FACIAL PARALYSIS RECONSTRUCTION

BOBBY SWADHARMA PUTRA (BSP)

Surabaya, 28 Februari 2011

Pendahuluan
Facial

deformitas disebabkan paralisis struktur pada wajah yang diinervasi oleh n. facialis. an aesthetic issue

paralysis adalah kondisi dimana terjadi

Not

Functional disability

Pada

otot wajah fungsi yang bisa terganggu adalah proteksi mata, jalan nafas, fungsi makan dan berbicara
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Klasifikasi
Berdasarkan penyebab : Berdasarkan anatomi : Extratemporal Kongenital Intratemporal Trauma Intracranial Infeksi Neoplasma Berdasarkan sisi wajah Idiopatik yang terkena : Toxic Bilateral Iatrogenik Unilateral
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18 paired muscle animate the face
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Pemeriksaan Klinis
Anamnesa
Keluhan pada mata seperti mata kering atau air mata berlebihan, kelopak mata tidak bisa menutup

Keluhan pada nasal airway

Bentuk mulut yang tidak simetris, gangguan bicara

Pemeriksaan Fisik

Eye symptoms: dryness,

excessive tearing, incomplete closure, outdoor discomfort, use of artificial tears.

Snap test
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Nasal airway obstruction : due

to the paralysis muscles and the sagging of the cheek, forced inspiration leading to collapse of the nostril.

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Oral symptoms: continence problems, speech.

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

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

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

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Pemeriksaan fisik dimulai dengan meminta pasien mengangkat alis, menutup mata, tersenyum, dan mengerucutkan bibir.

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Tatalaksana
Secara

umum bertujuan :

Proteksi mata Mengembalikan posisi simetri wajah Mengembalikan fungsi gerakan wajah Ekspresi wajah ( senyum ) Konseling pasien diperlukan oleh karena sulit mengembalikan semua fungsi dan bentuk wajah seperti semula
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Tatalaksana
Non

surgical

Sering diterapkan untuk kelainan pada mata, seperti lid taping, eye lubrication, eye patches Melatih pergerakan otot wajah (rehabilitasi medik)

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Tatalaksana
Surgical

Treatment

Alis :

Direct brow lift, coronal brow lift, endoscopic brow lift

Kelopak mata atas (lagophtalmus) :

Gold weight, temporalis transplantation, spring, tarsoraphy

Kelopak mata bawah (ektropion) :

Tendon sling, lateral canthoplasty, horizontal lid shortening, termporalis lid transplatation, cartilage graft

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Surgical Treatment
Nasal airway :

Static sling, alar base elevation, septoplasty

Bibir atas & pipi: Muscle transplantation with use of ipsilateral 7th nerve,

cross facial nerve graft, or other cranial nerve for motor inervation, temporalis transplantation with or without masseter transplantation, static sling, soft tissue balancing procedure

Bibir bawah : Depressor labii inferioris resection, muscle

transplantation (digastric platysma ), wedge excision

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Alis
Direct

Incision
koronal

Insisi

Endoscopic

Brow Lift

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Direct brow lift

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Direct brow lift

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Coronal Brow lift

Endoscopic Brow lift
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Kelopak Mata Atas

Lid

Loading (gold prothese) Pemasangan Palpebral Spring

Transfer

m. temporalis Free Platysma transfer

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Lid Loading

Early technique
Incision in the supratarsal crease Subcutaneous pocket Insert weight Close skin

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Gold Weight

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Surgical Procedures

Gold weight implant-placed beneath levator aponeurosis

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Gold Weight

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Gold Weight Placement

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Combination of Gold Weight and Lower Lid Shortening

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Combination of Gold Weight and Lower Lid Shortening

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Platinum Chain

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Palpebral Spring

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Kelopak Mata Bawah

Static

Sling Cartilage graft to tarsal plate jarang dilakukan Wedge Incision

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Tendon sling placement

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Horizontal lid shortening

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Lower lid shortening

Wedge excision with lateral canthopexy Used in combination with gold weight implantation

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Temporalis Muscle Transplantation

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Tarsorrhaphy
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Lateral canthorhaphy

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Nasal
Elevasi

ala nasi, kemudian dilakukan pemasangan sling dari tendon. bila perlu

Septoplasty

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Bibir & Pipi

Rekonstruksi dibagi 2 : Static pemasangan sling (fascia, tendon, goretex) Dynamic pemindahan otot : Regional : temporalis, masseter

Cross facial nerve graft coaptation to masseter motor branch

-

Free muscle transplantation

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Regional Muscle Transfer

M. temporalis

M. masseter

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Free muscle transplantation

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Free muscle transplantation

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Cross Facial Nerve Graft

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Bibir Bawah
Reseksi

otot m. depressor labii inferior

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Resection of the depressor labii inferioris of the normal side

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Resection of the depressor labii inferioris of the normal side

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Algoritma

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Surgical management

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Tow stage Microneurovascular muscle transplantation

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Dissection of the facial nerve branches on the normal side

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Mapping of the facial nerve branches

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Mapping of the facial nerve branches

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Sural nerve harvesting with a nerve stripper

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Gracilis muscle harvesting

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Placement and anastomosis of the pedicle

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Placement and anastomosis of the pedicle

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Temporalis & masseter muscle transplantation

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Static tendon slings placement

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Daftar Pustaka
Leedy, E. Jason : Facial Reanimation. Essentials of Plastic Surgery. QMP Publishing. 2007; 347-361 Neligan, C. Peter; Zuker, M.Ronald : Facial Paralysis Reconstruction. Grabb & Smiths Plastic Surgery 6th edition. Lippincott Williams & Wilkins. 2007; 417-427 Zuker, M.Ronald ; Manktelow, T. Ralph; Hussain, Gazi : Facial Paralysis. Mathes Plastic Surgery Volume 3. 2006; 883-915

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