Modern concepts in facial nerve reconstruction

Abstract

BackgroundReconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons. The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques. On this background it is worthwhile to develop a standardized approach for diagnosis and treatment of patients asking for facial rehabilitation.ConclusionA standardized approach is feasible: Patients with chronic facial palsy first need an exact classification of the palsy's aetiology. A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy, an individual surgical concept is applicable using three main approaches: a) early extratemporal reconstruction, b) early reconstruction of proximal lesions if extratemporal reconstruction is not possible, c) late reconstruction or in cases of congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardized evaluation of the therapeutic results is recommended to evaluate the necessity for adjuvant surgical procedures or other adjuvant procedures, e.g. botulinum toxin application. Up to now controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies.

Human olfactory stem cells for injured facial nerve reconstruction in a rat model

“…Spontaneous recovery is not common among various peripheral facial nerve pathologies (congenital, tumor, iatrogenic operation‐based), especially with total axonal nerve damage. For this reason, various treatment modalities have been used, including end‐to‐end cooptation, cooptation with autologous or decellularized grafts, cooptation with nerve conduits, and neurotization of distal facial nerves with proximal neighboring cranial nerves …”

Reconstruction for Facial Nerve Defects of Zygomatic or Marginal Mandibular Branches Using Upper Buccal or Cervical Branches

“…These circumstances have a great influence on the patients from a physiological, psychological, and social point of view. 1 Therefore, immediate or early facial nerve reconstruction might be indicated including recovery of the facial symmetry and facial expression. Direct tension-free end-to-end facial-facial nerve anastomosis is an alternative choice in cases of minor nerve defects caused by traffic accident or capital crime facial nerve injury.…”

Rééducation des paralysies faciales

“…Il faut veiller à ne pas exagérer les mouvements. La récupération est plus nette sur le territoire moyen et le réflexe de clignement reste souvent altéré [10].…”