Treatment of facial paralysis has come a long way. No longer do you need to “live with” facial paralysis. There are options available for virtually every patient, no matter where they are in the process. In order to get the best outcome, it is important to initiate treatment as early as possible. Dr. Panossian is a world expert in the field and has pioneered and refined some of the treatments listed below.
Lengthening Temporalis Myoplasty
Dr. Panossian’s signature technique, the lengthening temporalis myoplasty is a highly effective way to re-establish dynamic smile symmetry. It involves using the temporalis muscle, one of four major muscles used for chewing, and re-purposing it for the purpose of reanimating the smile.
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Selective Neurolysis for Synkinesis
Synkinesis is one of the most vexing problems of facial nerve recovery. It can result in unusual spasm of the facial muscles and distortion of facial features. When traditional methods of Botox® injection and therapy are ineffective, selective neurolysis is an option for interrupting the abnormal pathways that result from the process of re-innervation.
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Botox®
One of the best ways to control asymmetry caused by facial paralysis is targeted Botox® injections. The idea is to interrupt synkinesis and weaken specific facial muscles in order to re-establish facial symmetry. Botox® can be injected into the eyelids, chin, forehead, and virtually any other muscle group that is causing unbalanced symmetry of the face.
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Gracilis Muscle Transplant
The gracilis is a long inner thigh muscle that can be used for reanimating the smile. There are different options of innervation that can power the muscle. The primary nerves that are used are the masseter (used for biting) and a cross face nerve graft (transplanted from the leg).
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Cross Face Nerve Graft
A cross face nerve graft is useful for bringing innervation into a paralyzed face, as long as the other half of the face is unaffected. The graft source is the sural nerve, a sensory nerve located in the lower leg. It is harvested through small incisions and provides a long extension cord for innervation of the paralyzed side.
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Nerve Transfers
Transferring nerves to a non-functioning facial nerve can offer quick return of muscle activity. Usually, it is done in conjunction with cross face nerve grafts to allow natural return of facial muscle function. However, the success of this procedure (called the “babysitter procedure”) is dependent on how early you are in the course of facial paralysis.
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Eyelid Surgery
Perhaps the most important function to restore in facial paralysis is eyelid closure. The facial nerve allows the eyelid muscles to close and blink, protecting the eye. Drying of the eyes and lack of protection can cause damage to the cornea and blindness. Various techniques for restoring eyelid function are available and should be the priority when considering a treatment plan.
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Correction of Facial Asymmetry
Facial paralysis can cause asymmetry of the face both at rest and with animation. There are a series of procedures available to balance the facial muscles and anatomic landmarks in order to lessen the distortion. This can include selective denervation and/or muscle excision.
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Static Sling
One of the simplest ways to resuspend sagging of the face and mouth in facial paralysis is by using a static sling. This option involves using a tough piece of tissue from the thigh, called the fascia lata. The procedure can be combined with other procedures to re-establish facial symmetry.
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Facelift for Facial Paralysis
A facelift is not always done for cosmetic reasons. In long-standing facial paralysis, the drooping face can be resuspended by tightening the underlying muscle layer as well as the skin. It can be combined with a static sling to reinforce the position of the mouth or in conjunction with other symmetry procedures.
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Brow Lift
Lifting a drooping forehead is done using a brow lift. This involves lifting the deep tissues of the forehead from the eyebrow to the hairline. It can be done using an endoscope and small incisions or by way of an open technique. A brow lift also helps alleviates drooping of the upper eyelid, which can cause obstruction of vision.
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