Question: The lower lip has a multitude of expressions and dysfunctions in facial paralysis. Can a treatment be standardized?

Method: 20 patients with unilateral complete (14) or partial (6) facial paralysis were reviewed preoperatively and postoperatively with attention to the lower lip. Patterns of form and function were classified according to etiology. Each patient was assessed for altered appearance, oral competency, and related speech abnormalities.

Result: Patients with complete unilateral paralysis undergoing reanimation showed improvement in appearance and speech. Oral competence was affected by the degree of correction of the commissure, as well as atrophy of the orbicularis muscle. Secondary procedures on the lower lip were performed in 12 of 14 patients with complete paralysis and 2 of 6 with partial isolated paralysis.

Discussion: The variable presentation of the lower lip in paralysis is responsible for the variety of symptoms noted. Reanimation procedures may deform the lower lip while improving commissural excursion. An algorithm will identify lower lip deformities in paralysis and review treatment focusing on fullness, dynamic tension, and speech control.

Conclusion: Lower lip paralysis shows variable preoperative and postoperative form and function. Based on etiology and degree of atrophy, an appropriate restoration of the lip can be designed.