Treatment Considerations in Facial Paralysis

ABSTRACT

Facial nerve paralysis and its sequelae are devastating to patients. For the reconstructive surgeon, the management of the patient with facial paralysis is challenging. There is a lack of consensus regarding the initial management. Then, there is the dizzying array of treatment options for each patient, including nonoperative observation, nerve transfers, static slings, dynamic muscle transfers, and chemodenervation. The appropriate timing of any intervention is often not clear. In this article, we will briefly outline some important considerations for the facial plastic surgeon in the management of facial paralysis. This includes the relevant anatomy and the initial evaluation. An overview of treatment options, with suggestions for the appropriate use of each option, is then provided.

KEYWORDS

Facial paralysis - facial nerve reanimation - electrophysiologic testing - radiographic imaging

REFERENCES

• 1 Gasser R F. The development of the facial nerve in man.  Ann Otol Rhinol Laryngol. 1967;  76 37-56
• 2 Jelks G W, Jelks E B. The influence of orbital and eyelid anatomy on the palpebral aperture.  Clin Plast Surg. 1991;  18 183-195
• 3 Nager G T, Proctor B. The facial canal: normal anatomy, variations and anomalies. II. Anatomical variations and anomalies involving the facial canal.  Ann Otol Rhinol Laryngol Suppl. 1982;  97 45-61
• 4 Proctor B, Nager G T. The facial canal: normal anatomy, variations and anomalies. I. Normal anatomy of the facial canal.  Ann Otol Rhinol Laryngol Suppl. 1982;  97 33-44
• 5 Vidic B. The anatomy and development of the facial nerve.  Ear Nose Throat J. 1978;  57 236-242
• 6 Schwaber M K, Larson III T C, Zealear D L et al.. Gadolinium-enhanced magnetic resonance imaging in Bell's palsy.  Laryngoscope. 1990;  100 1264-1269
• 7 Wilson D F, Talbot J M, Hodgson R S. Magnetic resonance imaging-enhancing lesions of the labyrinth and facial nerve. Clinical correlation.  Arch Otolaryngol Head Neck Surg. 1994;  120 560-564
• 8 Moore G F. Facial nerve paralysis.  Prim Care. 1990;  17 437-460
• 9 Smith I M, Murray J A, Cull R E et al.. A comparison of facial grading systems.  Clin Otolaryngol Allied Sci. 1992;  17 303-307
• 10 May M, Harvey J E, Marovitz W F et al.. The prognostic accuracy of the maximal stimulation test compared with that of the nerve excitability test in Bell's palsy.  Laryngoscope. 1971;  81 931-938
• 11 Fisch U. Maximal nerve excitability testing vs electroneuronography.  Arch Otolaryngol. 1980;  106 352-357
• 12 Fisch U. Surgery for Bell's palsy.  Arch Otolaryngol. 1981;  107 1-11
• 13 Baker D C. Facial paralysis. In: McCarthy J, May J, Littler W Plastic Surgery. Philadelphia, PA; WB Saunders 1990: 2237-2319