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Surgical Technique |

Rehabilitation of Long-standing Facial Nerve Paralysis With Percutaneous Suture–Based Slings

Daniel Alam, MD
Arch Facial Plast Surg. 2007;9(3):205-209. doi:10.1001/archfaci.9.3.205.
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Long-standing facial paralysis creates significant functional and aesthetic problems for patients affected by this deficit. Traditional approaches to correct this problem have involved aggressive open procedures such as unilateral face-lifts and sling procedures using fascia and implantable materials. Unfortunately, our results with these techniques over the last 5 years have been suboptimal. The traditional face-lift techniques did not address the nasolabial fold to our satisfaction, and suture-based techniques alone, while offering excellent short-term results, failed to provide a long-term solution. This led to the development of a novel percutaneous technique combining the minimally invasive approach of suture-based lifts with the long-term efficacy of Gore-Tex–based slings. We report our results with this technique for static facial suspension in patients with long-standing facial nerve paralysis and our surgical outcomes in 13 patients. The procedure offers re-creation of the nasolabial crease and suspension of the oral commissure to its normal anatomic relationships. The recovery time is minimal, and the operation is performed as a short outpatient procedure. Long-term 2-year follow-up has shown effective preservation of the surgical results.

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Figure 1.

Diagram of surgical technique. A, Nasolabial and commissure stab incisions are made. B, Liposuction cannula is introduced and sutured to Gore-Tex strip (W.L. Gore & Associates, Elkton, Md). C, Gore-Tex strip is pulled through. D, Temporal incision is made and the strip is clamped. E, Dissection is completed on the deep temporal fascia to protect the frontal nerve. F, Suture is passed through the implant out the temporal incision wound. G, Sutures are tightened to reconstitute the nasolabial fold. H, Sutures are anchored down with a Mayo needle. I, Final result.

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Figure 2.

Patient with a history of long-standing facial hemiplegia from a stroke is shown here preoperatively (A) and 15 months postoperatively (B).

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Figure 3.

Patient with iatrogenic facial nerve injury from an otologic procedure is shown here preoperatively (A) and 12 months postoperatively (B) after suspension and a lateral tarsal strip ectropion repair.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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