Section of Facial Plastic Surgery
Division of Otolaryngology, Plastic & Reconstructive Surgery
University of New Mexico Health Sciences Center
2211 Lomas Blvd, NE (2-ACC)
Albuquerque, NM 87131
MANAGEMENT of fixed facial paralysis following extirpative surgery of lateral skull base and parotid tumor malignant neoplasms has proven to be a difficult problem. Traditionally, this deformity has been managed in a delayed fashion, long after the development of the predictable sequelae that occur with such facial paralysis. Facial paralysis can be quite minimal in a younger patient but clinically significant in an older patient. In the younger patient, the youthful elastic skin tends to remain tight despite the paralytic loss of underlying muscle tone. Similarly, the lower eyelid region is less likely to develop the manifestations of paralytic ectropion. Conversely, in the aging patient, this loss of underlying muscle tone, in combination with previously existing inelastic and ptotic soft tissues, leads to significant cosmetic and functional deformities. These include oral commissure ptosis, facial soft tissue ptosis, and lower eyelid ectropion. Lower eyelid ectropion is believed to be secondary to laxity of the lower eyelid as well as the increasing pull of the paralyzed and ptotic midface soft tissues.
Frodel JL. Primary Facial Rehabilitation in Facial Paralysis After Extirpative Surgery. Arch Facial Plast Surg. 2000;2(4):249-251. doi: