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Facial Nerve Trauma: Clinical Evaluation and Management Strategies

Brown, Stav B.S.; Isaacson, Brandon M.D.; Kutz, Walter M.D.; Barnett, Samuel M.D.; Rozen, Shai M. M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1498-1512
doi: 10.1097/PRS.0000000000005572
Reconstructive: Head and Neck: Special Topic

Summary: The field of facial paralysis requires the reconstructive surgeon to apply a wide spectrum of reconstructive and aesthetic principles, using a comprehensive array of surgical tools, including microsurgery, peripheral nerve surgery, and aesthetic facial surgery on the road to optimize patient outcomes. The distinct deficits created by different anatomical levels of facial nerve injury require a fundamental understanding of facial nerve anatomy. Palsy duration, followed by location and mechanism, will determine mimetic muscle salvageability, by means of either direct repair, grafting, or nerve transfers, whereas longer palsy durations will necessitate introducing a new neuromuscular unit, whether by muscle transfer or free functional muscle transplant. A thorough history, physical examination, and basic understanding of ancillary studies, emphasizing palsy duration, location, and mechanism of injury, are critical in evaluation, prognostication, and treatment strategies in traumatic facial palsy patients. The importance of ancillary and aesthetic procedures cannot be overstated. Although these do not provide motion, they constitute essential tools in the treatment of facial paralysis, providing both protective and improved aesthetic outcomes, yielding the highest impact in final surgeon and patient satisfaction, bringing our patients to smile not only on the outside, but also on the inside.

Tel Aviv, Israel; and Dallas, Texas

From the Sackler School of Medicine, Tel Aviv University; and the Departments of Otolaryngology, Neurosurgery, and Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center.

Received for publication April 11, 2018; accepted September 11, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Shai M. Rozen, M.D., Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, 5th Floor, Dallas, Texas 75390-9132,, Instagram: @DRSHAIROZEN

Copyright © 2019 by the American Society of Plastic Surgeons