Surgical treatment of facial paralysis

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.

Keywords: Facial paralysis; Surgical management.

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.

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.