Managing Facial Trauma: Concerns and Solutions for Lip and Nerve Issues

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Hello: A year ago, I suffered a car accident that resulted in a defect of approximately 0.3 cm near the philtrum of my left upper lip.
The doctor performed a flap surgery by cutting tissue from the left upper lip to the corner of the mouth and sutured it to the defect.
Additionally, the accident caused paralysis in the area below the left cheekbone.
After six months of recovery, I intended to undergo further surgery for both the lip and the left cheek paralysis.
Currently, the condition of my lip post-surgery shows asymmetry between the left and right sides, and the defect area is raised.
Furthermore, during cold weather, the defect area of my lip experiences pain, along with the persistent numbness in my left cheek.
I consulted with a plastic surgeon at Kaohsiung Chang Gung Memorial Hospital, and the doctor advised that I should adapt to the paralysis in my left face and that no further lip reconstruction was necessary.
(The doctor clearly stated that the paralysis condition cannot be changed and that it will remain this way for life!)...
I am genuinely worried that over time this may lead to muscle atrophy.
What should I do? Thank you.

Youyou, 20~29 year old female. Ask Date: 2007/03/13

Dr. Lu Daokuan reply Plastic Surgery

Facial paralysis occurring below the eyes may require further examination.
If the paralysis is long-term and leads to atrophy, nerve grafting may be necessary.
If the condition is not that severe, it is likely to improve gradually over time.
For the lips, it is important to assess whether the lip line is symmetrical.
If the results are still unsatisfactory, volume augmentation, possibly through autologous fat grafting, may be beneficial.

Reply Date: 2007/03/13

More Info

Managing facial trauma, particularly when it involves nerve damage and cosmetic concerns, can be a complex and emotionally challenging process. Your situation, stemming from a car accident that resulted in both a lip defect and facial nerve impairment, raises several important considerations regarding recovery, treatment options, and long-term management.

Understanding Your Condition
1. Facial Nerve Damage: The facial nerve (cranial nerve VII) is responsible for controlling the muscles of facial expression. Damage to this nerve can lead to weakness or paralysis on one side of the face, resulting in asymmetry, difficulty with facial expressions, and potential complications such as synkinesis (involuntary movements). The fact that you are experiencing numbness and weakness in your left cheek indicates that the nerve may have been affected during the trauma.

2. Lip Reconstruction: The surgical procedure you underwent to repair the lip defect is a common approach to restoring function and aesthetics. However, the outcome can vary based on the extent of the injury, the timing of the surgery, and individual healing processes. The uneven appearance and discomfort you describe, especially in cold weather, are not uncommon following such injuries.

Concerns About Atrophy and Long-Term Effects
You expressed concern about potential atrophy over time due to the nerve damage. Muscle atrophy can occur when muscles are not used, which is a possibility if the facial muscles on the affected side are not functioning properly. Over time, if the nerve does not regenerate or if muscle activity is not restored, you may notice further changes in muscle tone and appearance.

Recommendations for Management
1. Physical Therapy: Engaging in facial rehabilitation therapy can be beneficial. A specialized therapist can guide you through exercises designed to improve muscle tone, coordination, and overall function. This may help mitigate some of the effects of nerve damage and improve your ability to express emotions.

2. Botulinum Toxin Injections: In some cases, botulinum toxin (Botox) can be used to help balance facial asymmetry by temporarily paralyzing overactive muscles on the unaffected side. This can create a more symmetrical appearance and improve function.

3. Surgical Options: While your current surgeon indicated that further surgical intervention may not be necessary, it might be worthwhile to seek a second opinion from a facial plastic surgeon or a reconstructive surgeon who specializes in nerve repair and facial aesthetics. They may offer alternative solutions or techniques that could improve your situation.

4. Pain Management: For the discomfort you experience in cold weather, consider discussing pain management strategies with your healthcare provider. This may include medications, topical treatments, or other interventions to alleviate discomfort.

5. Psychological Support: Dealing with the aftermath of facial trauma can be emotionally taxing. Seeking support from a mental health professional can help you cope with the psychological impact of your injuries and the changes in your appearance.

Conclusion
While the prognosis for nerve recovery can vary, it is essential to remain proactive in your management. Engaging in physical therapy, exploring additional surgical options, and addressing pain management can significantly improve your quality of life. It’s also crucial to maintain open communication with your healthcare providers, ensuring that all your concerns are addressed and that you feel supported throughout your recovery journey. Remember, adapting to changes in your body takes time, and seeking help is a sign of strength.

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