Facial paralysis reconstruction in children and adolescents with central nervous system tumors

Abstract

Facial paralysis remains a vexing problem in the treatment of posterior cranial fossa tumors in children. Fortunately, current techniques are available to reconstruct the paralyzed face in restoring balance, symmetry, and amelioration of functional sequelae. The restoration of structure and function of the paralyzed face is tantamount to proper social integration and psychosocial rehabilitation. In addition, the facial nerve is important in preventing drying of the eyes, drooling, and speech abnormalities, among other functions. The most visible evidence of facial paralysis is stark asymmetry, especially with animation. This is perhaps the most troubling aspect of facial paralysis and the one that leads to the greatest amount of psychosocial stress for the child and family members. Management strategies include early and late intervention. Early reconstructive goals focus on preservation and strengthening of intact motor end plates through native stimulatory pathways. Late reconstructive efforts are centered on surgically reconstructing permanently lost function based on each third of the face. Use of adjunct modalities such as chemical or surgical denervation and myectomies are also critical tools in restoring symmetry. Physical therapy plays a large role in both early and late facial nerve paralysis in optimizing cosmetic and functional outcome.

Combined Sequential Bilateral Hypoglossal-to-facial and Masseter-to-facial Transfers for Bilateral Facial Paralysis

“…The combination of HFT and MFT brings together the best of both techniques with good facial resting tone provided by the hypoglossal nerve and wider smile reanimation provided by the masseteric nerve. 2 , 11 Performing the dual nerve transfer bilateral reanimation surgery gives the opportunity of a balanced symmetry of the face both at rest and with movement due to a similar time for recovery in each neurorrhaphy. Having the same donor inputs in each hemiface lessens the possibility of right-left discrepancies.…”

“… 1 Specifically, posterior fossa tumors imply a high risk of neurological deficits, including FP, because of the tumors themselves or their treatment. 2 Surgical treatment, when needed, includes nerve transfers, mainly masseter-to-facial, or muscle transfers, gracilis free flap or temporalis transposition. Deciding on which surgical option depends on the duration of the paralysis and the feasibility of facial muscles.…”

Management of facial paralysis following treatment of neurosurgical tumours

“…Dynamic facial reanimation involves complex, time consuming procedures performed under general anesthesia, that are not without risks. In patients operated for intracranial tumors in which the injured proximal facial nerve cannot be used for primary reconstruction using interposition nerve grafts, a dynamic reanimation may necessitate the scarification of another cranial nerve, including the trigeminal, accessory, hypoglossal or contralateral facial nerve (1,2). The indication for such an invasive procedure should carefully consider the general condition of the patient, the existing associated disorders as well as the long-term prognosis.…”

“…Definitive facial nerve injury during neurosurgical procedures for benign or malignant tumors of the posterior and middle cranial fossae, cerebellopontine angle and lateral skull base, is often unavoidable, either due to existing preoperative tumor invasion or compression, or due to the proximity of the nerve, since the most important desiderate is avoiding tumor recurrence (1,2).…”

Physical Therapy in Patients with Cancer

“…To date, no previous study has reported positive effects of physical therapy in adult brain tumor patients. However, a few reports showed that physical therapy may be effective in pediatric brain tumor patients [47]. In general, physical therapy performed in brain tumor patients is also performed in stroke patients [48].…”