Contemporary Solutions for the Treatment of Facial Nerve Paralysis

Abstract

Facial expression is a complex neuromotor and psychomotor process that is disrupted in patients with facial paralysis breaking the link between emotion and physical expression. Contemporary reconstructive options are being implemented in patients with facial paralysis. While static procedures provide facial symmetry at rest, true 'facial reanimation' requires restoration of facial movement. Contemporary treatment options include neurotization procedures (a new motor nerve is used to restore innervation to a viable muscle), contiguous regional muscle transfer (most commonly temporalis muscle transfer), microsurgical free muscle transfer, and nonsurgical adjuvants used to balance facial symmetry. Each approach has advantages and disadvantages along with ongoing controversies and should be individualized for each patient. Treatments for patients with facial paralysis continue to evolve in order to restore the complex psychomotor process of facial expression.

Anatomical study of the zygomatic and buccal branches of the facial nerve: Application to facial reanimation procedures

“…The facial nerve's arborization pattern is an example of highly complex and fascinating neural anatomy. The facial nerve is responsible for any involuntary and voluntary facial expression channeling emotions through a complex neuromotor and psychomotor interplay (Garcia et al, ). Linking the brain with at least 21 muscles it represents a protagonist in this delicate interplay (Kehrer et al, ).…”

Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes

“…It allows for a fasted nerve recovery since it may allow direct nerve coaptation close to the target muscle. Selection of donor nerves in facial reanimation include the hypoglossal, masseter, contralateral facial with cross‐face nerve grafts, spinal accessory, and phrenic nerves (Garcia et al, ; Klebuc & Shenaq, ). Spira () proposed the use of masseteric nerve as a viable alternative to facial nerve reconstruction.…”

“…The subsequent facial palsy affects facial function, psychological health, and aesthetic outcomes (Bianchi, Ferri, & Sesenna, ; Manktelow, Tomat, Zuker, & Chang, ). A large number of surgical techniques and modifications have been published for the rehabilitation of the face after nerve transection including nerve grafting, nerve transfers, regional muscle transposition, and free muscle transfers (Coombs, Ek, Wu, Cleland, & Leung, ; Garcia et al, ; Klebuc, ; Labbé & Huault, ; Terzis & Konofaos, ; Terzis & Tzafetta, ). Nerve transfers provide a healthy source of axons close to the target muscles and allows for direct coaptation.…”

The Emerging Role of Botulinum Toxin in the Treatment of Orofacial Disorders: Literature Update

“…In patients with facial asymmetry, BTX injections into the normal side have been reported to result in an apparent symmetrical function of the face [107][108][109]. BTX-A is commonly used to treat facial synkinesis with marked improvement of facial symmetry at rest and during voluntary movements [110,111].…”