
What are the intratemporal segments of the facial nerve?
Canalicular (within the internal auditory canal), labyrinthine,
tympanic, and mastoid
What are the extratemporal branches of the facial nerve?
Posterior auricular nerve, nerve to the stylohyhoid, nerve to the posterior
belly of the digastric, temporal, zygomatic, buccal, marginal mandibular, and cervical branches
What is the primary blood supply to the facial nerve distal to the stylomastoid foramen?
Posterior auricular artery
What are some causes of facial nerve paralysis?
Ramsay Hunt syndrome, otitis media, otitis externa,
mastoiditis, Lyme disease, birth injury (traumatic forceps delivery), penetrating facial trauma, cerebrovascular accident, AIDS, diabetes mellitus, Mobius syndrome, skull base fracture, acoustic neuroma, meningioma, temporal bone malignancy, parotid malignancy, iatrogenic injury (partoidectomy, mohs surgery, mastoidectomy), amyloidosis, Wegener’s granulomatosis, neurosarcoidosis, multiple scle-
rosis, Guillain-Barre syndrome, Bell palsy (idiopathic)
Describe the House-Brackmann grading scale for
facial paralysis.
Grade I: Normal facial function
Grade II: Complete eye closure, minimal asymmetry with
facial movement
Grade III: Symmetry at rest, complete eye closure with
effort, slight mouth asymmetry with movement
Grade IV: Symmetry at rest, incomplete eye closure,
obvious asymmetry with movement
Grade V: Asymmetry at rest, barely perceptible movement
Grade VI: No facial movement
What physical examination findings are associated
with facial paralysis?
Brow ptosis, upper eyelid ptosis, lagophthalmos, ectropion,
increased scleral show, loss of midfacial width, effacement
of nasolabial fold, collapse of external nasal valve, inferior
position of oral commissure, jowling, synkinesis
Describe the role of electroneuronography (ENoG) in preoperative evaluation of facial paralysis.
ENoG measures the motor response of facial musculature
to an electrical stimulus applied to the facial nerve near the
ipsilateral stylomastoid foramen. Comparison is made between the paralyzed and nonparalyzed sides of the face.
If the paralyzed side shows greater than 90% degeneration
relative to the non-paralyzed side, the prognosis for return of satisfactory facial nerve function is poor.
What surgical options exist for the correction of
brow ptosis resulting from facial paralysis?
Direct brow lift, midforehead brow lift, pretrichial brow lift, endoscopic brow lift, and coronal brow lift
What surgical options exist for the correction of ectropion resulting from facial paralysis?
Tarsorrhaphy, lateral tarsal strip procedure, canthoplasty, canthopexy, fascia lata sling, temporalis transfer, expanded polytetrafluoroethylene (e-PTFE) sling, suborbicularis oculi lift
What surgical options exist for the correction of lagophthalmos resulting from facial paralysis?
Tarsorrhaphy, gold weight placement, placement of upper
eyelid spring
What materials can be used to perform a static facial sling?
Fascia lata, temporalis fascia, acellular human dermal allograft, e-PTFE, and permanent suture
What are some potential complications of static sling placement for the treatment of facial
paralysis?
Stretching of graft material and loss of correction, infection, extrusion of graft, allergic reaction to graft, hematoma, skin
necrosis
Describe the technique of direct VII–XII neurorrhaphy with parotid release for the treatment of facial paralysis.
A mastoidectomy is performed, and the vertical segment of
the facial nerve is decompressed to the stylomastoid
foramen and divided just distal to the second genu. The
facial nerve is then released from the fibrous attachments
at the stylomastoid foramen and followed to the pes
anserinus. The posterior parotid is then released from the surrounding soft tissue, providing additional length. The hypoglossal nerve is then found near the submandibular
gland and direct end-to-side neurorrhaphy of the facial and hypoglossal nerve is performed.
Describe the technique of cross-facial nerve
grafting for the treatment of facial paralysis.
Recipient nerves are identified on the paralyzed hemiface
and followed back to the pes anserinus. Next, the contralateral facial nerve is identified proximally and
followed out to the terminal branches. Regions with
redundant innervation are selected using facial nerve stimulation to minimize donor-site morbidity. A sural nerve or great auricular nerve graft is then harvested and interposed between donor and recipient nerve endings.
Describe the technique for temporalis muscle sling for the treatment of facial paralysis.
A curvilinear incision is extended superiorly from the helical root into the parietal scalp. Dissection is carried down to the deep temporalis fascia and the middle third of the muscle is incised, leaving an inferior pedicle. A subcutaneous tunnel is created from the oral commissure to the temporal region.
The myofascial flap is brought through the subcutaneous
tunnel, and the distal ends are secured to the superior and
inferior orbicularis oris.
