Reanimating the Paralytic Face after Head and Neck Tumor Excision

Facial palsy can result from direct invasion of the facial nerve with tumor, or as a sequel of surgical treatment of head and neck neoplasms. Facial reanimation after tumor excision in this category poses a special challenge, with indications and management strategies that are different from that of facial palsy with other etiologies such as Bell's palsy. The tumor type (benigh 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 reconstructive strategy in each particular case.

Between 1986 and 2002, 172 patients with facial palsy were treated by surgery. In 78 patients (45%), the etiology of facial paralysis was head and neck tumor compression or tumor ablation: 74 patients treated with functioning free muscle transplantation, two treated with hypoglossal–facial nerve transfer, and two treated with nerve grafts. Tumors involving the facial nerve were either primary, such as facial nerve schwannomas or secondary, including acoustic neuroma. Whenever facial nerve reconstruction can be done immediately after tumor ablation, it should not be delayed. If the facial nerve palsy is complicated by neurapraxia after tumor surgery, or is caused by malignant tumor invasion that is not eradicated completely or that requires postoperative radiation, then delay facial reanimation is the optimal strategy. Here the author demonstrated different reconstructive strategies for facial palsy caused by head and neck tumor excision, as well as tumor resection in childhood. Results and complications were also reported.