Facial Re-animation – thereconstructiondoc

Facial Reanimation

About Facial Reanimation

Facial reanimation is a set of surgical procedures aimed at restoring movement, symmetry, and expression to the face after facial paralysis. Facial paralysis can be caused by:

Cancer surgeries (parotid gland tumors)
Congenital conditions (from birth)
Bell’s palsy
Facial nerve injury
Trauma or stroke

People with facial paralysis often struggle to smile, close their eyes, speak, or eat
properly. They may also experience social and emotional distress due to loss of
expression.

Goals of Facial Reanimation

Restore natural smile and facial movement
Improve facial symmetry at rest and during expression
Protect the eye (by helping with eyelid closure)
Enhance confidence and quality of life

Surgical Options in Facial Reanimation

1. Static Procedures (Non-moving support techniques)

These techniques improve symmetry at rest, but don’t restore movement

1.Facial slings:

Use tendons (from the thigh or other parts) to lift the corner of the mouth

1.Facelift techniques:

Tighten and reposition facial tissues

1.Eyelid weights or tarsorrhaphy:

Help with eye closure

2. Dynamic Procedures (Restore real movement)

These are aimed at restoring active, voluntary movement, especially smiling

a.Nerve Transfers

Redirect working nerves to the paralyzed facial muscles:

1.Cross-facial nerve graft (CFNG):

Connects a nerve from the healthy side to the weak side

1.Masseteric nerve transfer:

Uses the chewing nerve (masseter nerve) to power smile muscles

1.Hypoglossal nerve transfer:

Uses tongue movement nerve to stimulate facial muscles

b.Muscle Transfers

When native muscles are non-functional, new muscle is transplanted:

1.Gracilis free muscle transfer:

A thin muscle from the inner thigh is transplanted to the face, and connected to blood vessels and nerves to restore smile movement.

2.Can be one-stage

(masseter nerve-based) or two-stage (cross-facial nerve graft + muscle)

c.Temporalis Muscle Transfer

A nearby chewing muscle is repositioned to lift the mouth when the patient bites or clenches.

Timing of Surgery

1.Early intervention

(within 6–12 months of paralysis) is ideal for nerve-based procedures

2.Delayed cases

(after long-standing paralysis) often require muscle transfers

Hospital Stay

Most facial reanimation surgeries require a 2–5 day hospital stay
Patients are monitored for swelling, flap/nerve function, and wound healing

When Will Movement Start?

This depends on the procedure:

1. Nerve Transfers (e.g., masseteric, hypoglossal, cross-facial)

New nerve supply takes 3 to 6 months to reach and activate facial muscles
Visible movement may begin around 4–6 months
Best results usually seen by 9–12 months

2. Gracilis Free Muscle Transfer

If connected to the masseteric nerve, patients may start smiling with effort
(like clenching teeth) within 3–4 months
If using a cross-facial nerve graft, results may take 6–12 months to appear
Full spontaneous smile may develop over 12–18 months

3. Temporalis Transfer / Static Slings

Immediate change in facial position/symmetry
No active movement, but improved appearance seen as early as 1–2 weeks
Functional use of temporalis transfer (by biting to smile) begins after 4–6
weeks of physiotherapy