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. 2007 Summer;15(2):77-82.
doi: 10.1177/229255030701500203.

Facial paralysis for the plastic surgeon

Aaron M Kosins  1 , Keith A Hurvitz, Gregory Rd Evans, Garrett A Wirth
Affiliations

Facial paralysis for the plastic surgeon

Aaron M Kosins et al. Can J Plast Surg. 2007 Summer.

Abstract
in English, French

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis.The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain.With respect to facial paralysis, surgeons tend to focus on the surgical, or 'hands-on', aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper.

La paralysie faciale pose un problème de taille au chirurgien plasticien. L’obtention de résultats acceptables et satisfaisants sur le plan esthétique exige non seulement une grande compétence et de bonnes techniques chirurgicales mais aussi une bonne connaissance de l’anatomie des nerfs faciaux et une bonne compréhension des causes de la paralysie faciale. L’incapacité de mouvoir le visage a des conséquences sociales et fonctionnelles. D’après une enquête menée à la Facial Palsy Clinic, à Édimbourg, en Écosse, auprès de 22 954 patients, plus de 50 % d’entre eux ont fait état d’une grande détresse psychologique et de retrait social en raison de leur paralysie faciale. Sur le plan fonctionnel, les patients présentent une perte, unilatérale ou bilatérale, de mouvement des muscles faciaux, volontaires et involontaires. Les signes et symptômes peuvent comprendre un sourire asymétrique, la syncinésie, l’épiphora ou une sécheresse des yeux, un clignement anormal, des troubles de l’élocution, l’écoulement de la bave, l’hyperacousie, l’altération du goût ou la douleur faciale.

En ce qui concerne la paralysie faciale, les chirurgiens ont tendance à mettre l’accent sur l’aspect technique ou chirurgical comme tel de l’intervention. Cependant, on croit qu’une bonne compréhension du processus pathologique est aussi importante, sinon plus, pour l’obtention de résultats satisfaisants. Le présent examen a pour but de passer en revue l’anatomie des nerfs faciaux et les schémas de diagnostic, l’épidémiologie et les principales causes de la paralysie faciale, ainsi que les aspects cliniques et les diagnostics. Il existe un large éventail de traitements possibles de la paralysie faciale, dont la décompression nerveuse, la chirurgie de revitalisation faciale et les injections de toxine botulinique, mais cela dépasse le cadre du présent article.

Keywords: Bell palsy; Facial nerve trauma; Facial palsy; Facial paralysis; Herpes zoster oticus.

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Figures

Figure 1)
Figure 1)
A diagram of the origins and contributions of the facial nerve throughout its course. The facial nerve contributes to hearing and balance, the lacrimal gland, the stapes, the tongue, the submandibular and sublingual glands, and the facial musculature, respectively
Figure 2)
Figure 2)
A diagram of the contributions of the facial nerve to the upper and lower face. The upper face receives bilateral contributions, while the lower face receives only contralateral contribution
Figure 3)
Figure 3)
Unilateral facial paralysis caused by Bell’s palsy
Figure 4)
Figure 4)
The auricular vesicles (A) and unilateral facial palsy (B) associated with Ramsey-Hunt syndrome
Figure 5)
Figure 5)
Status of a patient with unilateral Möbius syndrome following gracilis free flap reconstruction
See this image and copyright information in PMC

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