Surgical method | Comments |
---|---|
A. Early reconstruction of extratemporal lesion | Â |
   Step I: |  |
A.1 Primary direct nerve suture | Â |
A.2 Interpositional graft | Â |
A.3 Upper lid weight | A.3. lid weight better than tarsorrhaphy |
   Step II: |  |
A.4 Adjuvant measures | Â |
B. Early up to delayed reconstruction of proximal lesion or impossibility to use reconstruction A (see above) | Â |
   Step I: |  |
B.1 Hypoglossal-facial jump anastomosis | B.1 better than classical hypoglossal-facial anastomosis |
B.2 Upper lid weight | Â |
B.3 Cross-face nerve suture | Â |
B.4 Temporalis muscle transfer | B.4 better than masseter muscle transfer |
B.5 Digastric muscle transfer | Â |
B.6 Sling plasty | Â |
   Step II: |  |
B.7 Cross-face nerve suture | Â |
B.8 Eye brow lift | B.8. in case of brow ptosis |
B.9 Rhinoplasty | B.9 in case of nasal asymmetry |
B.10 Rhytidectomy | B. 10 in case of cheek or chin ptosis |
B.11 Botulinum toxin, Myectomies | Â |
C. Late reconstruction or congenital disease | Â |
   Step I: |  |
   Mimic musculature existing: |  |
C.1 Hypoglossal-facial jump anastomosis | C.1 Hypoglossal nerve: better than any other donor nerve |
C.2 Upper lid weight | Â |
C.3 Cross-face nerve suture | Â |
   Mimic musculature not existing, but nerve supply existing: |  |
C.4 Microvascular muscle transfer | C.4 Best choice for congenital lesions |
C.5 Temporalis muscle transfer | Â |
   Mimic musculature not existing, and nerve supply not existing: |  |
C.6 Sling plasty | C. 6 Use palmaris longus tendon or fascia lata |
   Step II: |  |
C.7 Eye brow lift | Â |
C.8 Rhinoplasty | Â |
C.9 Rhytidectomy | Â |
C.10 Botulinumtoxin, Myectomies | C.10 Correction of defective healing or facial asymmetry on lesioned and healthy side |