Reconstruction of the Paralyzed Face

Abstract

Facial nerve paralysis can be difficult to treat because it presents a variety of functional, aesthetic, and psychosocial challenges. The goals of treatment include facial symmetry at rest, corneal protection, oral competence, restoration of voluntary and spontaneous facial movements, and minimal synkinesis. A multitude of static and dynamic procedures have been used to achieve these goals. Facial nerve reapproximation or interpositional grafting is associated with the best end results. The results of dynamic procedures are generally better than those of static procedures. Optimal reconstruction of the paralyzed face usually requires multiple surgeries with both types of procedures. Patients must be extensively counseled regarding expected results before they embark on what is an oftentimes lengthy reconstructive process. In this article, we discuss the anatomy of the facial nerve, the etiologic factors associated with facial nerve paralysis, the evaluation of the patient with facial paralysis, and the various surgical options for static and dynamic reconstruction of the paralyzed face. We also review the literature.