Surgical Treatment of Acute and Chronic Facial Paralysis

Abstract

The assessment and management of facial palsy depend on a comprehensive understanding of three key factors: the duration of the palsy, its anatomical location, and the underlying cause or mechanism. Clinical history and physical examination are the cornerstones for diagnosis, though diagnostic tools like CT scans, MRIs, and electromyography also offer valuable insights. These tools, however, have limitations, particularly in the initial and late stages post-injury. Facial palsy is categorized into acute (0–72 hours), subacute (72 hours up to 12–18 months), and chronic (beyond 12–18 months) phases. Treatment strategies are primarily guided by the mechanism and location of the injury rather than the stage of palsy. Acute injuries may be intratemporal or extracranial, each requiring different approaches. In the subacute phase, surgical interventions like nerve transfers become important. For longstanding facial paralysis, a new neuromuscular unit is often required, with multiple treatment options available. Static procedures offer valuable adjunctive treatments for aesthetic and functional outcomes. Various muscle transplant methods, graft choices, and ancillary procedures are under exploration and offer promise for better outcomes. Overall, the focus remains on a tailored, multi-disciplinary approach for effective management of facial palsy.