15840 Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)

Name of the Procedure:

Graft for Facial Nerve Paralysis; Free Fascia Graft

Summary

A graft for facial nerve paralysis using a free fascia graft involves transferring tissue (fascia) to restore function and improve facial movement in patients experiencing paralysis. It includes obtaining the fascia from the patient's own body.

Purpose

This procedure addresses facial nerve paralysis, which can cause muscle weakness or complete loss of movement on one side of the face. The goal is to reconstruct the nerve pathway using a fascia graft to restore facial muscle function and symmetry, improving the patient's ability to express and move their facial features.

Indications

• Partial or complete facial nerve paralysis.
• Failure of other treatments to restore facial movement.
• Conditions such as Bell's palsy, trauma, or following tumor removal.

Preparation

• Patients may need to fast for a certain period prior to the procedure.
• Medication adjustments could be necessary, particularly blood thinners.
• Preoperative assessments may include imaging studies and nerve testing.
• Discussions on anesthesia options and consent processes.

Procedure Description

1. Anesthesia: General anesthesia is typically administered.
2. Harvesting the Fascia: Fascia tissue is usually taken from a site such as the thigh.
3. Incision and Exposure: An incision is made near the facial nerve area to expose the paralyzed nerves.
4. Graft Placement: The fascia is carefully placed and secured to bridge the gap in the damaged nerve.
5. Closure: Both the donor site and facial incisions are closed with sutures.
6. Postoperative Care: Monitoring and initial recovery under medical supervision.

Duration

The procedure typically takes about 2-4 hours, depending on the complexity of the case.

Setting

The procedure is usually performed in a hospital's surgical suite.

Personnel

• Surgeon: A specialist in plastic or reconstructive surgery.
• Anesthesiologist: To manage the general anesthesia.
• Nurses: For anesthesia assistance and immediate postoperative care.
• Surgical Technicians: Assist the surgeon during the procedure.

Risks and Complications

• Common Risks: Infection, bleeding, scarring.
• Rare Risks: Graft failure, nerve damage, incomplete restoration of function.
• Management of complications includes antibiotics for infection and additional surgical interventions if necessary.

Benefits

• Improved facial symmetry and movement.
• Enhanced facial expressions and improved quality of life.
• Benefits are typically realized gradually over several months as nerve function restores.

Recovery

• Patients usually stay in the hospital for several days post-surgery.
• Swelling and bruising around the site are common initially.
• Pain management with prescribed medication.
• Physical therapy may be recommended.
• Full recovery and final outcomes can take several months.

Alternatives

• Conservative Treatments: Physical therapy and facial exercises.
• Botox Injections: To manage muscle imbalances.
• Other Surgical Options: Different nerve grafting techniques or muscle transfers.
• Each alternative varies in invasiveness, effectiveness, and recovery time.

Patient Experience

• During the Procedure: Patients will be under general anesthesia and will not feel pain.
• After the Procedure: There may be discomfort and swelling, managed with medication.
• Patients can expect a gradual improvement in facial function as they heal, with follow-up visits to monitor progress and address any concerns that might arise.