Head and Neck

FACIAL PARALYSIS:

Facial paralysis is the satate of weakness of the facial muscles mostly starting
immediately, seen on one side or sometimes both sides of the face. The one half
of the face hangs down, the side of the mouth is seen as if pulled downwards and
the patient is unable to close the affected side eye lid. The patient can not
perform whistling or smiling. In the severe cases, the patient can have
difficult in eating and controlling his saliva. The dryness of the eye can be
encountered due to the open eye lid.

The reason of the facial paralysis is unknown in most of the patients. The
patient mostly define an exposure to cold or wind before the paralysis.
Infection, trauma, tumor or vascular diseases can result in facial paralysis.

Some of the patients experiencing facial paralysis can be treated with drug
therapy. Some cases can not treated with the drug therapy and the weakness
perseveres. The mouth is drawn to one side, the eye lid is left opened.The
danger of blindness due to the unability to close the eyelid and the
disturbances of the nourishment are severe problems. These situations can affect
the patient’s social life and should be treated appropriately.

The patients that can not be treated by drug theraphy for one year, should
attend to a plastic and reconstructive surgeon. The rotation of the chewing
muscles of the face, transfer of muscles from other parts of the body, the
repair of the nerve or hanging are some treatment modalities. The surgical
intervention can prevent severe problems, such as blindness and nourishment
disturbances and aesthetic results achieved by the plastic and reconstrcutive
surgeons can help the patient to have a normal social life.

TUMORS of FACE:

Face is the region that is the most exposed to sun and environmental factors and
that is the reason of encountering increased number of lesions over the face.
The treatment at the early phase of these lesions are very easy whereas, severe
and late cases can be troublesome.

The most common lesion is the nevus. The misbelief of transformation of the
nevus to cancer if surgically excised culminates in insufficient treatment.
However, a nevus can transform into cancer with exposure to sun and
environmental factors and should be excised by a plastic and reconstructive
surgeon with an appropriate width and depth limit and should be closed with an
appropriate technique.

The skin tumor should be excised with the intact border seen macroscopically.
Only in the malignant melanoma, this situation is peculiar. The skin tumours
should be excised totally avoiding biopsies that are done for diagnosis.

The treatment of the lesion done by other specialists (eg. dermatologist,
general surgeon..etc.) will not be enough in most of the cases, as they have
difficuties in closing a wider wound and they pretend to excise the lesion
smaller to be able to close easier. The lesion should be excised by a pastic and
reconstructive surgeon who is capable of closing any kind of wound or defect
easly and perfectly.

Any lesion or defect that tend not to heal spontaneously or tend to increase in
size should not be neglected and should be treated ergently.

BURNS of FACE:

Hot liquid, flame or chemical substances can cause burn and depending of the
depth of the burn, unaesthetic appereance ans scars can be encountered
especially around the face region. The liquid loss in the first 48 hours after
the burn is the crucial time for life saving and the patient should be supplied
with liquids.

The second important point is the infection after burns. The protection from the
infection is more important than the treatment of it. The burn should not be
applied any materials such as, yoghurt, toothpaste…etc. except water (sterile
isotonic solution). If the burn is as extensive as 15% or more of the body, the
patient should be hospitalized.

The late period treatment of burns after 6-12 months is executed by plastic and
reconstructive surgeon. The stretched tissues around eye can result even in
blindness. The disturbances in breathing and nourishment can be encountered with
the stretched tissues around mouth and nose. The burns around ear result in loss
of the external parts of the ear and the narrowing of the external auditiory
canal. The unpleasent appereance of the head and hair after burns can be one of
the annoying problems for the patient.

The stretched tissues maturate until 6-12 months and any early intervention can
result in recurrences. The functional disturbances are more important in the
burns around the eye, mouth, nose and neck. The treatment can be a simple z-plasty
method or utilisation of expander technique depending of the type of the
stretched tissue and localization.

The face being the most vital and aesthetic region of our body, any undesirable
effect can result in social and psychological disturbances. The hinderance of
the unwanted results and appropriate treatment not only saves the patient’s life
but also helps to have a better life quality.

FACE INJURIES(TRAUMA):

The facial region is the most important part in the communication with the
environment. Any wound or a simple abrasion can make the patient anxious. The
plastic and reconstructive surgeon can tranquilize the patient with a trauma to
the face.

The face injuries can be cathegorized in two groups

The first; the injuries of the face without any broken facial bones. These can
be in a wide perspective of small lacerations to amputation of ear or nose. Any
intervention to the face that is not appropriate can result in very unpleasent
situations. To avoid such a tragic situaiton, any injury to face should remind a
specialised aesthetic, plastic and reconstructive surgeon. The plastic surgeon
can treat a cut with aesthetic suturation or replant an amputated organ and can
achieve excellent results.

The second; the injuries of the face with broken face bones. The fractures of
the bone at the prominent part of the cheek(zygomatic bone), the upper or lower
jaws can result in extensive aesthetic disturbances or functional disorders in
chewing when treated late or wrongly. Following the 24 hours of the injury, the
fracture can be treated with an elastic bandage or with fixation with plates
according to the type of the injury.

This decision is made by the plastic surgeon depending on the fracture. The
fracture of the bones surrounding the eye(orbita) is very important and these
can result in disturbances in seeing, such as diplopia(double vision).

The unacceptable results can be prevented by the plastic surgeon even at the
first examination. The excellent results achieved in the face injuries honour
the plastic and reconstructive surgeons and differentiate them from any other
specialisations.