April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Reprinted by permission of Otolaryngol Clin North Am. 2018; 51(6):1093-1105.

Management of F lacc id Fac ial Paralys i s of Less Than Two Years ’ Durat ion

Andrew William Joseph, MD, MPH , Jennifer C. Kim, MD *

KEYWORDS Facial palsy Facial paralysis Facial reanimation Facial reinnervation Nerve grafting

KEY POINTS

The treatment of patients with facial paralysis should involve a systematic approach. Treatment should be individualized based on duration of facial paralysis, accessibility and functional status of the distal and proximal facial nerve branches, as well as patient- specific factors, such as comorbidities and patient goals. Primary nerve repair has been shown to have the best outcome and is the preferred approach when possible. In cases of flaccid facial paralysis of less than 2 years’ duration in which primary nerve repair is not possible, nerve substitution procedures serve as the primary modality for restoring facial tone and dynamic motion.

INTRODUCTION

The management of flaccid facial paralysis is complicated and treatment ap- proaches are based on patient-specific and disease-specific factors. Flaccid facial paralysis can cause profound facial disfigurement and negatively affect quality of life and how strangers perceive these individuals. 1 Furthermore, patients with facial paralysis frequently have functional sequelae, with potentially cata- strophic ophthalmic outcomes in patients with periocular involvement. Most pa- tients with facial palsy screened in ophthalmology clinics demonstrate evidence of corneal abnormalities despite that few report symptoms. 2 Other functional sequelae include oral incompetence, articulation difficulty, and psychosocial isola- tion and distress.

Disclosure Statement: The authors have nothing to disclose. Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology– Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA * Corresponding author. 19900 Haggerty Road, Suite 103, Livonia, MI 48152. E-mail address: jennkim@med.umich.edu

Otolaryngol Clin N Am 51 (2018) 1093–1105 https://doi.org/10.1016/j.otc.2018.07.006 0030-6665/18/ ª 2018 Elsevier Inc. All rights reserved.

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