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Ординатура / Офтальмология / Английские материалы / Advanced Surgical Facial Rejuvenation_Erian, Shiffman_2011.pdf
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B.J. Wilhelmi and Y. Hazani

mandibular branch innervates the major depressors of the lip. Therefore, paralysis of this nerve results in an inability to show the lower teeth with grimacing. At rest, the corner of the mouth will elevate due to the unopposed pull of the innervated zygomaticus major.

Treatment of facial nerve injury can be controversial, but ideally, primary microsurgical repair is advocated when nerve transection is noticed in the operating room. For patients who present with palsy in the postoperative period, several options are available. Since neuroprexia is the most likely cause of facial palsy after a facelift, most symptoms will improve after a 6 months period of observation. If nerve function does not return after a year of conservative management, patients may benefit from chemical (Botox) or surgical denervation of the contralateral side. This is particularly applicable for frontal nerve palsy patients. Other approaches include static sling procedures or ipsilateral nerve transfers. Dynamic facial reanimation procedures can restore spontaneous motion to affected side of the face; however, these are complex operations requiring a surgical team skilled with the microsurgical technique.

35.7 Conclusions

In elevating the SMAS with a facelift, the facial nerve branches are prone to injury anterior to the parotid gland. The safe facelift technique is based on surface anatomic landmarks to predict the location of the anterior edge of the parotid gland and avoid inadvertent injury to these branches. The facial nerve branches can be predicted to exit the anterior edge of the parotid gland 3.9 cm anterior to the tragus along a transverse axis of the zygomatic arch. Moreover, the anterior edge of the parotid gland can be predicted to be near the oblique vector from the inferior lateral orbital wall to the masseteric tuberosity. Based on our safe approach to facelift surgery, a sub-SMAS dissection anterior to the parotid gland is discouraged given the inherent risk of a more aggressive dissection.

References

1.Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg. 1976;58(1):80–8.

2.Skoog T. Plastic surgery: new methods and refinements. Philadelphia: W.B. Saunders; 1974.

3.Davis RA, Anson BJ, Budinger JM, Kurth LR. Surgical anatomy of the facial nerve and parotid gland based upon a study of 350 cervicofacial halves. Surg Gynecol Obstet. 1956;102(4):385–412.

4.Dingman RO, Grabb WC. Surgical anatomy of the mandibular ramus of the facial nerve based on the dissection of 100 facial halves. Plast Reconstr Surg Transpl Bull. 1962;29:266–72.

5.Pitanguy I, Ramos AS. The frontal branch of the facial nerve: the importance of its variations in face lifting. Plast Reconstr Surg. 1966;38(4):352–6.

6.Gosain AK, Sewall SR, Yousif NJ. The temporal branch of the facial nerve: how reliably can we predict its path? Plast Reconstr Surg. 1997;99(5):1224–33.

7.Stuzin JM, Wagstrom L, Kawamoto HK, Wolfe SA. Anatomy of the frontal branch of the facial nerve: the significance of the temporal fat pad. Plast Reconstr Surg. 1989;83(2):265–71.

8.Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg. 1992;89(3):441–9.

9.Wilhelmi BJ, Mowlavi A, Neumeister MW. The safe face lift with bony anatomic landmarks to elevate the SMAS. Plast Reconstr Surg. 2003;111(5):1723–6.

10.Har-Shai Y, Bodner SR, Egozy-Golan D, Lindenbaum ES, Ben-Izhak O, Mitz V, et al. Viscoelastic properties of the superficial musculoaponeurotic system (SMAS): a microscopic and mechanical study. Aesthetic Plast Surg. 1997; 21(4):219–24.

11.May M, Schaitkin BM. The facial nerve. 2nd ed. New York: Thieme Medical Publishers; 2000. p. 97.

Recommended Reading

Baker DC, Conley J. Avoiding facial nerve injuries in rhytidectomy. Anatomical variations and pitfalls. Plast Reconstr Surg. 1979;64(6):781–95.

Gonyon Jr DL, Barton Jr FE. The aging face: rhytidectomy and adjunctive procedures. SRPS. 2005;10(11):7.

Hazani R, Mowlavi A, Wilhelmi BJ. Facelift anatomic landmarks to avoid injury to the marginal mandibular nerve. Aesth Surg J. 2011;31(3):286–9.

Mathes SJ, Hentz VR. Plastic surgery, vol. II. Philadelphia: Elsevier; 2005. p. 159–297.

Mowlavi A, Wilhelmi BJ. The extended SMAS facelift: identifying the lateral zygomaticus major muscle border using bony anatomic landmarks. Ann Plast Surg. 2004;52(4):353–7.

Nahai F. The art of aesthetic surgery: principles & techniques, vol. II. St. Louis: Quality Medical Publishing; 2005.

Owsley JQ, Agarwal CA. Safely navigating around the facial nerve in three dimensions. Clin Plast Surg. 2008;35(4): 469–77.

Seckel BR. Facial danger zones: avoiding nerve injury in facial plastic surgery. St. Louis: Quality Medical Publishing; 1994.

Thorne CH. Facelift. In: Thorne CD, editor. Grabb & Smith’s plastic surgery. Philadelphia: Lippincott-Williams & Wilkins; 2007.