Reanimating the Paralyzed Face after Head and Neck Tumor Excision

ABSTRACT

Facial paralysis can be resulted from direct invasion of the facial nerve with tumor, or a sequel of surgical treatment of head and neck neoplasms. Facial reanimation after tumor excision in this category poses a special challenge, with indication and management strategies that are different from that of facial paralysis with other etiologies. The tumor type (benign or malignant), the requirement of postoperative radiation, the surgeon's facility with different reconstructive techniques, and the patient's age and motivation are all factors involved in determining the appropriate timing and the reconstructive strategy in each particular case. Tumor cure is always the first concern, overriding that of facial paralysis reconstruction. Whenever facial nerve reconstruction can be done immediately after tumor ablation, such as following malignant parotid gland resection, it should not be delayed. However, if the facial nerve injury is impressed with neurapraxia after tumor surgery, such as following acoustic neuroma resection, or the facial paralysis is caused by malignant tumor invasion that is not eradicated completely or that required postoperative radiation, then delayed facial reanimation is the optimal strategy. In delayed reconstruction, a classic two-stage procedure with cross-face nerve grafts in the first stage followed by functioning free muscle transplantation in the second stage is preferred.

KEYWORDS

Facial paralysis - Head and neck tumor surgery

REFERENCES

• 1 May M. Differential diagnosis by history, physical findings and laboratory results. In: May M, ed. The Facial Nerve New York: Thieme 1986: 181-216
• 2 Barnes L, May M. Pathologic considerations in facial nerve disorders: clinical-pathological correlations. In: May M, ed. The Facial Nerve New York: Thieme 1986: 143-177
• 3 Sando I, Ikeda M, Kitajiri M, May M. Histopathology of the facial nerve temporal bone. In: May M, ed. The Facial Nerve New York: Thieme 1986: 107-141
• 4 May M. Facial nerve disorders in the newborn and children. In: May M, ed. The Facial Nerve New York: Thieme 1986: 401-419
• 5 Harrison D H. The treatment of unilateral and bilateral facial palsy using free muscle transfers.  Clin Plast Surg . 2002;  29 539-549
• 6 Chuang D CC. Technique evolution for facial paralysis reconstruction using functioning free muscle transplantation-experience of Chang Gung Memorial Hospital.  Clin Plast Surg . 2002;  29 449-459
• 7 Conley J, Baker D C. Hypoglossal facial nerve anastomosis for reinnervation of the paralyzed face.  Plast Reconstr Surg . 1979;  63 63
• 8 Pensak M L, Jackson C G, Glasscock M E, Gulya A J. Facial reanimation with VII-XII anastomosis: analysis of the functional and psychological results.  Otolaryngol Head Neck Surg . 1986;  94 305
• 9 Terzis J K, Noah M E. Analysis of 100 cases of free-muscle transplantation for facial paralysis.  Plast Reconstr Surg . 1997;  99 1905
• 10 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation with microneurovascular anastomoses for the treatment of facial paralysis.  Plast Reconstr Surg . 1976;  57 133
• 11 Tolhurst D E, Bos K E. Free revascularized muscle grafts in facial palsy.  Plast Reconstr Surg . 1982;  69 760
• 12 O'Brien B C, Pederson W C, Khazanchi R K, Morrison W A, Macleod A M, Kumar V. Results of management of facial palsy with microvascular free-muscle transfer.  Plast Reconstr Surg . 1990;  86 12
• 13 Manktelow R T. Free muscle transplantation for facial paralysis.  Clin Plast Surg . 1984;  11 215
• 14 Harrison D H. The pectoralis minor vascularized muscle graft for the treatment of unilateral facial palsy.  Plast Reconstr Surg . 1985;  75 206
• 15 Baker D C, Colonley J. Regional muscle transposition for rehabilitation of the paralyzed face.  Clin Plast Surg . 1979;  6 317
• 16 Rubin L R. The anatomy of a smile: its importance in the treatment of facial paralysis.  Plast Reconstr Surg . 1974;  53 384
• 17 Chuang D CC. Aberrant reinnervation of the facial paralysis and its surgical treatment. Presented in 2003 annual meeting of American Society for Reconstructive Microsurgery, Hawaii, January 11, 2003.
• 18 Chuang D CC, Devaraj V S, Wei F C. Irreversible muscle contracture after functioning free muscle transplantation using the ipsilateral facial nerve for reinnervation.  Br J Plast Surg . 1995;  48 1-7
• 19 Chuang D CC, Mardini S, Lin S H, Chen H C. Free proximal gracilis muscle and its skin paddle compound flap transplantation for complex facial paralysis (in press).  Plast Reconstr Surg.
• 20 Wei F C, Demirkan F, Chen H C, Chen I H. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer.  Plast Reconstr Surg . 1999;  103 39-47
• 21 Wei F C, Demirkan F, Chen H C. et al . Management of secondary soft-tissue deficits following microsurgical head and neck reconstruction by means of another free flap.  Plast Reconstr Surg . 1999;  103 1158-1166
• 22 Harii K, Asato H, Yoshimura K, Sugawara Y, NakatsukaT, U eda. One-stage transfer of the latissimus dorsi muscle for reanimation of a paralyzed face: a new alternative.  Plast Reconstr Surg . 1998;  102 941
• 23 O'Brien B M. One-stage reconstruction of facial paralysis using the gracilis muscle transfer. Presented at the 10th Symposium of the International Society of Reconstructive Microsurgery, Munich, Germany, September 1991.
• 24 Jiang H, Guo T, Ji Z L, Zhang M L, Lu V. One-stage microneurovascular free abductor hallucis muscle transplantation for reanimtion of facial paralysis.  Plast Reconstr Surg . 1995;  96 78
• 25 Guelinckx P, Sinsel N K. Muscle transplantation for reconstruction of a smile after facial paralysis past, present and future.  Microsurgery . 1996;  17 391
• 26 Hamilton S GL, Terzis J K, Carraway J H. Surgical anatomy of the facial musculature and muscle transplantation. In: Terzis JK, ed. Microreconstruction of Nerve Injuries Philadelphia: Saunders 1987: 571-586