Table 2.
Plan by stages for facial reanimation (Modified after. [35])
| Surgical method | Comments |
|---|---|
| A. Early reconstruction of extratemporal lesion | |
| Step I: | |
| A.1 Primary direct nerve suture | |
| A.2 Interpositional graft | |
| A.3 Upper lid weight | A.3. lid weight better than tarsorrhaphy |
| Step II: | |
| A.4 Adjuvant measures | |
| B. Early up to delayed reconstruction of proximal lesion or impossibility to use reconstruction A (see above) | |
| Step I: | |
| B.1 Hypoglossal-facial jump anastomosis | B.1 better than classical hypoglossal-facial anastomosis |
| B.2 Upper lid weight | |
| B.3 Cross-face nerve suture | |
| B.4 Temporalis muscle transfer | B.4 better than masseter muscle transfer |
| B.5 Digastric muscle transfer | |
| B.6 Sling plasty | |
| Step II: | |
| B.7 Cross-face nerve suture | |
| 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 | |
| C. Late reconstruction or congenital disease | |
| 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 | |
| C.3 Cross-face nerve suture | |
| 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 | |
| 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 | |
| C.8 Rhinoplasty | |
| C.9 Rhytidectomy | |
| C.10 Botulinumtoxin, Myectomies | C.10 Correction of defective healing or facial asymmetry on lesioned and healthy side |