Facial Muscle Reanimation Procedures
Preparation For Facial Muscle Reanimation
You will meet with Dr. Mourad where he usually spends an hour going over everything related to your surgery. He will evaluate and make sure that he can specifically tailor a custom care plan to your exact needs. During the consultation, Dr. Mourad will determine the exact nature of your complaints and the exact causes. He may prescribe medications that will assist in your complaints. Once a tailored plan is made, Dr. Mourad and his staff will take you through all the necessary information needed to make sure that your surgery happens without issue. We take care of the details so that you can have the most enjoyable experience.
Dr. Mourad views treating his patients to be nothing short of a privilege and an honor and enjoys taking the time to get to know his patients and fully understand their issues. Dr. Mourad’s office provides a boutique experience that takes you out of the mindset of being at the doctor’s office. It is a warm, comfortable environment, providing a bespoke experience.
Facial Muscle Reanimation: Dynamic Techniques
Cable Nerve Grafting
Facial paralysis that results from transection of the nerve, for example from trauma, or surgery, may be treated with cable grafting. This technique involves replacing a segment of damaged nerve with healthy nerves from the patient. Nerves can be obtained from the legs or neck and used as grafts to connect the damaged and/or severed nerve endings.
Cross Nerve Grafting
Long segments of healthy donor nerves are used to connect the facial nerve from the unaffected side to the paralyzed side.
Jump Nerve Grafting
Jump grafting uses neighboring nerves that control the tongue or jaw to connect to the damaged facial nerve. By controlling the jaw and/or tongue, a person can learn to control their facial muscles.
Temporalis Muscle Transfer
This technique involves the attachment of muscles that move the jaw to the facial muscles. By activating the jaw muscle, a patient may learn to voluntarily control their smile.
Gracilis Free Flap
Muscle, nerves, and arteries are obtained from the inner thigh and used to reconstruct a patient smiling through attachment to the muscles of the face.
Facial Muscle Reanimation: Static Techniques
A tissue sling may be used to suspend and elevate the paralyzed side of the face into a more favorable position. Tendon like tissue can be harvested from the thigh in order to serve as the sling. Other slings may involve the use of synthetic material or tendons harvested from other body sites.
Lid Tightening Procedures
Also known as a tarsorrhaphy, the lower eyelids can be placed in a more favorable position by tightening and repositioning the eyelid in a more favorable position.
Small gold weights can be placed in a pocket in the upper eyelid in order to allow gravity to assist in closing the eyes.
Facial Paralysis may cause the brow and forehead to droop. This descent can be so severe that it may compromise vision. Brow lifts involve elevating the brow and placing in a more favorable and natural position.
Some patients may experience nasal congestion and airway obstruction due to a collapse of the nasal structures on the affected side. Reconstruction of the nose to reinforce the collapse will allow for improved breathing.
After Surgery and Recovery
Depending on your work, Dr. Mourad typically recommends taking a minimum of 3 days off before returning to work. He also discourages his patients from any heavy lifting. If you wear glasses, you may require some alterations if applicable. Dr. Mourad will provide you with pain medications, ointments, nasal sprays, all to help maximize your results. Dr. Mourad will then see you in visitations two weeks later, and then one month after that. Dr. Mourad enjoys the continued visitation of his patients and will see them in follow up for many years thereafter.
- Anesthesia: Depending on the type of anesthesia administered, patients may have a reaction. This is exceedingly rare, and it is important to discuss your personal risk with your anesthesiologist.
- Infection: In rare circumstances patients may develop an infection following reconstructive procedures. These are usually managed with intraoperative and postoperative antibiotics.
- Bleeding: Although rare, patients may have bleeding episodes following reconstructive surgery. Your surgeon will likely order blood work to make sure you are healthy enough to undergo the procedure, and minimize risk of bleeding. Your surgeon should also go over all medications and supplements to minimizing bleeding risk.
- Need for secondary surgeries: Depending on the complexity of the reconstruction, sometimes multiple surgeries are required to ensure the best aesthetic and functional outcomes.
- Scarring and Poor wound healing: Some patients with underlying medical conditions or more prone to poor wound healing and scarring. It is important to understand these risks prior to embarking on a treatment strategy.
Select Relevant Publications
Kadakia S, Mourad MW, and Ducic Y. Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects. Journal of Reconstructive Microsurgery. 2017 May; 33(4):275-280. Link to Article.