You perform functions such as transferring your facial expressions to the other side, closing your eyes tightly, and moving your lips while speaking, by using some of the muscles on your face. The movements that you can control on this face are generally called facial expressions. In order for you to make your facial facial movements:
1-Central type facial paralysis:
In cases of congenital or acquired loss due to a disease in the brain. It is the most common type of facial paralysis. If this condition is unilateral and the opposite side is functioning properly, paralysis occurs in the parts of the paralyzed side below the forehead area.
2-Peripheral type facial paralysis:
Face It occurs when the Facial Nerve, which carries signals to the muscles, does not work properly due to a disease inside or outside the skull after leaving the brain tissue. In peripheral type facial paralysis, if the opposite side is healthy, half of the face is completely inoperable.
What complaints occur in facial paralysis?
-Brow lifting on the affected side, Mimic movements such as frowning, squinting the eyelids, pursing the lips, showing teeth and smiling cannot be made. Forehead wrinkling and other forehead movements cannot be made.
-The eyelid cannot be closed on the affected side. While sleeping, that side's eyelid remains open. During eyelid closure, the eyeball may slide upwards.
-The cheek area cannot be inflated on the affected side. Food inside the mouth may come out while eating.
-The corner of the mouth sags on the affected side, and smiling cannot be made adequately. In some cases, loss of taste and sensitivity to loud sounds may be observed.
What causes facial paralysis?
– Tumors (masses) that cause damage in the relevant region of the brain. or disruptions in blood circulation (brain infarctions)
– Bell's palsy: It is a disease whose exact cause is unknown. cause of disease When investigated, no reason can be found. It is the cause of 80% of acute peripheral facial paralysis. There is a risk of occurrence in one in every 64 people. Pregnant women whose family members have had this complaint before are at greater risk.
–Ramsey Hunt syndrome (Herpes zoster oticus): It occurs as a result of a viral infection of the facial nerve. It is characterized by facial paralysis, earache, hearing loss, skin vesicles, vertigo (dizziness).
–Trauma: Temporal bone fractures, blunt or cutting facial nerve injuries, intraoperative Facial nerve injuries are examples of these.
– Acute-chronic middle ear infections
– Neurosarcoidosis
–Moebius syndrome: Congenitally both types of ear infections are present. It is the absence of the facial nerve. In addition to bilateral facial paralysis, eye movement problems and hearing problems may also occur. The exact cause is unknown.
–Tumors: Facial neuroma, hemangiomas, parotid (salivary) gland tumors, acoustic neuromas and metastatic tumors are the most common tumors that cause facial paralysis.
-Other (AIDS, autoimmune, Kawasaki disease, Guillain-Barre syndrome, birth trauma…)
In the treatment of facial paralysisSURGICAL OPTIONSwhat are they?
Surgical methods are divided into two areas: staticdynamicreanimation methods. Static methods do not restore movement in the face; rather, they aim to correct the positions of the sagging parts due to facial paralysis and thus provide a more natural appearance, at least when the face is at rest. Dynamic methods are applied to restore some important movements.
Static Reanimation Methods:
Static Reanimation methods, as the name suggests, include fixed repair methods that do not provide movement. They are used to correct sagging or deformities that occur over time on the paralyzed side of the face. These are methods that can be used in patients who do not want dynamic methods or for whom dynamic methods are not suitable.
Placing gold on the eyelid: As mentioned before, patients with facial paralysis have difficulty closing their eyes. ar. A gold weight of appropriate weight is placed inside the upper eyelid to ensure that the eyelid can be closed by gravity. A patient with facial paralysis can open his eyes. In cases where he does not try to open his eye, he will be able to close his eyelid with the effect of gravity, thanks to this placed weight. Being able to close the eyelid is necessary to prevent the eye from drying out and to prevent the development of keratitis.
Tarsorraphy: It is a method that aims to prevent the eyelids from remaining open by partially stitching them together in patients with short-term facial paralysis.
Face lift surgery:Face lift surgery can be performed to recover skin and soft tissue sagging on the paralyzed side. In this way, a more symmetrical and non-disturbing appearance is achieved, at least during rest.
Lower Eyelid Correction:The lower eyelids of patients suffering from Facial Paralysis will also become sagging and loose over time. . In order to correct these problems, hanging or shortening the lower eyelids will correct this problem.
Static Hanging Methods: It is applied to correct the sagging in the corner of the mouth and prevent the fluids from flowing out. It is the process of hanging the patient sideways and upwards from several points around the mouth, usually with the help of his/her own tissues.
Dynamic Reanimation Methods:
After the nerve stimulation of the facial muscles is eliminated, an average of 2 seconds They continue to maintain their capacity for up to a year. If they can be stimulated by a nerve again during this period, they can regain their functions. However, since approximately 1 year will be required for this healing process, it is ideal that the surgery for this purpose be performed within 1 year after the injury at the latest.
In cases where the Facial Nerve is cut as a result of an injury or surgery, it is as early as possible“ Direct Nerve Repair should be performed.
If facial paralysis occurs due to a disorder originating from the brain, the facial nerve will not function. In such a case or if it is not possible to repair the nerve after it is damaged, the muscles in the face must be damaged. It is necessary to ensure that it continues to be stimulated by another nerve. These surgeries are called "Nerve Transfer". Nerve transfer can be performed using another motor nerve from the paralyzed side of the face or by using a healthy "Nerve Bridge from Facial Nerve"on the opposite side of the face. When a nerve is used from the same side of the face, the function of the used nerve is eliminated. For example, if the nerve leading to a chewing muscle is used, there will be weakness in the chewing function, but since chewing is done by many muscles, chewing will not be completely impaired despite the weakness. To make a bridge from the facial nerve on the other side of the face, a long nerve that is not related to movement (related to touch) is taken from another part of the body and a connection is created that will provide transmission from the healthy nerve to the opposite side of the face. If this created bridge is successful, movement can be achieved on the paralyzed side of the face at the same time as movement on the healthy side of the face.
Since the capacity of the mimic muscles will disappear 2 years after the injury, other muscles that will function in the face area must be used instead of these muscles. “Muscle Transfer”surgeries are the names given to this method. Muscle transfers can also be achieved by performing "Free Muscle Transfer" from some chewing muscles in the head area or from a remote area. Free muscle transfer is performed using microsurgical methods. When free muscle transfer is performed, nerve transfer surgery, which will ensure the functioning of these muscles, should be performed at the same time or before this surgery.
As you, the patient and the patient's relatives, will understand, dynamic methods are somewhat complicated to understand, explain and apply.
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