Plastic Surgery Essentials for Students-Chapter 11: Head and Neck

Chapter 11: Head and Neck

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Chapter 11 focuses on facial paralysis, describing the anatomy of the facial nerve (Cranial Nerve VII), which innervates 23 paired muscles critical for facial expression and communication. Damage to this nerve results in facial paralysis with significant social and physical impacts. Facial reanimation techniques exist, but none can perfectly mimic the balance of normal facial movements.<br /><br />The facial nerve exits the skull from the stylomastoid foramen and branches into five motor divisions: temporal, zygomatic, buccal, marginal mandibular, and cervical, which innervate various facial muscles. Damage to this nerve can result from idiopathic factors like Bell’s Palsy, trauma, or infections like Herpes Zoster. Congenital conditions like Moebius Syndrome or iatrogenic causes also contribute to facial paralysis risk.<br /><br />Evaluating facial paralysis involves meticulous history taking and physical examinations to assess muscle function, looking for signs of asymmetry, difficulty in movements, and conditions like synkinesis, where different muscle groups are wrongly innervated.<br /><br />Management involves both non-surgical and surgical methods. Non-surgical approaches include using electrophysiological testing such as EMG for diagnosis, botulinum toxin injections, and physical therapy. Surgical options range from nerve repair and grafting to more complex procedures like muscle transfers or nerve transfers. Specific surgical interventions can address distinct areas of the face, notably improving symmetry and function through techniques like brow lifts, eyelid procedures, and facial muscle transfers. <br /><br />In summary, facial paralysis is complex, arising from varied causes, and its management requires a tailored approach, balancing between surgical and non-surgical methods to restore function and expression.

Keywords

facial paralysis

facial nerve

Cranial Nerve VII

facial reanimation

Bell's Palsy

Moebius Syndrome

synkinesis

botulinum toxin

nerve transfers

muscle transfers