Facial Paralysis & Ear Reconstruction
The deformity of face and jaw could significant impact in patient well being and quality of life. In addition, the deformity causes unacceptable appearance to the society, which lead to social isolation in many patients. The deformity could be after cancer surgery, trauma, infection, radiation injury, and congenital diseases.
The Chaiyasate passionate in restore and rebuild the face back using innovated modern surgical techniques. It is common to bring a tissue and its blood supply from another part of the body to face area. The blood supply of interested tissue will be re connected to the neck vessel. This type of surgery called microvascular surgery. Dr. Chaiyasate has performed several hundreds of this type of surgery with very high success rate. The operation usually takes 6-8 hours from start to end.
Generally, Dr. Chaiyasate will replace the missing tissue with “like” tissue. If the skin only is missing, the new replacing tissue will be skin. However, if the missing tissues are skin, muscle and bone. The reconstruction will be more complicated. The leg bone (fibula) with skin, the hip bone with skin, the forearm bone with skin could be brought up to the face to restore the missing bone and skin.
This type of reconstruction requires a skilled plastic surgeon with artistic mind who understand facial proportion, facial anatomy, and science of beauty.
Facial Paralysis Reconstruction
Facial paralysis is a multifaceted disorder involving functional, cosmetic, and psychosocial issues. When the muscles of the face do not work, functional problems revolving around the eye sphincter and the oral sphincter can occur. The eye sphincter is crucial in protecting the cornea and providing appropriate lubrication to prevent irritation and potential desiccation and ulceration. The oral sphincter, comprising the orbicularis oris muscle, provides for oral competence. From a functional standpoint, this affect one’s ability to maintain liquids within the mouth and to produce effective bilabial sounds.
Paralysis to the facial musculature can also have major aesthetic effects. These may range from an asymmetrical blink, which may be troublesome to some patients. On the severe end of the cosmetic scale, one may observe gross asymmetry at the rest with drooping of the involved side because of lack of muscle support and tone. These facial differences produced by the asymmetry can have devastating emotional consequences.
The lack of active normal facial musculature can impact on the psychosocial wellbeing of patients. This is mainly reflected in asymmetrical or absent of facial expression. The quality and progression of the interaction are compromised and a variety of misinterpretations may occur. Thus the facial muscle is paramount in an individual’s ability to effectively communicate, interact normally on a psychosocial basis, appear within the scope of normality on a cosmetic basis, and to provide functional protection against corneal exposure and oral incompetence.
For Moebius syndrome, Dr. Chaiyasate prefers to wait until children are at least 5 years of age. For the adult patients, the reconstruction can be performed at any age.
The surgical approach to the management of facial paralysis will be divided into the upper face and lower face. The upper face will be addressed as it relates to the brow, to the upper eyelid, and to the lower eyelid. The lower face will be addressed as it relates to the noise and cheek, the commissure, and upper lip and lastly the lower lip.
Dr. Chaiyasate’s approach includes:
- : corrected by Brow Lift.
Unable to close upper eyelid
- : corrected by upper lid gold weight loading or dynamic upper lid support with a temporalis transfer.
Toneless Lower lid
- : corrected by lower eyelid tendon sling.
Asymmetry Lower lip
- : corrected either by static suspension with tendon graft or dynamic reconstruction with gracilis muscle transplantation.
The external ear is composed of a complex cartilaginous framework giving rise to the many involutions and folds that make ear reconstruction a challenging task. Missing a part of the ear or all parts of the ear could lead to a significant psychosocial embarrassment, which lead to social isolation and low self esteem.
The defect of the ear could be congenital or acquired. The congenital missing ear is commonly referred to “microtia”. The most common causes of acquired missing ear are cancer and trauma.
Microtia is estimated to occur in 1 in 7,000-8,000 births. Eighty percent of cases of microtia or anotia are unilateral, with just over half occurring on the right side, and there may be a male preponderance. Many microtia patients have associated congenital craniofacial difference such as hemifacial microsomia, Goldenhar syndrome and Treacher Collin syndrome. ‘Isolated’ microtia occurs in about 65% of cases.
The ear reconstruction could be divided to “partial reconstruction” and “total ear reconstruction”. The treatment options for partial ear reconstruction include local tissue flaps, and skin grafts. The framework reconstruction from rib cartilage graft or opposite ear may be indicated depending on the size of the defect. Dr. Chaiyasate will evaluate the defect and come up with surgical plans specifically for your deformity.
The total ear reconstruction including “microtia” reconstruction is much more complex. The ear framework is needed to be reconstructed. There are two options for framework reconstruction including patient own rib cartilage (autologous)or premade ear framework implant (alloplastic). In Autologous reconstruction, the pieces of rib cartilage are carved to match the opposite ear and placed underneath the affected side. In alloplastic reconstruction, the ear framework implant was inserted underneath the skin just like the autologous reconstruction. No matter what framework is chosen, it is important to make sure that the skin and soft tissue on the affected side is healthy to allow to framework to heal without extrusion. The total ear reconstruction is multi stage reconstruction. It is usually takes 2-4 stage to complete a reconstruction. Dr. Chaiyasate will use his craniofacial skills combined with microvascular skills to come up with the best surgical plans specifically for individual patient.