Chapter

Anatomy and physiology of the facial nerve and aetiology of facial nerve palsy

August 2021

DOI:10.1093/med/9780199682874.003.0216

In book: Oxford Textbook of Plastic and Reconstructive Surgery (pp.963-968)

Authors:

Kallirroi Tzafetta

ST ANDREWS CENTRE OF PLASTIC SURGERY, BROOMFIELD HOSPITAL, CHELMSFORD

The Oxford Textbook of Plastic and Reconstructive Surgery is a comprehensive reference text detailing all aspects of plastic surgery pertinent to a surgeon in training for specialization and suitable to use in preparation for the Intercollegiate Examination as all aspects of the curriculum are covered. This volume is also the perfect resource for practising plastic surgeons, summarizing contemporary trial knowledge as well as discussing anatomy, examination, and techniques. Chapters are divided into those that detail basic principles and technique, and those that, on a regional basis, describe the conditions and their treatments that form the wide spectrum of reconstructive and aesthetic plastic surgery. Bringing together the expertise of almost 200 specialist contributors in the field, the Oxford Textbook of Plastic and Reconstructive Surgery is a highly valuable source of information.

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Article

Full-text available

Facial Palsy and Reconstruction

February 2012 · Plastic & Reconstructive Surgery

Learning Objectives: After reviewing this article, the participant should be able to: 1. Classify facial palsy systematically. 2. Perform a comprehensive evaluation of the patient with facial palsy. 3. Apply a multidisciplinary approach and understand important treatment objectives. 4. Formulate a logical reconstructive strategy. 5. Review the most recently published literature. Summary: This ... [Show full abstract] article outlines a thorough approach to facial nerve palsy and reconstruction. (Plast. Reconstr. Surg. 129: 340e, 2012.)

Article

Full-text available

Surgery for patients with facial palsy in Germany: a diagnosis-related-groups-based nationwide analy...

September 2023 · European Archives of Oto-Rhino-Laryngology

Purpose Chronic flaccid paralysis of the facial nerve leads to permanent dysfunction of eye closure, problems with drinking and eating, and lack of emotional expression. Modern facial surgery can help those affected. An analysis of the development of facial surgery in Germany over time is presented. Methods Nation-wide population-baes diagnosis-related case group (DRG) data of virtually all ... [Show full abstract] inpatients who underwent facial surgery for facial palsy between 2005 and 2019 were included. Binomial regression models for changes in surgery rates over time were calculated in relation to gender and treating specialty. Results Between 2005 and 2019, there were 28,622 inpatient stays for facial surgery. Most surgeries were provided by otolaryngology (39%) and ophthalmology or dentistry, oral and maxillofacial surgery (20% each). The mean treatment rate was 2.33 ± 0.53 surgeries per 100,000 person-years. The surgery rate was highest for nerve reconstruction surgery (0.46 ± 0.15) and static sling surgery (0.44 ± 0.0.16). The greatest increase was seen in men for nerve surgery (3.9-fold; relative risk [RR] = 3.68; confidence interval [CI] = 3.18–4.26) and sling surgery (5.0-fold; RR = 4.25; CI = 3.38–5.33). Conclusions While nerve and sling surgery increased significantly over time, this was less true or not true at all for surgical techniques. Surgical rates and their change over time were greater in men, without explanation from the data.

Article

Lip Wedge Resection with Orbicularis Oris Plication for Facial Paralysis: A Novel Technique

March 2022 · Plastic Surgery

Introduction: Oral incompetence (OI) following facial nerve injury or sacrifice remains a frustrating problem for patients and clinicians alike. Dynamic procedures for facial paralysis often do not fully address OI and static surgeries are frequently needed. Current static options frequently involved multiple facial incisions. Methods: We describe a novel technique to address OI due to lower ... [Show full abstract] division facial nerve paralysis and report outcomes in an initial series of patients. Results: OI symptoms improved in 94% of patients following a single-stage surgery. Revision was required in one patient with subsequent resolution of symptoms. Major complications (19%) included persistent OI, wound dehiscence, and bothersome lip “bulk”. Conclusion: Lip wedge resection with orbicular oris plication resolves OI in facial paralysis patients with the added benefit of only a single incision on the face.

Article

Facial Nerve Paraganglioma Masquerading as Bell palsy: A Reconstructive Pitfall

March 2021 · The Journal of craniofacial surgery

Background: Facial paralysis can drastically diminish satisfaction in one's social interactions and overall quality of life. Bell palsy is the most common cause of facial palsy, however, a diagnosis of "atypical" BP may originate from an entirely different pathological process. This case highlights a rare case of facial nerve paraganglioma, initially misdiagnosed as BP, that resulted in facial ... [Show full abstract] paralysis from neoplastic invasion of the facial nerve. Case presentation: A 66-year old Hispanic woman with systemic lupus erythematosus presented to the plastic surgery clinic with complaints of drooling and being unable to smile. She experienced several episodes of left facial paralysis and was diagnosed with BP at an outside institution. Each episode was only partially responsive to steroid therapy. Imaging at our institution demonstrated lobulated enhancement along the vertical and extratemporal segments of the facial nerve, which prompted surgical intervention. The patient underwent left transmastoid approach for removal of the lesion involving the facial nerve followed by facial nerve reanimation via gracilis free flap without complication. Conclusions: This report outlines an extraordinarily rare case of a patient with facial nerve paraganglioma. This case represents the importance of reconstructive surgeons in considering a thorough diagnostic work-up with imaging and histopathology in the setting of idiopathic facial paralysis. Successful collaboration between otolaryngology and plastic surgery made streamlined diagnosis and surgical treatment of this unique case possible.

Article

Full-text available

Adherence to Clinical Practice Guidelines for Treatment of Bell's Palsy

December 2022

Background: Bell's palsy is the most common cause of acute facial nerve paresis and paralysis with devastating disability yet high rate of spontaneous recovery. Patients who do not fully recover have functional disability that may require reconstructive surgery. The Clinical Practice Guideline: Bell's Palsy recommends treatment with high-dose steroids as it shows a higher likelihood of complete ... [Show full abstract] recovery. However, guideline adherence rates are inconsistent and unstudied. Objective: To identify the frequency at which hospital-based clinicians at the University of Wisconsin-Madison follow recommended clinical guidelines and prescribe high-dose steroid medication. Methods: Charts were reviewed from a single hospital (University Hospital) to evaluate Bell's palsy guideline adherence. All hospital-based encounters from 2008 through 2018 with primary diagnosis of Bell's palsy (ICD-9 351.0 and ICD-10 G51.0) were identified. Encounters were excluded if they had a diagnosis of Bell's palsy within 1 year prior (n=250) and did not have a medication list available (n=353). We examined patient demographics, common comorbidities, and any radiology and lab orders. Results: We identified 565 patients with a primary diagnosis of Bell's palsy with available medication lists; 77.70% received the recommended treatment. The patients' median age was 47 (interquartile range 34-59), 52.16% were male, and 82.46% were treated by emergency medicine clinicians. Other treating clinicians were hospital-based primary care, otolaryngology and plastic surgery, and others. Multivariate analysis showed that treating clinician specialty was the only significant positive predictor. Conclusions: A significant portion of clinicians followed treatment guidelines for Bell's palsy. Further and larger research is needed to better identify points of intervention to improve guideline adherence.

Chapter

Management of facial palsy

August 2021

The Oxford Textbook of Plastic and Reconstructive Surgery is a comprehensive reference text detailing all aspects of plastic surgery pertinent to a surgeon in training for specialization and suitable to use in preparation for the Intercollegiate Examination as all aspects of the curriculum are covered. This volume is also the perfect resource for practising plastic surgeons, summarizing ... [Show full abstract] contemporary trial knowledge as well as discussing anatomy, examination, and techniques. Chapters are divided into those that detail basic principles and technique, and those that, on a regional basis, describe the conditions and their treatments that form the wide spectrum of reconstructive and aesthetic plastic surgery. Bringing together the expertise of almost 200 specialist contributors in the field, the Oxford Textbook of Plastic and Reconstructive Surgery is a highly valuable source of information.

Article

Full-text available

Modern concepts in facial nerve reconstruction

November 2010 · Head & Face Medicine

Background Reconstructive 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 ... [Show full abstract] facial rehabilitation. Conclusion A 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.