Chapter 64 - Facial Reanimation Flashcards Preview

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Flashcards in Chapter 64 - Facial Reanimation Deck (16)
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1
Q

How soon does facial reinnervation need to take place

A

by 12-18mo post injury

nerve and motor endplate fibrosis

2
Q

Tool to use to tell if spontaneous recovery occuring

A

EMG

3
Q

Synkinesis

A

hyperkinetic uncoordinated mass facial movement
aberrent regeneration
May present as increased lacrimation
Tx botox

4
Q

How to easily distinguish between HB 3, 4, 5

A

3: noticeable weakness, complete eye closure requiring maximum effort
4: incomplete eye closure
5: asymmetry at rest

5
Q

How EMG works

A

study depolarization of mm fiber
Denervated: spontaneous fibrillation potentials
Regen: polyphasic action potentials
Normal: no electrical activity at rest

6
Q

potential sequelae of lagophthalmos

A

dry eye, exposure keratitis, corneal ulceration, blindness

7
Q

Ways to dynamically reanimate face

A

cable graft, cross-facial n graft, XII to VII, V to VII

gracilis flap, transposition of temporalis or masseter, temporalis tendon transfer

8
Q

how to treat lower lid with CN VII paralysis

A

snap test to determine laxity
medial laxity –> tx with medial canthoplasty to prevent eversion of inferior punctum and epiphora
lateral laxity –> tx with horizontal lid shortening of producing scleral show or ectropion

9
Q

Upper lip tx with CN VII paralysis

A

gold or platinum weight (low reactivity, high density)

Can give you undesirable lid closing when supine

10
Q

How soon should you repair a transected facial nerve?

A

Within 72 hours (when wallerian degeneration occurs)

Must reapproximate primarily without tension (may need to mobilize or re-route adjacent segments)

11
Q

What should you do if you can’t reapproximate CN VII primarily without tension?

A

interposition nerve graft (auricular or sural)

12
Q

Cross-facial nerve graft

A

graft sural nerve onto functioning side buccal and zygomatic branches
9-12mo later, do neurorraphies between paralyzed nerve branches and the cross-face graft…requires functional motor end plates on paralyzed side

13
Q

What is nerve transposition

A

coap facial n to another CN
Use when distal branches viable, but no viable proximal facial stump
XII, V

14
Q

When to use muscle transposition

A

If nerve graft not possible
temporalis tendon over lateral commissure or melolabial fold.
temporalis muscle transfer has cosmetic deformity associated

15
Q

free flap facial reanimation

A

cross-facial nerve graft
Wait 9-12 mo
gracilis transfer, connect anterior br of obturator nerve to cross graft, and adductor br of deep femoral plus venae comitantes to facial a/v

16
Q

Static facial procedures used for CN VII paralysis

A

for asymmetry of brow

May also do sling procedures to correct midface, melolabial fold, nasal obstruction

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