Facial paralysis

Abstract

Detailed knowledge of embryology, anatomy, and function of the facial nerve is essential in treating the devastating functional, aesthetic, and psychological sequelae of facial paralysis. Two basic factors influence the method of repair and the subsequent outcome of the effort to combat facial paralysis. First is the availability of a viable proximal nerve stump which can be used as the source for motor axons, and which is related to the level of the injury. Second is the duration of the paralysis, which will dictate the possibility of reinnervating the facial muscles. Early restoration of nerve continuity, and therefore reestablishment of the neuromuscular junction and preservation of the function of the facial muscles, lead to superior functional and aesthetic rehabilitation. Secondary reconstruction, after the establishment of atrophy of the motor endplates of the facial muscles, is possible with nerve grafts and microsurgical free functional muscle transfer. These techniques, although not perfect, greatly improve aesthetic balance and alleviate the functional and psychological implications of the paralysis.

Unilateral Atrophy of the Cheek

“…Unilateral lipoatrophy of the face is also observed after facial nerve paresis due to ischemic or mechanical trauma and in different kinds of lipodystrophies. 21,22 For example, chronic pressure against any body part can result in atrophy of subcutaneous adipose tissue as a result of microtrauma or reduced perfusion. 12 Although localized unilateral atrophy of the cheek is a recognized result of inflammatory panniculitides, the data from our patient do not support the existence of an early inflammatory phase in this region.…”

Reconstruction of the Paralyzed Face

“…Th ese trunks then divide into fi ve main branches: temporal (frontal), zygomatic, buccal, marginal mandibular, and cervical. 6 Th e parasympathetic division of cranial nerve VII supplies fi bers that contribute to the greater petrosal nerve (which supplies the lacrimal gland), the lesser petrosal nerve (which supplies the parotid gland), and the chorda tympani (which supplies the submandibular and sublingual glands). Th e general sensory component of cranial nerve VII supplies sensation to the conchal skin, and the special sensory component supplies the taste sensation to the anterior two-thirds of the tongue via the chorda tympani.…”

“…Th e hypoglossal nerve-facial nerve jump graft can be employed as a "babysitter" because the short distance of neural regeneration results in relatively fast facial muscle reinnervation, which can prevent muscular atrophy. 6 Cross-face nerve graft . Cross-face nerve graft ing involves sacrifi cing a large buccal branch on the nonparalyzed side.…”

Surgical anatomy of the human middle ear: an insight into cochlear implant surgery

“…Once the facial recess has been opened, knowledge of the round window anatomy as it relates to normal or abnormal middle ear topography is vital [12]. The ability to visualize the round window membrane by removing the bony round window niche is important for competently creating a cochleostomy.…”