The Surgical Management of Facial Nerve Injury

The surgical management of facial nerve injuries is dependent upon a thorough understanding of facial nerve anatomy, nerve physiology, and microsurgical techniques. When possible, primary neurorrhaphy is the “gold standard” repair technique. Injuries resulting in long nerve gaps or a significant delay between the time of injury and repair requires alterative techniques, such as nerve grafts, nerve transfers, regional muscle transfers, free tissue transfers, and static procedures. Scrupulous technique, selection of the appropriate surgical management, and aggressive physiotherapy with motor reeducation are all critical to obtaining a functionally and aesthetically acceptable result while minimizing synkinesis and facial asymmetry. This review of the literature provides an overview of current concepts in the surgical management of facial nerve injuries.

KEYWORDS

Facial nerve - reanimation - nerve repair

REFERENCES

• 1 Bell C. On the nerves, giving an account of some experiments on their structure and functions, which leads to a new arrangement of the system.  Trans R Soc Lond. 1821;  3 398
• 2 Ballance C A, Ballance H A, Stewart P. Operative treatment of chronic facial palsy of peripheral origin.  Br Med J. 1903;  1009-1013
• 3 Bunnell S. Suture of the facial nerve within the temporal bone with a report of the first successful case.  Surg Gynecol Obstet. 1927;  45 7-12
• 4 Dott N M. Facial paralysis: restitution by extrapetrous nerve graft.  Proc R Soc Med. 1958;  51 900-902
• 5 Kennedy R A, McKendrick F RS. On the restoration co-ordinated movements after nerve-crossing, with interchange of function of the cerebral cortical centres.  Philos Trans R Soc Lond B Biol Sci. 1901;  194 127-162
• 6 Lexer E, Eden R. Uber die chirurgische Behandlung der peripheren Facialislaehmung.  Beitr Klin Chir. 1911;  73 116
• 7 Sawicki B. The status of neurosurgery. Paris; J Reuff 1902
• 8 Tamai S, Komatsu S, Sakamoto H, Sano S, Sasauchi N. Free muscle transplants in dogs, with microsurgical neurovascular anastomoses.  Plast Reconstr Surg. 1970;  46 219-225
• 9 Thompson N. Autogenous free grafts of skeletal muscle. A preliminary experimental and clinical study.  Plast Reconstr Surg. 1971;  48 11-27
• 10 Thompson N. Investigation of autogenous skeletal muscle free grafts in the dog with a report on a successful free graft of skeletal muscle in man.  Transplantation. 1971;  12 353-363
• 11 Terzis J K. Pectoralis minor: a unique muscle for correction of facial palsy.  Plast Reconstr Surg. 1989;  83 767-776
• 12 Mackinnon S E, Dellon A L. Technical considerations of the latissimus dorsi muscle flap: a segmentally innervated muscle transfer for facial reanimation.  Microsurgery. 1988;  9 36-45
• 13 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report.  Plast Reconstr Surg. 1976;  57 133-143
• 14 Dellon A L, Mackinnon S E. Segmentally innervated latissimus dorsi muscle. Microsurgical transfer for facial reanimation.  J Reconstr Microsurg. 1985;  2 7-12
• 15 Scaramella L F. Cross-face facial nerve anastomosis: historical notes.  Ear Nose Throat J. 1996;  75 343-354
• 16 Scaramella L F. Facial reanimation.  Ear Nose Throat J. 2002;  81 411
• 17 Manktelow R T, Zuker R M. Muscle transplantation by fascicular territory.  Plast Reconstr Surg. 1984;  73 751-757
• 18 Freilinger G, Happak W, Burggasser G, Gruber H. Histochemical mapping and fiber size analysis of mimic muscles.  Plast Reconstr Surg. 1990;  86 422-428
• 19 Happak W, Liu J, Burggasser G et al.. Human facial muscles: dimensions, motor endplate distribution, and presence of muscle fibers with multiple motor endplates.  Anat Rec. 1997;  249 276-284
• 20 May M. Anatomy for the clinician. In: May M, Schaitkin BM The Facial Nerve. New York; Thieme 2000: 19-56
• 21 May M. Anatomy of the facial nerve (spatial orientation of fibers in the temporal bone).  Laryngoscope. 1973;  83 1311-1329
• 22 Podvinec M, Pfaltz C R. Studies on the anatomy of the facial nerve.  Acta Otolaryngol. 1976;  81 173-177
• 23 Happak W, Burggasser G, Liu J, Gruber H, Freilinger G. Anatomy and histology of the mimic muscles and the supplying facial nerve.  Eur Arch Otorhinolaryngol. 1994;  S85-S86
• 24 Seiler W A, Dellon A L, Mackinnon S E. Correlation of facial muscle anatomy and motor function in Macaca fascicularis .  Peripheral Nerve Repair Regeneration. 1986;  1 41-48
• 25 Norris C W, Proud G O. Spontaneous return of facial motion following seventh cranial nerve resection.  Laryngoscope. 1981;  91 211-215
• 26 Anderl H. Cross-face nerve transplant.  Clin Plast Surg. 1979;  6 433-449
• 27 Anderl H. Cross-face nerve transplantation in facial palsy.  Proc R Soc Med. 1976;  69 781-783
• 28 Scaramella L F, Tobias E. Facial nerve anastomosis.  Laryngoscope. 1973;  83 1834-1840
• 29 Fournier H D, Denis F, Papon X, Hentati N, Mercier P. An anatomical study of the motor distribution of the mandibular nerve for a masseteric-facial anastomosis to restore facial function.  Surg Radiol Anat. 1997;  19 241-244
• 30 Frydman W L, Heffez L B, Jordan S L, Jacob A. Facial muscle reanimation using the trigeminal motor nerve: an experimental study in the rabbit.  J Oral Maxillofac Surg. 1990;  48 1294-1304
• 31 Hadlock T A, Cheney M L. Update on facial nerve repair.  Facial Plast Surg. 1998;  14 179-184
• 32 Endo T, Hata J, Nakayama Y. Variations on the “baby-sitter” procedure for reconstruction of facial paralysis.  J Reconstr Microsurg. 2000;  16 37-43
• 33 Stennert E I. Hypoglossal facial anastomosis: its significance for modern facial surgery. II. Combined approach in extratemporal facial nerve reconstruction.  Clin Plast Surg. 1979;  6 471-486
• 34 Yoleri L, Songur E, Yoleri O, Vural T, Cagdas A. Reanimation of early facial paralysis with hypoglossal/facial end-to-side neurorrhaphy: a new approach.  J Reconstr Microsurg. 2000;  16 347-355
• 35 Manni J J, Beurskens C H, van de Velde C, Stokroos R J. Reanimation of the paralyzed face by indirect hypoglossal-facial nerve anastomosis.  Am J Surg. 2001;  182 268-273
• 36 Koh K S, Kim J K, Kim C J, Kwun B D, Kim S Y. Hypoglossal-facial crossover in facial-nerve palsy: pure end-to-side anastomosis technique.  Br J Plast Surg. 2002;  55 25-31
• 37 Darrouzet V, Dutkiewicz J, Chambrin A, Stoll D, Bebear J P. Hypoglosso-facial anastomosis: results and technical development towards end-to-side anastomosis with rerouting of the intra-temporal facial nerve (modified May technique) (in French).  Rev Laryngol Otol Rhinol (Bord). 1997;  118 203-210
• 38 Mackinnon S E, Dellon A L. Fascicular patterns of the hypoglossal nerve.  J Reconstr Microsurg. 1995;  11 195-198
• 39 Kalantarian B, Rice D C, Tiangco D A, Terzis J K. Gains and losses of the XII-VII component of the “baby-sitter” procedure: a morphometric analysis.  J Reconstr Microsurg. 1998;  14 459-471
• 40 Mersa B, Tiangco D A, Terzis J K. Efficacy of the “baby-sitter” procedure after prolonged denervation.  J Reconstr Microsurg. 2000;  16 27-35
• 41 Thanos P K, Terzis J K. A histomorphometric analysis of the cross-facial nerve graft in the treatment of facial paralysis.  J Reconstr Microsurg. 1996;  12 375-382
• 42 Thanos P K, Terzis J K. Motor endplate analysis of the denervated and reinnervated orbicularis oculi muscle in the rat.  J Reconstr Microsurg. 1995;  11 423-428
• 43 Yoshimura K, Asato H, Jejurikar S S et al.. The effect of two episodes of denervation and reinnervation on skeletal muscle contractile function.  Plast Reconstr Surg. 2002;  109 212-219
• 44 Baker D C, Conley J. Regional muscle transposition for rehabilitation of the paralyzed face.  Clin Plast Surg. 1979;  6 317-331
• 45 Sachs M E, Conley J. Dual simultaneous systems for facial reanimation.  Arch Otolaryngol. 1983;  109 137-139
• 46 Schauss F, Schick B, Draf W. Regional muscle flap-plasty and adjuvant measures for rehabilitation of the paralyzed face (in German).  Laryngorhinootologie. 1998;  77 576-581
• 47 Harii K, Asato H, Yoshimura K et al.. One-stage transfer of the latissimus dorsi muscle for reanimation of a paralyzed face: a new alternative.  Plast Reconstr Surg. 1998;  102 941-951
• 48 Hata Y, Yano K, Matsuka K et al.. Treatment of chronic facial palsy by transplantation of the neurovascularized free rectus abdominis muscle.  Plast Reconstr Surg. 1990;  86 1178-1187
• 49 Koshima I, Moriguchi T, Soeda S et al.. Free rectus femoris muscle transfer for one-stage reconstruction of established facial paralysis.  Plast Reconstr Surg. 1994;  94 421-430
• 50 Koshima I, Umeda N, Handa T, Moriguchi T, Orita Y. A double-muscle transfer using a divided rectus femoris muscle for facial-paralysis reconstruction.  J Reconstr Microsurg. 1997;  13 157-162
• 51 Ashayeri M, Karimi H. One-stage reversed and rotated gracilis muscle free flap for chronic facial palsy: a new technique.  Plast Reconstr Surg. 2002;  110 1298-1302
• 52 Wei W, Zuoliang Q, Xiaoxi L et al.. Free split and segmental latissimus dorsi muscle transfer in one stage for facial reanimation.  Plast Reconstr Surg. 1999;  103 473-480
• 53 Wang W, Qi Z, Lin X et al.. Neurovascular musculus obliquus internus abdominis flap free transfer for facial reanimation in a single stage.  Plast Reconstr Surg. 2002;  110 1430-1440
• 54 Jobe R P. A technique for lid loading in the management of the lagophthalmos of facial palsy.  Plast Reconstr Surg. 1974;  53 29-32
• 55 Manktelow R T. Use of the gold weight for lagophthalmos.  Oper Tech Plast Reconstr Surg. 1999;  6 157-158
• 56 Jiang H. Microneurovascular free abductor hallucis muscle transplantation for resuscitation of facial paralysis in one stage (in Chinese).  Zhonghua Wai Ke Za Zhi. 1992;  30 420-422,444
• 57 Dinces E A, Mauriello J A, Kwartler J A, Franklin M. Complications of gold weight eyelid implants for treatment of 5th and 7th nerve paralysis.  Laryngoscope. 1997;  107 1617-1622
• 58 Constantinides M, Galli S K, Miller P J. Complications of static facial suspensions with expanded polytetrafluoroethylene (ePTFE).  Laryngoscope. 2001;  111 2114-2121
• 59 Carruthers J D. Ophthalmologic use of botulinum A exotoxin.  Can J Ophthalmol. 1985;  20 135-141
• 60 Fagien S, Brandt F S. Primary and adjunctive use of botulinum toxin type A (Botox) in facial aesthetic surgery: beyond the glabella.  Clin Plast Surg. 2001;  28 127-148
• 61 Guerrerosantos J. Long-term outcome of autologous fat transplantation in aesthetic facial recontouring: sixteen years of experience with 1936 cases.  Clin Plast Surg. 2000;  27 515-543
• 62 Kesselring U K. Rejuvenation of the lips.  Ann Plast Surg. 1986;  16 480-486
• 63 Burres S A. Lip augmentation with preserved fascia lata.  Dermatol Surg. 1997;  23 459-462
• 64 Singh S, Baker J L. Use of expanded polytetrafluoroethylene in aesthetic surgery of the face.  Clin Plast Surg. 2000;  27 579-593