Facial Nerve Trauma: Evaluation and Considerations in Management

Abstract

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.

Long-term Outcomes After Middle Fossa Approach for Traumatic Facial Nerve Paralysis

“…The perigeniculate region is the site inwhich the facial nerve is most often damaged and the meatal foramen and labyrinthine segment are the narrowest portion of the bony facial canal. These areas are most commonly accessed through a MF approach, if hearing preservation is desired (8,17,16). MF decompression and repair of the facial nerve has been offered to patients at risk for a poor long-term outcome with good results in published series, 66.7 to 100% of patients improved to normal or near normal facial function (HB I or II) (3,9,10,(22)(23)(24)(25)(26)(27)(28)(29), compared with a 53% rate of recovery for patients who were observed (40).…”

“…The long-term consequences of facial paralysis result in functional limitations, are emotionally distressing, and have significant psychosocial implications (7). Patients who are high risk for poor outcomes, as determined by electrodiagnostic testing, may benefit from surgical management (8)(9)(10).…”

Показання І Протипоказання До Проведення Хірургічного Лікування Наслідків Ураження Лицевого Нерва

“…Досконале володіння анатомією лицевого нерва та клініко-діагностичними й інструментальними методами оцінки ступеня ураження лицевого нерва має вирішальне значення для успішного лікування хворих із цією патологією [9].…”

“…Якщо проведення первинного шва є неможливим, віддають перевагу автопластиці ЛН, використовуючи інший нерв-донор (переважно n.suralis). Якщо за наявності тривалого паралічу м'язів обличчя з переродженням кінцевих рухових пластинок проведення первинної реіннервації ЛН буде малоефективним, тоді віддають перевагу невротизації ЛН різними нервами-донорами та статичним методам корекції обличчя [9,11].…”

Sydney Facial Nerve Clinic: experience of a multidisciplinary team

“…Facial nerve disorders can arise from many different aetiologies, with morbidity arising from these depending on the site and severity of the injuries. Outcomes can involve loss of corneal protection, speech problems and oral incompetence, as well as nasal valve collapse . Altered emotional expression following facial palsy also has a profound impact on patient's quality of life .…”