ABSTRACT
Facial paralysis can be resulted from direct invasion of the facial nerve with tumor, or a sequel of surgical treatment of head and neck neoplasms. Facial reanimation after tumor excision in this category poses a special challenge, with indication and management strategies that are different from that of facial paralysis with other etiologies. The tumor type (benign or malignant), the requirement of postoperative radiation, the surgeon's facility with different reconstructive techniques, and the patient's age and motivation are all factors involved in determining the appropriate timing and the reconstructive strategy in each particular case. Tumor cure is always the first concern, overriding that of facial paralysis reconstruction. Whenever facial nerve reconstruction can be done immediately after tumor ablation, such as following malignant parotid gland resection, it should not be delayed. However, if the facial nerve injury is impressed with neurapraxia after tumor surgery, such as following acoustic neuroma resection, or the facial paralysis is caused by malignant tumor invasion that is not eradicated completely or that required postoperative radiation, then delayed facial reanimation is the optimal strategy. In delayed reconstruction, a classic two-stage procedure with cross-face nerve grafts in the first stage followed by functioning free muscle transplantation in the second stage is preferred.
KEYWORDS
Facial paralysis - Head and neck tumor surgery
