Abstract
BackgroundReconstructive 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 facial rehabilitation.ConclusionA 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.
Highlights
Peripheral facial palsy is the most common pathology of the cranial nerves with an incidence ranging from 20 to 30 cases per 100.000 people per year, only a minority of the patients need a surgical treatment
During the acute phase of the palsy the indication for surgery is less dependent on the aetiology, but more on the individual chance of spontaneous and good functional recovery
Any tumour in the course of the facial nerve from the brainstem to the periphery can cause facial palsy or surgical treatment of the tumour might be the reason for facial palsy
Summary
Head and neck surgeons faced with acute or chronic facial palsy demanding surgical repair need a broad spectrum of surgical tools in order to ensure optimal treatment of the patient. Consent It is stated that informed written consent was obtained for publication of the patients images. Authors’ contributions The authors issued the whole manuscript. All three authors have read and approved the final manuscript. Competing interests The authors declare that they have no competing interests
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