Facial Reanimation Surgery

Facial nerve disorders encompass a broad spectrum of dysfunction, ranging from subtle dynamic facial asymmetry to complete, dense paralysis. Facial nerve regeneration following injury can vary greatly and may result in hypofunction (persistent weakness or poor excursion of facial muscles), hyperfunction (hypertonicity, spasm), or aberrant regeneration (synkinesis). The impact of a facial nerve disorder can be dramatic. Disabilities encountered include corneal exposure of the affected eye, oral incompetence and articulation difficulties from orbicularis oris weakness, and functional nasal obstruction from dilator nares paralysis. None of these is perhaps as significant as the social isolation these patients often succumb to based on their perceived disfigurement and inability to convey emotion through facial expression. Because of the profound effect of this disorder on patient quality of life, a great deal of effort has been focused toward rehabilitation of the paralyzed face. When facial nerve discontinuity is encountered, the first approach is to attempt to reestablish direct neural continuity between the facial motor nucleus and the distal facial nerve through either primary repair or autografting techniques. When this is not possible, other methods of reestablishing facial balance and movement may be considered. Facial reanimation procedures refer to interventions that restore facial symmetry, resting tone, voluntary movement, or a combination of these. Several broad categories of facial reanimation techniques exist, each appropriate to a specific set of clinical, anatomic, or outcome-related circumstances. These include reinnervation techniques, muscle transfers, and static procedures. The aim of this chapter is to describe each of these approaches, including appropriate clinical scenarios, technical aspects of the surgery, and adjunctive management strategies to optimize postoperative appearance and function.