The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm.

OverviewHead and neck trauma is commonly encountered and managed by general plastic surgeons, oral maxillofacial surgeons, and otolaryngologists. It is important to be aware of the relative prevalence of carotid artery injury found in asymptomatic blunt facial trauma patients, as they can develop devastating ischemic stroke or even death. With improved screening criteria, studies have demonstrated increased detection of blunt carotid injury (BCI) occurring in of 1-2.6% of blunt trauma cases. Skull base fractures, facial fractures, cervical spine fractures, and thoracic injuries, along with a host of other risk factors, have been identified as risk factors for BCI. The importance of early diagnosis and initiation of immediate treatment of BCI is highlighted by high rates of ischemic stroke (60%) and mortality (19-43%) associated with untreated extracranial carotid artery injuries (ECAI) that could be reduced significantly with timely treatment. [1][2][3][4][5][6] Similarly, intracranial carotid artery injuries (ICAIs) carry poor prognosis and require prompt management. With increased awareness of screening criteria and improved detection, there is a growing consensus for aggressive, early antithrombotic therapy. The majority of surgical interventions consist predominantly of endovascular techniques. Although long-term data are lacking, endovascular techniques have shown efficacy in reducing neurologic complications and demonstrated safety measures in both select extracranial and ICAIs. AnatomyThe carotid artery is located adjacent to vital neurovascular structures and is responsible for supplying adequate blood flow to the brain. It is divided by a segmental classification popularized by Bouthillier et al (►Fig. 1). AbstractWith increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention.

The evidence for BT-A in headache is mixed, and even more so in CTTH. However, the putative technique of injecting BT-A directly into the ubiquitous MTPs in CTTH is partially supported in this pilot study. Definitive trials with larger samples are needed to test this hypothesis further.

The tongue is paramount to natural speech and swallowing, and good tongue function is important in the overall quality of life. Autologous free-flap reconstruction of the tongue after glossectomy allows for adequate speech, swallow, and quality-of-life outcomes in a majority of patients. Herein, the authors review autologous free-flap reconstruction of the tongue with a focus on different flap options, speech and swallow outcomes, quality-of-life outcomes, and factors that affect how patients perform after tongue reconstruction.

This study demonstrates injectate volumes needed to reach specific anatomic landmarks in L-TFEIs. A volume of 4.0 mL of injectate reaches both the superior aspect of the superior IVD and the inferior aspect of the inferior IVD 93% of the time.