Facial Nerve Injury and Repair: A Practical Review for Cutaneous Surgery

Abstract

BACKGROUND The facial nerve and its branches are at risk of injury during dermatologic surgery. Few publications in the dermatologic literature discuss facial nerve injury and management. OBJECTIVE To review facial nerve injury and management, including static and dynamic repair techniques, and to review outcomes in facial nerve reconstruction. METHODS Two detailed literature reviews were performed using PubMed. First, articles reporting facial nerve injury and/or management in the dermatologic literature were identified. In addition, articles pertaining to outcomes in facial nerve reconstruction with a minimum of 20 patients were included. RESULTS Fifty-three articles reporting outcomes in facial nerve reconstruction were identified and consist of retrospective reviews and case series. Most patients achieve improvement in facial symmetry and movement with nerve repair. CONCLUSION Timing of facial nerve repair is an important consideration in management of facial nerve injury, with earlier repairs achieving better outcomes. Facial nerve repair does not result in normal facial movement, and improvements may require a year or more to be realized. Many options exist for facial nerve reconstruction, and patients with long-standing facial nerve injuries may still benefit from treatment.

The Anatomic Landmark Approach to Extratemporal Facial Nerve Repair in Facial Trauma

“…Theoretically, the sooner the facial nerve is repaired, the better the outcome of the surgery [ 1 ]. In acute trauma, nerve repair done within 72 hours has the highest rate of recovery because Wallerian degeneration does not occur in such cases and the distal nerve endings can still be stimulated [ 11 ].…”

“…In developing countries, injuries caused by traffic and labor accidents and assault are a significant concern. Maxillofacial trauma accounts for 16% of major trauma injuries [ 1 ]. Maxillofacial trauma includes injuries to the soft tissue, facial bone fractures, and facial paralysis.…”

“…Microsurgical techniques have enabled surgeons to re-anastomose the facial nerve. However, in post-traumatic cases, the surgeon needs to find the proximal and distal end of each injured branch to perform end-to-end re-anastomosis or use a nerve graft to maximize the surgical outcome [ 1 ]. Facial nerve branching is complex and many of its branches are small and difficult to find and dissect [ 2 ].…”

Overexpression of c‐Jun inhibits erastin‐induced ferroptosis in Schwann cells and promotes repair of facial nerve function

“…The facial nerve is one of the key mixed nerves, which shares the motor and sensory functions. Clinically, facial nerve injury is not only difficult to treat but also causes serious psychological and social loads to patients and their families 3 . Early studies suggested that nerve injury triggers the proliferation of SCs, but recent studies have differed from this view.…”

“…Clinically, facial nerve injury is not only difficult to treat but also causes serious psychological and social loads to patients and their families. 3 Early studies suggested that nerve injury triggers the proliferation of SCs, but recent studies have differed from this view. Wagstaff found the number of SCs increased approximately 2.5-fold after sciatic nerve injury…”