The surgical treatment of extratemporal facial paralysis: An overview

Abstract

At present there is no single surgical approach that is ideally suited to rehabilitation of the paralyzed face. Dynamic reconstruction and neural reconstitution are usually preferred to static methods, except under special circumstances. Experience with over 150 autogenous facial-nerve grafts using epineural suture technique has resulted in return of movement in 95% of properly selected patients. When grafting is not feasible, as in the obliterated central facial nerve, hypoglossal-facial-nerve crossover is a simple and powerful source of reinnervation, usually resulting in minimal intraoral crippling and mild mass movement. A newer procedure, the cross-face nerve graft, is an alternative to hypoglossal crossover, although it results in less axonal input and longer regenerative time. In cases of long-standing facial paralysis with muscle atrophy, temporalis and masseter transfers are dependable and may sometimes be combined with a nerve graft.

Local delivery of glial cell line–derived neurotrophic factor improves facial nerve regeneration after late repair

“…This is the case particularly in lesions of the mandibular or frontal branches, when cross-facial nerve grafts have to be performed in aged patients and when the delay between the lesion and its repair is prolonged. 3,5,23,26 So far, facial nerve regeneration with local application of nerve growth factor or brain derived neurotrophic factor, two neurotrophic factors of the neurotrophin family, had revealed only limited improvement. 27,28 Our previous study demonstrated that GDNF is a potent neurotrophic factor, which improves facial nerve regeneration in the peripheral nervous system, and promotes survival in the central nervous system.…”

Glial cell line‐derived neurotrophic factor released by synthetic guidance channels promotes facial nerve regeneration in the rat

“…Recovery after facial nerve injury is often poor despite the various grafting techniques that have been applied in the clinic to bridge large gaps. This is particularly the case for lesions of the mandibular or frontal branches or when cross‐facial nerve grafts have to be performed in the absence of a proximal nerve stump (Conley and Baker, 1978; Anderl, 1979; Spector et al, 1991; Kerrebijn and Freeman, 1998). Because experimental work on facial nerve regeneration had revealed only limited improvement with the application of regeneration‐promoting molecules, such as the neurotrophic factors NGF or BDNF (Spector et al, 1993; Kohmura et al, 1999), we looked for alternative growth‐promoting factors in order to optimize effects on regeneration of the facial nerve.…”

Surgical management of facial nerve paralysis in the pediatric population

“…2). Dynamic facial reanimation may be achieved by either the use of a muscle free flap or a local rotational muscle flap [54][55][56]. When free flaps are used, the flap must be innervated by one of many potential donor nerves including branches of ipsilateral/contralateral facial nerve, masseteric branch of the trigeminal nerve, and as others [32,50,[57][58][59][60][61][62][63] (Fig.…”