Management of Traumatic Facial Nerve Injuries

Abstract

Management of facial nerve injuries requires knowledge and skills that should be in every facial plastic surgeon's armamentarium. This article will briefly review the anatomy of the facial nerve, discuss the assessment of facial nerve injury, and describe the management of facial nerve injury after soft tissue trauma.

Neuropathies Associated with Cosmetic Surgeries

“…13 Electrophysiological studies including nerve conduction studies of sensory and motor nerves and electromyography should be performed at the time of the diagnosis and during follow-up monitoring. Somatosensory Evoked Potentials tests, electroneurography and electromyography are very helpful in diagnosing nerve injury 14 Electromyography has proven to be the most useful test in the study of these types of injuries. It evaluates and registers the electrical activity produced by skeletal muscles measuring the electrical potential generated by the muscle cells.…”

“…Electromyography is performed 14 to 21 days after the injury when Wallerian degeneration of the axons has occurred. However in the acute phase, it is not possible to distinguish the extent of the axonal degeneration until the 3 rd to 14 th day 14 . In acute injuries increased spontaneous activity including positive waves and fibrillation potentials are noted.…”

“…However rhytidectomies are the commonest cause of facial nerve injuries. Patients can present with paresis with loss of function of the facial nerve-an event which can have a significant psychological impact for the patient 14 .…”

“…The facial muscles are therefore innervated by the facial nerve from a deep position with the exception of the muscles elevating the corner of the mouth: buccinator and mentalis. With this in mind it is therefore necessary to perform a superficial dissection of the SMAS in order to avoid nerve-related complications 2,14,16 . Fig.…”

“…Nerve transfers can sometimes cause synkinesis in the face 13 . Nerve repair can be epinerual and perineural or one can use surgical adheshives for the appostion of nerves without needing to perform neurorrhaphy 14 . One ought to follow the basic principles of nerve suturing which are to alleviate the tension and to avoid excessive scarring and fibrosis at the site of anastomosis 14 .…”