Advances in Facial Reanimation
The effects of facial nerve paralysis are debilitating and often depressing emotional conditions with a variety of possible functional and aesthetic problems. One characteristic of the loss of oral competence is speech difficulties with articulation and drooling. Dysfunctional lacrimation, paralytic eyelid ectropion, and lagophthalmos can lead to exposure keratopathy, corneal ulcerations, and even blindness. Nasal valve dysfunction is also seen. The psychological impact of facial disfigurement can result in fear of public places and impaired socialization.
Preferred treatment protocols and specific techniques for management of facial nerve paralysis often differ among surgeons. The cause of the facial nerve dysfunction can range from oncologic resection, temporal bone surgery, skull base surgery, posttraumatic, idiopathic, or congenital (e.g. Mo¨ebius syndrome). Cheney et al.  suggest four considerations in comprehensive facial nervemanagement, including forehead and brow symmetry; eyelid closure and competence; smile function; and oral commissure and symmetry. In elderly patients, a one-stage surgical procedure that provides immediate improvement is preferable to a more complex, staged procedure (microvascular free tissue transfer). Long-term goals of facial reanimation are to achieve normal appearance at rest, symmetry with movement, and restoration of muscle control . Although voluntary movement may be improved, no current method restores spontaneous involuntary movement associated with emotions.
The surgeon should educate the patient on the range of reconstructive options and then formulate a treatment plan together. The specific cause of facial paralysis, the degree and duration of paralysis, functional limitations, and the patient’s age and general health must also be taken into consideration. Comprehensive management of facial nerve paralysis should restore function and appearance, as well as prevent delayed sequelae (e.g. corneal exposure) through either reanimation (dynamic) or static procedures. For simplicity, we discuss these procedures in four categories: neural, musculofascial transposition, eyelid alloplasts, and ancillary soft tissue procedures. The following reviews the new innovations in facial reanimation.
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Otolaryngology & Head and Heck Surgery [1068-9508] Tate (2006) volume: 14 issue: 4 page: 242-8