eMedicine Specialties > Plastic Surgery > Head/Neck

Facial Nerve Paralysis: Follow-up

Author: John YS Kim, MD, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Northwestern Medical Faculty Foundation; Consulting Staff, Northwestern Plastic Surgery
Coauthor(s): Andreas Niederbichler, MD, Staff Physician, Department of Plastic Surgery, University Hospital of Hannover, Germany; Arturo Armenta, MD, Staff Physician, Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Nov 20, 2008

Follow-up

Further Inpatient Care

  • In microneurovascular transfers, follow-up care involves close monitoring in the hospital with Doppler signals and thorough examination of the flap. Capillary refill and the pinprick test can be used to assess flap viability. As mentioned before, thermocouple devices can be used for free tissue transfer follow-up care, but this technique is only available at some hospitals.

Further Outpatient Care

  • For interposition or cross-facial nerve grafts, the Tinel sign can be observed along the course of the regenerating nerve, approximately 1 mm/d. Nerve conduction studies also can be used as adjunct studies.
  • For static procedures, clinical examination is the basis of follow-up care. Closely monitor overcorrection, since both gravity and skin laxity should equalize facial hemispheres by approximately 6 months postoperatively.

Complications

  • Terzis studied a large group of 100 patients with free muscle transfer for facial paralysis. Results are as follows:
    • Complications observed in 11%
    • Arterial thrombosis in 5%
    • Venous thrombosis in 3%
    • Complete arterial and venous occlusion in 1 patient (1%)
    • Hematoma (3%)
    • Failure of muscle transplantation (4%)
    • Muscle necrosis (1%)
    • No signs of reinnervation noted in 3 patients; improvement after reexploration

Prognosis

  • A large study conducted by Terzis et al demonstrated an overall improved result postoperatively in 94 of 100 patients. The outcome was assessed by panel ranking.
    • Of these, the panel ranked 80% as moderate or better compared to preoperative stage.
    • Terzis also found that women received higher scores and had an earlier onset of muscle function than men, younger patients had better results than older patients, and patients with developmental cause of facial nerve paralysis had a better outcome than patients with posttraumatic facial nerve paralysis.
    • Intraoperative ischemia did not correlate with onset of muscle function.
    • Concerning outcome and donor muscle selection, patients with pectoralis minor muscle transplants were found to have an earlier onset of muscle function than those with gracilis transfers.57
  • Overall, free tissue transfer to the face can be considered a safe and efficient method for the restoration of facial muscle movement.

Miscellaneous

Medicolegal Pitfalls

  • Preoperative documentation of all damage to the facial nerve branches is mandatory with EMG studies. Each deficit should be documented clearly and explained to the patient.
  • The consent for surgical correction should detail all the risks of surgery, including donor site morbidity and loss of donor nerve function in cases of nerve transfers.
  • Counseling patients as to the length of rehabilitation and the difficulties attendant to nerve regeneration (suboptimal return of function) also is necessary.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Saleh M Shenaq, MD†, to the development and writing of this article.



More on Facial Nerve Paralysis

Overview: Facial Nerve Paralysis
Differential Diagnoses & Workup: Facial Nerve Paralysis
Treatment & Medication: Facial Nerve Paralysis
Follow-up: Facial Nerve Paralysis
Multimedia: Facial Nerve Paralysis
References
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Further Reading

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Keywords

facial nerve paralysis, facial nerve, facial paralysis, facial muscles, facial musculature, Bell palsy, Bell’s palsy, facial palsy, facial paralysis treatment, facial muscle movement, facial nerve injury, facial nerve reconstruction, facial nerve repair, facial movement, free muscle transplant, vascular microanastomosis, microsurgery, facial microsurgery, peripheral nerve repair, injured facial nerve, cranial nerve VII

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Contributor Information and Disclosures

Author

John YS Kim, MD, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Northwestern Medical Faculty Foundation; Consulting Staff, Northwestern Plastic Surgery
John YS Kim, MD is a member of the following medical societies: American College of Surgeons and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Andreas Niederbichler, MD, Staff Physician, Department of Plastic Surgery, University Hospital of Hannover, Germany
Disclosure: Nothing to disclose.

Arturo Armenta, MD, Staff Physician, Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Lawrence Ketch, MD, FAAP, FACS, Head, Program Director, Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Colorado Health Sciences Center; Chief, Pediatric Plastic, The Children's Hospital of Denver
Lawrence Ketch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

R Edward Newsome, MD, Program Director and Chief of Plastic Surgery, Henderson Chair in Surgery, Assistant Dean for Graduate Medical Education, Tulane University School of Medicine
R Edward Newsome, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Louisiana State Medical Society
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

 
 
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