Dynamic Reanimation for Facial Paralysis Workup
- Author: Steven M Parnes, MD; Chief Editor: Arlen D Meyers, MD, MBA more...
Electrophysiologic testing is very useful in predicting recovery of neural functioning and determining motor endplate function. Electroneurography (ENoG) is useful in the acute period after facial paralysis. Within 5-14 days after injury, an ENoG study determines the percent of denervation. If 90% degeneration of the nerve is present, the prognosis for return of function is quite poor. In situations of smaller percent degeneration, the patient should be observed for 12-24 months for any return of facial nerve function.
Electromyography (EMG) is a beneficial examination 2 weeks after injury and beyond. The examination may show polyphasic action potentials of the examined muscle, which indicated active neural input and a good prognosis for eventual return of function. Fibrillations indicate denervation with intact motor endplates, which portends a poor prognosis for recovery of function without surgical intervention. Electrical silence, seen in the setting of prolonged facial paralysis, signifies that the motor endplates are no longer viable, and, therefore, nerve transposition procedures would ultimately fail.
If any doubt exists, a muscle biopsy always can be performed to observe for any surviving motor endplates. This procedure helps determine the appropriate techniques, such as nerve procedures, musculofascial transpositions, or static techniques.
May et al. Thieme. Facial Paralysis. Rehabilitation Techniques. 2003. 24-25.
Labbè D, Bussu F, Iodice A. A comprehensive approach to long-standing facial paralysis based on lengthening temporalis myoplasty. Acta Otorhinolaryngol Ital. 2012 Apr. 32(3):145-53. [Medline]. [Full Text].
Nduka C, Hallam MJ, Labbe D. Refinements in smile reanimation: 10-year experience with the lengthening Temporalis Myoplasty. J Plast Reconstr Aesthet Surg. 2012 Jul. 65(7):851-6. [Medline].
Gousheh J, Arasteh E. Treatment of facial paralysis: dynamic reanimation of spontaneous facial expression-apropos of 655 patients. Plast Reconstr Surg. 2011 Dec. 128(6):693e-703e. [Medline].
Hontanilla B, Qiu SS. Transposition of the hemimasseteric muscle for dynamic rehabilitation of facial paralysis. J Craniofac Surg. 2012 Jan. 23(1):203-5. [Medline].
Manktelow RT, Tomat LR, Zuker RM, Chang M. Smile reconstruction in adults with free muscle transfer innervated by the masseter motor nerve: effectiveness and cerebral adaptation. Plast Reconstr Surg. 2006 Sep 15. 118(4):885-99. [Medline].
Snyder-Warwick AK, Fattah AY, Zive L, Halliday W, Borschel GH, Zuker RM. The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density. Plast Reconstr Surg. 2015 Feb. 135 (2):370e-81e. [Medline].
Liu AT, Lin Q, Jiang H, Sun MQ, Zhang JL, Zhang YF, et al. Facial reanimation by one-stage microneurovascular free abductor hallucis muscle transplantation: personal experience and long-term outcomes. Plast Reconstr Surg. 2012 Aug. 130(2):325-35. [Medline].
Iseli TA, Harris G, Dean NR, Iseli CE, Rosenthal EL. Outcomes of static and dynamic facial nerve repair in head and neck cancer. Laryngoscope. 2010 Mar. 120(3):478-83. [Medline].
Burgess LPA, Goode RL. Total facial paralysis. Burgess LPA, Goode RL eds. Reanimation of the paralyzed face. New York, NY: Thieme Medical Publishers; 1994. 11-26.
Byrne PJ, Kim M, Boahene K, Millar J, Moe K. Temporalis tendon transfer as part of a comprehensive approach to facial reanimation. Arch Facial Plast Surg. 2007 Jul-Aug. 9(4):234-41. [Medline].
Chen M, McKenna M. Management of Facial Paralysis after Intracranial Surgery. Massachusetts General Hospital. Available at http://neurosurgery.mgh.harvard.edu/CranialBaseCenter/b95.htm. Accessed: 9/28/2007.
Conley J. Perspectives in facial reanimation. May M, ed. The Facial Nerve. New York, NY: Thieme; 1986. 645.
Frey M, Giovanoli P, Tzou CH, Kropf N, Friedl S. Dynamic reconstruction of eye closure by muscle transposition or functional muscle transplantation in facial palsy. Plast Reconstr Surg. 2004 Sep 15. 114(4):865-75. [Medline].
Hadlock TA, Cheney ML. Single-incision endoscopic sural nerve harvest for cross face nerve grafting. J Reconstr Microsurg. 2008 Oct. 24(7):519-23. [Medline].
Hadlock TA, Greenfield LJ, Wernick-Robinson M, Cheney ML. Multimodality approach to management of the paralyzed face. Laryngoscope. 2006 Aug. 116(8):1385-9. [Medline].
Hontanilla B, Marré D. Comparison of hemihypoglossal nerve versus masseteric nerve transpositions in the rehabilitation of short-term facial paralysis using the Facial Clima evaluating system. Plast Reconstr Surg. 2012 Nov. 130(5):662e-672e. [Medline].
May M. Surgical rehabilitation of facial palsy. May M, ed. The Facial Nerve. New York, NY: Thieme; 1986. 695.
Parnes SM. The facial nerve. Jahn AF, Santos-Sacchi J, eds. Physiology of the Ear. New York, NY: Raven Press; 1988. 125.
Tate JR, Tollefson TT. Advances in facial reanimation. Curr Opin Otolaryngol Head Neck Surg. 2006 Aug. 14(4):242-8. [Medline].