The main goal of reconstructive surgery for facial paralysis is the restoration of smiling and function of eye closure. The deformity of the lower lip in paralysis is ptosis of the corner of the mouth, eversion of the vermillion and the lip is pulled to the normal side. While these may not be noticeable at rest in children, these are more marked in the elderly. Various dynamic approaches have been described for the paralysed lower lip; none are performed popularly due to the invasive nature, long recovery and unstable outcomes. The authors describe their innovative technique using modified bi-directional fascia grafting, in nine patients treated between 2009 and 2011. The patients had this procedure alone or in combinations including one stage free muscle transfer. Postoperatively patients were graded using a lower lip paralysis score and showed upgrading from poor to excellent. While this is a small cohort and it is difficult to objectively assess outcomes, this is a useful technique and in combinations with other static / dynamic methods should be entertained. The technique is well described and photographs show good results.

Bidirectional/double fascia grafting for simple and semi-dynamic reconstruction of the lower lip deformity in facial paralysis.
Watanbe Y, Sasaki R, Agawa K, Akizuki T.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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