Our Summary

Nasal obstruction, or difficulty breathing through the nose, is a common problem for people with facial paralysis. This is often because the muscles on the paralyzed side of the face are weaker, causing the nose to narrow and the base of the nostril to shift downwards and inwards. Traditionally, surgeons have used techniques like grafts or sutures to support the nose, but these methods may not always fix the position of the nostril. This research paper describes two other techniques - suture resuspension and fascia lata resuspension - which can better correct the nostril position. The paper also suggests modifications to these techniques to make their effects last longer.

FAQs

  1. What is nasal obstruction and how is it related to flaccid facial paralysis?
  2. What techniques are used in rhinoplasty to support the nasal side wall in cases of facial paralysis?
  3. What are suture resuspension and fascia lata resuspension techniques, and how are they modified to improve the longevity of the suspension?

Doctor’s Tip

One helpful tip a doctor might give a patient about rhinoplasty is to follow all post-operative care instructions carefully to ensure proper healing and optimal results. This may include avoiding strenuous activities, keeping the surgical site clean, and attending follow-up appointments as scheduled. Additionally, it is important to communicate any concerns or changes in symptoms to your doctor promptly.

Suitable For

Patients with nasal obstruction due to flaccid facial paralysis are typically recommended for rhinoplasty. These patients may experience narrowing of the nasal valve and inferomedial displacement of the alar base due to weakness of nasal musculature on the paralyzed side of the face. Standard rhinoplasty techniques such as alar batten grafts or flaring sutures may be used to support the nasal side wall, while suspension techniques may be necessary to address inferomedial alar displacement. Suture resuspension and fascia lata resuspension techniques are commonly used in these patients, with modifications made to improve the longevity of the suspension.

Timeline

  • Before rhinoplasty:
  1. Patient consultation: The patient meets with a plastic surgeon to discuss their desired outcome and assess their candidacy for rhinoplasty.
  2. Pre-operative evaluation: The patient undergoes a physical examination, medical history review, and possibly imaging studies to determine the best approach for the surgery.
  3. Surgical planning: The surgeon outlines the specific techniques to be used during the rhinoplasty procedure and discusses potential risks and complications with the patient.
  • After rhinoplasty:
  1. Immediate post-operative period: The patient is monitored closely for any complications and is given instructions for post-operative care, including pain management and wound care.
  2. Recovery period: The patient may experience swelling, bruising, and discomfort in the days and weeks following surgery. They are advised to avoid strenuous activities and follow-up appointments are scheduled to monitor healing.
  3. Long-term results: Over time, the swelling will subside and the final results of the rhinoplasty will become more apparent. The patient may need to make adjustments to their lifestyle, such as avoiding certain activities or wearing sunscreen to protect their new nose.

What to Ask Your Doctor

  1. Can rhinoplasty help improve my nasal obstruction caused by facial paralysis?
  2. What specific techniques will be used to address the nasal valve narrowing and alar base displacement?
  3. What are the potential risks and complications associated with rhinoplasty in patients with facial paralysis?
  4. What is the expected recovery time and post-operative care for rhinoplasty in this situation?
  5. How long will the results of the surgery last and will I need any additional procedures in the future?
  6. Can you provide me with before and after photos of previous patients who have undergone rhinoplasty for facial paralysis?
  7. What is your experience and expertise in performing rhinoplasty for patients with facial paralysis?
  8. Are there any alternative treatments or procedures that may be beneficial for my specific situation?
  9. Will I need to follow up with other specialists, such as a facial plastic surgeon or neurologist, after the rhinoplasty procedure?
  10. What are the expected outcomes and potential benefits of rhinoplasty for improving nasal obstruction in patients with facial paralysis?

Reference

Authors: Shukla A, Lu GN. Journal: Facial Plast Surg. 2023 Dec;39(6):638-641. doi: 10.1055/a-2127-3768. Epub 2023 Jul 11. PMID: 37433310