Clin Exp Otorhinolaryngol.  2009 Mar;2(1):1-5. 10.3342/ceo.2009.2.1.1.

Surgical Treatment of Facial Paralysis

• Mehta RP

• KMID: 1466552
• DOI: http://doi.org/10.3342/ceo.2009.2.1.1

Abstract

The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (<3 weeks duration), intermediate duration facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy.

Keyword

Facial paralysis; Surgical management

MeSH Terms

Cosmetics
Decompression
Facial Nerve
Facial Paralysis
Humans
Muscles
Nerve Transfer
Cosmetics

Figure

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  Fig. 1 Coaptation of the sural nerve graft to the donor facial nerve branches anterior to the parotid gland followed by tunneling of the sural nerve graft to the contralateral paralyzed side of the face.

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  Fig. 2 (A) Harvest of gracilis muscle from the medial thigh. (B) Inset of gracilis muscle in the paralyzed side of the face with vascular anastomosis to the facial artery and vein and neurorrhaphy of the obturator nerve to the cross-face nerve graft.

Reference

1. Melvin TA, Limb CJ. Overview of facial paralysis: current concepts. Facial Plast Surg. 2008; 5. 24(2):155–163. PMID: 18470826.

2. Hadlock TA, Greenfield LJ, Wernick-Robinson M, Cheney ML. Multimodality approach to management of the paralyzed face. Laryngoscope. 2006; 8. 116(8):1385–1389. PMID: 16885741.

3. Sofferman RA. Nadol JB, Mckenna MJ, editors. Facial nerve injury and decompression. Surgery of the ear and temporal bone. 2005. Philadelphia (PA): Lippincott Williams and Wilkins;p. 435–450.

4. Humphrey CD, Kriet JD. Nerve repair and cable grafting for facial paralysis. Facial Plast Surg. 2008; 5. 24(2):170–176. PMID: 18470828.

5. Chu TH, Du Y, Wu W. Motor nerve graft is better than sensory nerve graft for survival and regeneration of motoneurons after spinal root avulsion in adult rats. Exp Neurol. 2008; 8. 212(2):562–565. PMID: 18555993.

6. Terzis JK, Konofaos P. Nerve transfers in facial palsy. Facial Plast Surg. 2008; 5. 24(2):177–193. PMID: 18470829.

7. Tai CY, Mackinnon SE. Surgical options for facial reanimation. Mo Med. 2006; May–Jun. 103(3):270–274. PMID: 16910436.

8. Hadlock TA, Cheney ML, McKenna MJ. Nadol JB, Mckenna MJ, editors. Facial reanimation surgery. Surgery of the ear and temporal bone. 2005. Philadelphia (PA): Lippincott Williams and Wilkins;p. 461–472.

9. Liu YM, Sherris DA. Static procedures for the management of the midface and lower face. Facial Plast Surg. 2008; 5. 24(2):211–215. PMID: 18470832.

10. Boahene KD. Dynamic muscle transfer in facial reanimation. Facial Plast Surg. 2008; 5. 24(2):204–210. PMID: 18470831.

11. Chuang DC. Free tissue transfer for the treatment of facial paralysis. Facial Plast Surg. 2008; 5. 24(2):194–203. PMID: 18470830.

12. Meltzer NE, Byrne PJ. Management of the brow in facial paralysis. Facial Plast Surg. 2008; 5. 24(2):216–219. PMID: 18470833.

13. Bergeron CM, Moe KS. The evaluation and treatment of upper eyelid paralysis. Facial Plast Surg. 2008; 5. 24(2):220–230. PMID: 18470834.

14. Bergeron CM, Moe KS. The evaluation and treatment of lower eyelid paralysis. Facial Plast Surg. 2008; 5. 24(2):231–241. PMID: 18470835.

15. Fay A, Rubin PA. Nadol JB, Mckenna MJ, editors. Oculoplastic considerations and management of facial paralysis. Surgery of the ear and temporal bone. 2005. Philadelphia (PA): Lippincott Williams and Wilkins;p. 473–484.