The 2003 Annual Meeting of OASYS_NEW

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Dynamic Restoration of Eyelid Spincter with Temporalis Sling as Part of the Re- Animation in Facial Paralysis

Gupta A1, McW KM2, McW KM2, McW KM2, and Gupta A1. (1) Plastic and Reconstructive Microsurgery, Bombay Hospital & Medical Research Centre, Laud Mansion, 21, M. Karve Road, Suite 16, 2nd floor, Bombat, India, (2) MIT, BeingHam, AK, USA

Complete re-animation of a paralyzed face is a Reconstructive Challenge, as well as a dream for patients affected by facial paralysis. Functioning muscle transfer is a dynamic method of facial re-animation, wherein spontaneous recovery of muscle function either has not taken place or is not possible, as in cases of facial paralysis long standing or following ablative surgery. Cross Face Nerve Grafts (CFNG) provide requisite motor control to these functioning muscle transfers; as well control synchronized facial movements on both sides. It must be stressed here that end-to-end co-optation of a severed / damaged facial nerve or interposition nerve graft, offer better results than all secondary reconstruction. Despite all the efforts for acceptable facial movements, restoration of Eyelid Sphincter with near normal dynamic movements of the upper and the lower eyelids has remained a challenge. Author uses Temporalis Mini innervated muscle-fascia sling for eyelid sphincter control along with cross face nerve grafts and a Free Functioning Muscle Transfer (FFMT) for elevation of upper lip, angle of mouth and lower lip. Anterior Belly of Digastric muscle is used to stabilize lower lip and to replace the action of lower lip depressors for a dynamic re-animation. Temporalis Mini innervated muscle-fascia sling was initially described by Gillies and has been redefined by the author with excellent results without any webbing of the Medial Canthus or eversion of the Lower or Upper Eye Lids. I would like to share my experiences of use of Temporalis Mini innervated muscle-fascia sling Transfers for restoration of Eyelid Sphincter as part of total Facial re-animation with 7 – 10 years of follow up of these patients.