Many surgical procedures that otolaryngologists perform put the facial nerve at risk of injury, a complication that the surgeon and patient fear alike. Unfortunately, injuries to the nerve can and do happen despite adequate precautions, and facial paralysis may be permanent, with the functional and cosmetic penalties this entails. Injury to the marginal branch of the facial nerve denervates muscles resulting in rolling of the vermillion border cranially and elevation of that half of the lower lip rather than weakness of the orbicularis oris muscle. This paper describes a static repair to the lower lip margin and associated muscles. An appropriately marked out skin ellipse adajcent to, but not including, the vermillion border is excised. Additionally, the denervated lip depressors are mobilised inferiorly. Performing this under local anaesthetic enables intraoperative adjustments to suit the cosmetic outcome desired. The author states that existing oral function is preserved and appearances maintained on follow-up.

Symmetrical repair of a paralysed lower lip.
Hakim SG.
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