Facial paralysis causes both aesthetic and functional problems. The face is altered at rest and this worsens during smiling or active facial expression. The biggest functional problems are related to reduced lubrication of the eyes because of eyelid paralysis. If the onset of palsy is recent, facial nerve function can be re-established by a microsurgical connection to the masseteric. If the paralysis is long-standing, it is typically necessary to transpose healthy muscles from other parts of the body to provide mimetic muscle function.

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Recent facial paralysis

In the recent facial paralysis, the triple innervation technique devised by Dr. Biglioli allows to restore the function of the nerve through an aesthetic incision usually utilized for the face lifting. Three connections are made between the paralyzed facial nerve and the masseteric nerve, 30% of the hypoglossus nerve and two branches of the facial nerve of the opposite side.

Before surgery

After surgery

Before surgery

After surgery

Prima

Before surgery

Dopo

After surgery

Long-standing facial paralysis

To address long-standing facial paralysis, Dr. Biglioli recently devised a technique combining two major advantages:
– The power of the gracilis muscle innervated by the masseteric nerve
– The spontaneity of smiling due to a “connection” with the facial nerve on the non paralysed side of the face.

Asymmetry of the face before surgery; the defect worsened while smiling.
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Asymmetry of the face for left facial paralysis.

Asymmetry of the face for left facial paralysis.

Worsening of asymmetry when smiling.

Worsening of asymmetry when smiling.

AFTER SURGERY
Recovery of facial symmetry after surgery.

Recovery of facial symmetry after surgery.

A well-balanced smile obtained after surgery.

A well-balanced smile obtained after surgery.

A well-balanced smile obtained after surgery.
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Clinical case

Evident asymmetry of the face preoperatively and during activation of the mimic muscles.

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Long-standing facial paralysis on the right side of the face: asymmetry of features at rest.

Long-standing facial paralysis on the right side of the face: asymmetry of features at rest.

Symmetry of features after surgery.

Symmetry of features after surgery.

Worsening of the asymmetry of the face during smiling before corrective surgery.

Worsening of the asymmetry of the face during smiling before corrective surgery.

Smile symmetry after surgery.

Smile symmetry after surgery.

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Caso clinico

Pre-operative asymmetry of the cheek and lip at rest.

Pre-operative asymmetry of the cheek and lip at rest.

Good symmetry of features at rest post-operatively.

Good symmetry of features at rest post-operatively.

Worsening of the asymmetry during pre-operative smiling.

Worsening of the asymmetry during pre-operative smiling.

Symmetrical smile after surgery.

Symmetrical smile after surgery.

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In selected cases, the rehabilitation of smiling may be done through the transposition of a latissimus dorsi muscle flap.

Before surgery

After surgery

Before surgery

After surgery

Before surgery

After surgery

The gracilis flap with double innervation is a variant of the single innervation flap, still valid in selected cases.

Clinic case

Before surgery

After surgery

Before surgery

After surgery

Prima

Before surgery

Dopo

After surgery

Eyelid closure

Eyelid reanimation occurs in two surgical stages: the sural nerve is transplanted into the lid from the thigh, by connecting it to a tiny branch of the facial nerve of the healthy side. Then, 6 months later, a second operation is performed by transplanting a portion of the platysma muscle in the upper paralytic eyelid. A direct connection between the platysma and the sural nerve in completed under surgical microscopic control. This allows for voluntary eyelid closure and automatic blinking, at 10-20 times per minute.

Mild left eyelid paralysis.

Mild left eyelid paralysis.

Complete eyelid closure was achieved after surgery.

Complete eyelid closure was achieved after surgery.

Middle-grade right eyelid paralysis.

Middle-grade right eyelid paralysis.

Complete eyelid closure was achieved after surgery.

Complete eyelid closure was achieved after surgery.

Severe right eyelid paralysis, limited preoperatively by a tarsorrhaphy (performed at another centre).

Severe right eyelid paralysis, limited preoperatively by a tarsorrhaphy (performed at another centre).

Complete eyelid closure was achieved after surgery.

Complete eyelid closure was achieved after surgery.

Surgical correction of eyelid paralysis is often addressed by rotating a small temporalis muscle flap.

Before surgery

After surgery

Before surgery

After surgery

Ancillary surgery

Small residual defects after the main surgery can be corrected by minor operations under local anaesthesia.

PARALYTIC ECTROPION: ITS CORRECTION BY A MINOR OPERATION UNDER LOCAL ANESTHESIA.

Open eye before surgery

Open eye after surgery

Incompetenza palpebrale ed ectropion - Occhio Chiuso

Closure of the eyelids before surgery

Closure of the eyelids after surgery

TEMPORARY APPLICATION OF A GOLD WEIGHT IN THE UPPER EYELID

Eyelid incompetence before surgery

Eyelid competence after surgery

EYEBROW PTOSIS CORRECTION

Before surgery

After surgery