Facial Reanimation

Abstract

Facial nerve disorders encompass a broad spectrum of dysfunction, ranging from subtle dynamic facial asymmetry to dense flaccid paralysis. Following repair or grafting, the extent of facial nerve regeneration can greatly vary. Restricted movement may result from hypofunction (persistent weakness of facial muscles), hyperfunction (hypertonicity, spasm), aberrant regeneration (synkinesis), or a combination of these states. Facial nerve dysfunction may lead to numerous functional problems including corneal exposure, dry eye, epiphora, oral incompetence, poor manipulation of the food bolus, speech and articulation difficulties, nasal obstruction, and facial pain. Inability to convey emotion through facial expression and the accompanying psychological penalty as well as social isolation have a profound impact on a patient’s quality of life. This chapter reviews anatomy of the facial nerve, grading of facial nerve injury, and contemporary surgical and adjunctive techniques for facial reanimation. An algorithm for zonal management of the paralyzed face is provided.