Cheiloplasty in the treatment of facial paralysis.

There have been dramatic improvements in the treatment of facial paralysis. These include the successful use of free autogenous nerve grafting, nerve crossover techniques, regional masticatory muscle transposition, and free muscle grafts. The techniques are applied to total, partial, and regional paresis. The bulk of information on rehabilitation of the face has come from clinical empiricism, but basic research in nerve and muscle physiology and attempts at multiple classifications regarding indications and criteria have added to the splendor of this drama. One facet that has not been emphasized is the use of cheiloplasty in long-standing facial paralysis. Long-standing facial paralysis has both a neural and muscular deficit that cannot be rectified by a single concept or operation. It is essential to regionalize the rehabilitation, implant a kinetic muscular potential, supply some static support and elevation, and address the nonfunctional muscles about the paralyzed lips. This latter concept includes lip shortening and lip-flap transposition. A coordinated combination of these techniques has the best opportunity of maximizing the improvement in long-standing facial paralysis associated with severe muscle atrophy.