Reanimation following facial palsy: present and future directions

Ramakrishnan, Yujay; Alam, Shahid; Kotecha, Amit; Gillett, David; D’Souza, Alwyn

doi:10.1017/s0022215110001507

Cited by 14 publications

(8 citation statements)

References 40 publications

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“…While clearly improving facial symmetry, rhytidectomy has the potential to augment the nasal airway as well. 65,66 Finally, functional septorhinoplasty may be of benefit in select patients with facial paralysis who complain of nasal obstruction, though this may be due to preexisting nasal-septal deformity, or nasal valve collapse.…”

Section: Nosementioning

confidence: 99%

Facial Nerve Trauma: Evaluation and Considerations in Management

Gordin

Lee

Ducic

et al. 2015

Craniomaxillofacial Trauma & Reconstruction

123

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The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm.

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Section: Nosementioning

confidence: 99%

Facial Nerve Trauma: Evaluation and Considerations in Management

Gordin

Lee

Ducic

et al. 2015

Craniomaxillofacial Trauma & Reconstruction

123

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“…32,33 Interestingly, rhytidectomy has been shown to improve nasal breathing in patients and may be of use in addition to addressing facial asymmetry. 34,35 Last, functional rhinoplasty is another option to address this problem. A careful physical exam will reveal that a substantial number of facial paralysis patients complaining of nasal obstruction on the side of the paralysis will have a septal deformity and/or nasal valve collapse that likely was present prior to the paralysis.…”

Section: Future Directions Of Management Of the Upper Third Of Facementioning

confidence: 99%

“…39 If direct repair cannot be performed, cable grafting using the great auricular nerve or sural nerve can achieve tension-free coaptation, albeit with two sites of cooptation that can lead to poorer functional recovery. 35 Mobilization of the facial nerve proximal to the stylomastoid foramen for coaptation should be avoided as the poor fascicular topography of the proximal facial nerve can lead to significant synkinesis and dyskinesis. 40,41 Nerve Transfers Nerve transfers may be considered if primary or interpositional nerve grafting is not feasible and the paralysis is of less than 2 years' duration.…”

Section: Nerve Repairmentioning

confidence: 99%

Management of Facial Paralysis in the 21st Century

Chan

Byrne

2011

Facial plast Surg

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Facial paralysis is a clinical entity associated with significant morbidity, which has a treatment paradigm that is continually evolving. Surgical management of the paralyzed face poses significant challenges to achieve the goal of returning patients to their premorbid states. Here we attempt to review the advances in facial reanimation, in particular with regards to chronic facial paralysis. These include recent developments in static and dynamic rehabilitation including advances like artificial muscles for eyelid reconstruction, dynamic muscle transfer for the eye, and orthodromic temporalis tendon transfer.

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“…25 There are a number of rehabilitative procedures to normalize facial appearance, including eyelid weights or springs, muscle transfers and nerve substitutions, static and dynamic facial slings, and botulinum toxin injections to eliminate facial spasm/synkinesis. [26][27][28][29][30] This guideline, however, focuses more on the acute management of Bell's palsy and will not address these interventions in detail.…”

Section: Introductionmentioning

confidence: 99%

Clinical Practice Guideline: Bell's Palsy

Baugh

Basura

Ishii

et al. 2013

Otolaryngol.--head neck surg.

389

114

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Objective Bell’s palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell’s palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell’s palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell’s palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell’s palsy. Many of these tests are of questionable benefit in Bell’s palsy. Furthermore, while patients with Bell’s palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell’s palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell’s palsy. Purpose The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell’s palsy, to improve the quality of care and outcomes for patients with Bell’s palsy, and to decrease harmful variations in the evaluation and management of Bell’s palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell’s palsy. The guideline is intended for all clinicians in any setting who are likely to diagnose and manage patients with Bell’s palsy. The target population is inclusive of both adults and children presenting with Bell’s palsy. Action Statements The development group made a strong recommendation that (a) clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis, (b) clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell’s palsy patients 16 years and older, (c) clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell’s palsy, and (d) clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure. The panel made recommendations that (a) clinicians should not obtain routine laboratory testing in patients with new-onset Bell’s palsy, (b) clinicians should not routinely perform diagnostic imaging for patients with new-onset Bell’s palsy, (c) clinicians should not perform electrodiagnostic testing in Bell’s palsy patients with incomplete facial paralysis, and (d) clinicians should reassess or refer to a facial nerve specialist those Bell’s palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 months after initial symptom onset. The development group provided the following options: (a) clinicians may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset for patients with Bell’s palsy, and (b) clinicians may offer electrodiagnostic testing to Bell’s palsy patients with complete facial paralysis. The development group offered the following no recommendations: (a) no recommendation can be made regarding surgical decompression for patients with Bell’s palsy, (b) no recommendation can be made regarding the effect of acupuncture in patients with Bell’s palsy, and (c) no recommendation can be made regarding the effect of physical therapy in patients with Bell’s palsy.

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Reanimation following facial palsy: present and future directions

Cited by 14 publications

References 40 publications

Facial Nerve Trauma: Evaluation and Considerations in Management

Facial Nerve Trauma: Evaluation and Considerations in Management

Management of Facial Paralysis in the 21st Century

Clinical Practice Guideline: Bell's Palsy

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