General Editor: Daniel Buchbinder

Authors: Damir Matic, John Yoo

Facial nerve - Irreversible paralysis, mouth - Lower lip

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Glossary

General considerations

Excessive horizontal lengthening of the lip can occur with longstanding paralysis and unopposed contralateral pull.

Due to atrophy of the orbicularis muscle, the red lip can thin as well as lengthen.

Horizontal shortening
Main indication Skill Equipment
Prolonged irreversible paralysis of the lower lip Basic surgical experience, no specialized skills Basic equipment only

Further indication

  • Unilateral thinning and elongation of the lower lip

Contraindication

  • Expectation of muscle recovery

Advantages

  • Simple
  • Immediate
  • Symmetry at rest
  • Improves oral competence, speech, and cosmesis

Disadvantages

  • Visible scar
  • may need to be repeated over time because of continued unopposed pull from the contralateral side
Contralateral depressor angularis muscle excision
Main indication Skill Equipment
Unilateral irreversible paralysis of the lower lip causing asymmetry Some specialized surgical experience Basic equipment only

Contraindication

  • Expectation of muscle recovery

Advantages

  • Permanent
  • Lower lip symmetry at rest and movement
  • No visible scar

Disadvantages

  • Potential change in lower lip sensation
  • Potential injury adjacent muscles
  • Potential contour deformity of lower lip due to incomplete muscle resection
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources