The surgical management of facial nerve injury☆
Section snippets
Historical review
Although the concept of repairing injured peripheral nerves is centuries old, it was not until 1821 when Sir Charles Bell demonstrated the loss of facial expression with transection of the seventh cranial nerve that surgical restoration of the facial nerve was attempted [1]. In 1879, Drobnik diverted axons from an intact spinal accessory nerve to the distal end of a transected facial nerve, thus affecting the first nerve transfer to reinnervate the mimetic muscles of the face [2]. The affects
Anatomic overview
The complex anatomy of the facial nerve is summarized here and can be thoroughly reviewed in other texts [20]. The branchial motor fibers constitute the largest component of the facial nerve and provide efferent innervation to the stapedius, stylohyoid, posterior belly of digastric, and the muscles of facial expression. The remaining three components of the facial nerve comprise the nervus intermedius, which includes visceral motor, general sensory, and special sensory fibers. A conscious or
Primary neurorrhaphy
Acute injuries to the extratemporal facial nerve should be repaired under magnification and with adequate lighting and microsurgical equipment (Fig. 1). A nerve stimulator may be used to confirm the location of the distal end of the transected facial nerve for approximately 72 hours after nerve injury [40]. Beyond this period, the neurotransmitter stores necessary to depolarize the motor end plates are depleted and cannot be replenished given the disruption of antegrade axoplasmic transport
Regional muscle transfers
It is well known that periods of denervation in excess of 1 year in the extremities and 1 to 2 years in the face leads to the irreversible loss of functional motor end plates and muscle contraction in response to neural stimuli. As a result, reinnervation alone does not successfully restore muscle contraction. As shown in Fig. 1, regional muscle transfers using the temporalis or masseter [72], cross-facial nerve grafts combined with free tissue transfers in a one- or two-stage procedure, and
Summary
Treatment of facial nerve injuries depends upon a detailed understanding of its anatomic course, accurate clinical examination, and timely and appropriate diagnostic studies. Reconstruction depends upon the extent of injury, the availability of the proximal stump, and the time since injury and duration of muscle denervation. Although no alternative is perfect, these techniques, in combination with static and ancillary procedures, can protect the eye, prevent drooling, restore the smile, and
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Cited by (44)
Iatrogenic facial nerve injury in mastoidectomy: The impact of variables on the outcome
2022, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :In the case of facial nerve injury, if the surgeon recognizes the damage during the procedure, the reconstruction is performed instantly; if the injury is observed after the surgery, nerve exploration and repair often occur at the earliest time [6,7]. Common nerve injury managements include nerve decompression, end-to-end anastomosis, great auricular nerve graft, and facial-hypoglossal nerve transfer [8]. The purpose of this study is to report IFNI according to certain factors and evaluate facial paralysis improvement after surgical management of injury based on management technique, the period between nerve injury and its management, and the effects of the surgeon's experience in the outcome.
Nerve repair and cable grafting in acute facial nerve injury
2022, Operative Techniques in Otolaryngology - Head and Neck SurgeryCitation Excerpt :Greater success can be seen in cable graft repair of distal branches when the main trunk of the facial nerve remains intact (Figure 4). Although an upper limit for the maximum length of a successful cable graft has not been defined, coaptation proximal to the stylomastoid foramen has been demonstrated to lead to increased synkinesis and inferior functional outcomes.60 As such, when long segment or proximal injuries of the facial nerve are encountered, surgeons may wish to consider alternative methods of reconstruction.
The evolving role of the masseter-to-facial (V-VII) nerve transfer for rehabilitation of the paralyzed face
2015, Annales de Chirurgie Plastique EsthetiqueThe history of facial paralysis
2015, Annales de Chirurgie Plastique EsthetiqueManagement of Facial Palsy
2015, Nerves and Nerve Injuries: Pain, Treatment, Injury, Disease and Future Directions: Vol 2Surgical Treatment of Peripheral Facial Paralysis
2012, Journal of OtologyCitation Excerpt :For best possible treatment results, decompression is recommended in patients with complete facial paralysis within the first 2 weeks [16, 19]. If hearing is normal, decompression of the labyrinthine and geniculate segments via the middle fossa approach is recommended, whereas translayrinthine approach can be considered when there is no useful hearing [20]. However, some reports indicate good results in cases where facial paralysis has been present for 3-6 months or even longer.
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No author has any financial interests associated with any aspect of this publication.