Microsurgery in Facial Paralysis
Repair of Facial Paralysis with Microsurgery Techniques; Facial paralysis is a very common deformity that occurs as a result of paralysis of the facial nerve (Facial nerve), which causes both aesthetic and functional problems on the face
Microsurgical Techniques in Facial Paralysis Repair
Facial paralysis is a very common deformity that occurs as a result of paralysis of the facial nerve (Facial nerve), which causes both aesthetic and functional problems on the face
The most common cause is sudden exposure to cold or sudden facial paralysis (Bell's palsy) which often develops for unknown reasons. These patients recover completely at a rate of 80% with appropriate drug treatment. However, the first 3 weeks are a very critical period. This period should be spent under the supervision of a doctor. 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 must be loosened urgently. Otherwise, the person is very likely to develop permanent facial paralysis.
The most common causes of chronic facial paralysis are congenital facial paralysis, post-surgery of the cerebellum and adjacent tumors called corner tumors, and trauma.
Therefore, in my clinical opinion, how facial paralysis should be treated is as follows.
If suddenly developing facial paralysis
- Steroid treatment
- Anti-inflammatory drug
- Hot application and protection from cold
As I said before, the critical period is 3 weeks. If there is no positive development in the paralysis during this period, the canal in which the facial nerves travel within the bone, called decompression, should be loosened urgently
Facial paralysis was not caught by the doctor in the first acute period, but there are cases newer than 6 months
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If each muscle does not receive an electrical stimulus from a self-stimulating nerve due to nerve damage for approximately 6 months, permanent damage occurs in this muscle. Even if the nerve is repaired after this period, this muscle has no chance of working. For this reason, I recommend to my patients that in order to save the muscles during this period, I use a technique called baby sitter in English to remove the tongue nerve or neck nerve. I am trying to save these muscles and ensure their normal functioning by suturing a nerve that operates the muscles of the face along with the facial nerve. In my opinion, this technique is the most appropriate surgical procedure to give the chance to save those muscles.
Late facial paralysis over 6 months-1 year;
Here, the muscles are irreversible. was damaged as. Therefore, a muscle transplant is needed to replace the facial muscles. Although there are many methods, I will tell you about my 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-stage method before, I now have some of the disadvantages of these methods. That's why I choose the one-step method. In the surgical procedure I have chosen, the muscle taken from the inner side of the leg (gracillis muscle) is thinned and placed on the sides of the face and nose.However, before this procedure, I thin the muscle considerably for an aesthetic result. Then, I stitch the nerve of the muscle to the nerve of the masticatory muscle. According to my clinical experience and as reported in recent scientific publications, this nerve activates the transplanted muscle very powerfully. When successful after approximately 6-8 months, this transplanted muscle adapts to the face enough to enable normal laughing, speaking and being able to be in social environments without attracting attention.
Removing the Grasillis Muscle and Transferring it to the Face
Even if the person initially thinks of chewing and laughs, the brain can learn this process very well over time and the person can laugh spontaneously later on. This development is at a very high level, especially in children.
In addition, patients with facial paralysis also have problems closing their eyes. The two methods I frequently use are the static method, which is to place a gold plate on the upper eyelid to gain weight to make it close, and the other, which I will call dynamic, to open and close the eye voluntarily by turning the temple chewing muscle to the upper and lower eyelids.
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