facial paralysis in functionally, aesthetically and psychologically devastating condition.

1. Plastic & Reconstructive Surgery, HMC, Peshawar 2011 Mansoor Khan M.B.B.S

2. Facial paralysis: aesthetically, functionally & psychologically a devastating condition

3. 18 17 paired & one unpaired muscle animate the face

7. Eye symptoms: dryness, excessive tearing, incomplete closure, outdoor discomfort, use of artificial tears.

8. Nasal airway obstruction : due to the paralysis of N & LN muscles and the sagging of the cheek, forced inspiration leading to collapse of the nostril.

9. Oral symptoms:continence problems, speech.

10. Psychological status & level of difficulty to communicate (happiness, anger & sadness)

11. Examination: Brow, eye, upper, lower lid, position of the inf.canalicularpunctum, corneal ulcerations, philtrum, depression of commisure, nasolabial fold, sagging of the cheek.

12. Bells Phenomena

13. Snap test

14. Synkinesis: simultaneous contraction of two or more muscle groups which should not contract togather

15. Patients’ expectations/concerns: sort out the problem of the patients’ concern, if you don’t correct that then the treatment is a failure

16. Aims:protect the eye, rest symmetry, provision of facial movements (involuntary, independent & spontaneous facial expression).

17. Goals of Eye Treatment:maintain vision, protection, functional eyelids, cosmesis improvement, expression of emotions

18. Goals of Mouth Treatment:correction of the asymmetry, oral continence, speech improvement, provision of balance symmetrical smile

19. The complete accomplishment of the goals is difficult: the patient should be counseled what are achievable expectations, the well informed patients are more likely to be satisfied what is achieved

20. Surgical management

21. Direct brow lift

22. Direct brow lift

23. Coronal Brow lift Endoscopic Brow lift

24. Gold weight placement

25. Gold weight placement

26. Gold weight placement

27. Palpebral spring placement

28. Temporalis Muscle Transplantation

29. Tarsorrhaphy

30. Tendon sling placement

31. Horizontal lid shortening

32. Lateral canthorhaphy

33. Tow stage Microneurovascular muscle transplantation

34. Dissection of the facial nerve branches on the normal side

35. Mapping of the facial nerve branches

36. Mapping of the facial nerve branches

37. Sural nerve harvesting with a nerve stripper

38. Gracilis muscle harvesting

39. Placement and anastomosis of the pedicle

40. Placement and anastomosis of the pedicle

41. Temporalis & masseter muscle transplantation

42. Static tendon slings placement

43. Resection of the depressor labiiinferioris of the normal side

44. Resection of the depressor labiiinferioris of the normal side