Rhinoplasty: Considerations for Patients with Facial Paralysis

Overview

Nasal obstruction is a common consequence of flaccid facial paralysis but is often not treated surgically. When the muscles on the paralyzed side lose tone, the nasal side wall loses both its resting shape and its ability to resist collapse on inhaling, and the base of the nostril drifts downward and inward. The review covers what can be done about each part of that problem.

Sections of note

• Article type: narrative review. No patient numbers, outcomes or complication rates are reported.
• Mechanism described: weakness of the nasal muscles causes loss of static and dynamic side wall tone.
• Second mechanism: inferomedial displacement of the alar base, meaning the nostril foot drifts down and inward.
• Standard rhinoplasty techniques named for supporting the side wall: alar batten grafts and flaring sutures.
• Those standard techniques are stated not to address the displaced alar base, which requires suspension.
• Two suspension techniques are described: suture resuspension and fascia lata resuspension.
• Modifications to each are described, aimed at improving how long the suspension lasts.

What it means for a patient

• Nasal blockage after facial paralysis has two separate causes, a collapsing side wall and a sagging nostril base, and each needs a different repair.
• Support grafts alone will not lift a nostril that has dropped. Suspension is needed for that part.
• Longevity is the acknowledged problem with suspension. The review's modifications are aimed at that, but the abstract reports no durability figures.
• No success rates, breathing scores or follow up lengths appear, so the effectiveness of these techniques cannot be judged here.

Why this paper matters

Breathing problems in facial paralysis are frequently overlooked because attention goes to the eye and the smile. Naming the two mechanisms separately gives a route to treating each. How long suspension holds, and which method holds longest, remains unresolved.

Terms

• Flaccid facial paralysis: loss of facial muscle function leaving the muscles slack.
• Nasal valve: the narrow part of the nasal airway that collapses when support is lost.
• Alar batten graft: a cartilage strip placed under the nasal sidewall to keep it from collapsing.
• Flaring suture: a stitch that pulls the sidewall outward to widen the airway.
• Fascia lata: a strong sheet of connective tissue from the outer thigh, used as graft material.
• Suspension: anchoring a drooping structure upward to a fixed point.