FIG. 22-18

FlG. 22-19. Postoperative follow-up at 2 years. The patient has good facial symmetry at rest.

FIG. 22-20. Mouth open. Right lower lip lag is seen.

FIG. 22-21. Four-year follow-up.

FIG. 22-22. Stronger smile.

FIG. 22-23. Strong smile. Lower lip lag is still noted.

CASE 3

A 6-year-old boy had congenital left facial palsy.

FIG. 22-24. Preoperatively, the nasolabial folds are marked for later intraoperative landmarks. At rest.

FIG. 22-25. Grimacing.

FIG. 22-26. Smiling.

FIG. 22-27. Cross-facial nerve graft is placed over tunnel across the upper lip. Suction catheter is in tunnel. We now pass this across the lower lip to make the second stage easier.

FIG. 22-28

FIG. 22-29. Muscle is isolated on neurovascular pedicle.

FIG. 22-30. Muscle on paralyzed cheek, ninth slip to lids, eighth slip to upper lip and nasolabial fold, seventh slip to angle of mouth.

FIG. 22-31. Postoperative follow-up shows symmetry at rest. There is strong muscle contraction and independent eye closure.

FIG. 22-32. Strong contracture, still improving.

FIG. 22-33. Lid closure.

CASE 4

A 16-year-old boy had suffered facial trauma at age 1 year, leaving an uncorrected left facial palsy.

FIG. 22-34. Preoperative appearance.

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