Semin Plast Surg 2020; 34(04): 277-285
DOI: 10.1055/s-0040-1721824
Review Article

Modern Management of Facial Nerve Disorders

Tom Shokri
1   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
,
Babak Azizzadeh
2   Department of Facial Plastic & Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California
3   Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
,
Yadranko Ducic
1   Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
› Author Affiliations

Abstract

Facial paralysis is a devastating condition, encompassing a spectrum of disorders, with resultant psychosocial, functional, and aesthetic sequelae. With this in mind, an individualized treatment approach based on the cause, pattern, and duration of palsy is necessary. Treatment options include pharmacologic agents, corneal protective interventions, physical therapy, and surgical procedures. The use of steroids and antivirals in the setting of idiopathic facial paralysis or virus-associated facial paralysis is well supported. Despite the diversity of surgical interventions described, there is a lack of consensus regarding optimal treatment. This article provides an overview of the current management of facial paralysis. Medical, surgical, and physical treatment options are discussed with a review of the relevant literature.

Disclosure Statement

Dr. Azizzadeh receives royalties from Wiley, Thieme, Elsevier, and Springer. Dr. Ducic and Dr. Shokri have no financial or conflicts of interest to disclose. No funding was received for this article.




Publication History

Article published online:
24 December 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Ho AL, Scott AM, Klassen AF, Cano SJ, Pusic AL, Van Laeken N. Measuring quality of life and patient satisfaction in facial paralysis patients: a systematic review of patient-reported outcome measures. Plast Reconstr Surg 2012; 130 (01) 91-99
  • 2 Ishii LE, Godoy A, Encarnacion CO, Byrne PJ, Boahene KD, Ishii M. What faces reveal: impaired affect display in facial paralysis. Laryngoscope 2011; 121 (06) 1138-1143
  • 3 Pavese C, Cecini M, Camerino N. et al. Functional and social limitations after facial palsy: expanded and independent validation of the Italian version of the facial disability index. Phys Ther 2014; 94 (09) 1327-1336
  • 4 VanSwearingen JM, Cohn JF, Turnbull J, Mrzai T, Johnson P. Psychological distress: linking impairment with disability in facial neuromotor disorders. Otolaryngol Head Neck Surg 1998; 118 (06) 790-796
  • 5 Valls-Solé J. Facial palsy, postparalytic facial syndrome, and hemifacial spasm. Mov Disord 2002; 17 (Suppl. 02) S49-S52
  • 6 Hohman MH, Hadlock TA. Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center. Laryngoscope 2014; 124 (07) E283-E293
  • 7 Slattery WH, Azizzadeh B. The Facial Nerve. 1st ed.. New York, NY: Thieme Medical Publishers, Inc.; 2014
  • 8 Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002; (549) 4-30
  • 9 Adour KK, Byl FM, Hilsinger Jr RL, Kahn ZM, Sheldon MI. The true nature of Bell's palsy: analysis of 1,000 consecutive patients. Laryngoscope 1978; 88 (05) 787-801
  • 10 Devriese PP, Schumacher T, Scheide A, de Jongh RH, Houtkooper JM. Incidence, prognosis and recovery of Bell's palsy. A survey of about 1000 patients (1974-1983). Clin Otolaryngol Allied Sci 1990; 15 (01) 15-27
  • 11 Azizzadeh B, Frisenda JL. Surgical management of postparalysis facial palsy and synkinesis. Otolaryngol Clin North Am 2018; 51 (06) 1169-1178
  • 12 Beurskens CH, Oosterhof J, Nijhuis-van der Sanden MW. Frequency and location of synkineses in patients with peripheral facial nerve paresis. Otol Neurotol 2010; 31 (04) 671-675
  • 13 Celik M, Forta H, Vural C. The development of synkinesis after facial nerve paralysis. Eur Neurol 2000; 43 (03) 147-151
  • 14 Kimura J, Rodnitzky RL, Okawara SH. Electrophysiologic analysis of aberrant regeneration after facial nerve paralysis. Neurology 1975; 25 (10) 989-993
  • 15 Wetzig P. Aberrant regeneration of oculomotor and facial nerves. Rocky Mt Med J 1957; 54 (04) 347-348
  • 16 Brach JS, VanSwearingen J, Delitto A, Johnson PC. Impairment and disability in patients with facial neuromuscular dysfunction. Otolaryngol Head Neck Surg 1997; 117 (04) 315-321
  • 17 Azizzadeh B, Irvine LE, Diels J. et al. Modified Selective Neurectomy for the treatment of post-facial paralysis synkinesis. Plast Reconstr Surg 2019; 143 (05) 1483-1496
  • 18 Devriese PP, Moesker WH. The natural history of facial paralysis in herpes zoster. Clin Otolaryngol Allied Sci 1988; 13 (04) 289-298
  • 19 Robillard RB, Hilsinger Jr RL, Adour KK. Ramsay Hunt facial paralysis: clinical analyses of 185 patients. Otolaryngol Head Neck Surg 1986; 95 (3 Pt 1): 292-297
  • 20 Marenda SA, Olsson JE. The evaluation of facial paralysis. Otolaryngol Clin North Am 1997; 30 (05) 669-682
  • 21 Gupta S, Mends F, Hagiwara M, Fatterpekar G, Roehm PC. Imaging the facial nerve: a contemporary review. Radiol Res Pract 2013; 2013: 248039
  • 22 Allen RC. Controversies in periocular reconstruction for facial nerve palsy. Curr Opin Ophthalmol 2018; 29 (05) 423-427
  • 23 Joseph SS, Joseph AW, Smith JI, Niziol LM, Musch DC, Nelson CC. Evaluation of patients with facial palsy and ophthalmic sequelae: a 23-year retrospective review. Ophthalmic Epidemiol 2017; 24 (05) 341-345
  • 24 Kleiss IJ, Eviston TJ, Hadlock TA. Quantitative assessment of facial function in patients with peripheral facial palsy: a systematic review. In: Assessment of Facial Function in Peripheral Facial Palsy. Nijmegen, Netherlands: Radboud University Nijmegen; 2015: 97-122
  • 25 Fattah AY, Gurusinghe ADR, Gavilan J. et al; Sir Charles Bell Society. Facial nerve grading instruments: systematic review of the literature and suggestion for uniformity. Plast Reconstr Surg 2015; 135 (02) 569-579
  • 26 Iacolucci CM, Banks C, Jowett N. et al. Development and validation of a spontaneous smile assay. JAMA Facial Plast Surg 2015; 17 (03) 191-196
  • 27 Watanabe Y, Akizuki T, Ozawa T, Yoshimura K, Agawa K, Ota T. Dual innervation method using one-stage reconstruction with free latissimus dorsi muscle transfer for re-animation of established facial paralysis: simultaneous reinnervation of the ipsilateral masseter motor nerve and the contralateral facial nerve to improve the quality of smile and emotional facial expressions. J Plast Reconstr Aesthet Surg 2009; 62 (12) 1589-1597
  • 28 Jowett N, Gaudin RA, Banks CA, Hadlock TA. Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes. Laryngoscope 2017; 127 (06) 1451-1458
  • 29 Smouha EE, Coyle PK, Shukri S. Facial nerve palsy in Lyme disease: evaluation of clinical diagnostic criteria. Am J Otol 1997; 18 (02) 257-261
  • 30 Su BM, Kuan EC, St John MA. What is the role of imaging in the evaluation of the patient presenting with unilateral facial paralysis?. Laryngoscope 2018; 128 (02) 297-298
  • 31 Gaudin RA, Jowett N, Banks CA, Knox CJ, Hadlock TA. Bilateral facial paralysis: a 13-year experience. Plast Reconstr Surg 2016; 138 (04) 879-887
  • 32 Jowett N, Hadlock TA. Contemporary management of Bell palsy. Facial Plast Surg 2015; 31 (02) 93-102
  • 33 Remenschneider AK, Michalak S, Kozin ED. et al. Is serial electroneuronography indicated following temporal bone trauma?. Otol Neurotol 2017; 38 (04) 572-576 DOI: 10.1097/MAO.0000000000001337.
  • 34 Yadav S, Panda NK, Verma R, Bakshi J, Modi M. Surgery for post-traumatic facial paralysis: are we overdoing it?. Eur Arch Otorhinolaryngol 2018; 275 (11) 2695-2703
  • 35 Engström M, Berg T, Stjernquist-Desatnik A. et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2008; 7 (11) 993-1000
  • 36 Madhok VB, Gagyor I, Daly F. et al. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2016; 7: CD001942
  • 37 Sullivan FM, Swan IR, Donnan PT. et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med 2007; 357 (16) 1598-1607
  • 38 Austin JR, Peskind SP, Austin SG, Rice DH. Idiopathic facial nerve paralysis: a randomized double blind controlled study of placebo versus prednisone. Laryngoscope 1993; 103 (12) 1326-1333
  • 39 Pitaro J, Waissbluth S, Daniel SJ. Do children with Bell's palsy benefit from steroid treatment? A systematic review. Int J Pediatr Otorhinolaryngol 2012; 76 (07) 921-926
  • 40 Unüvar E, Oğuz F, Sidal M, Kiliç A. Corticosteroid treatment of childhood Bell's palsy. Pediatr Neurol 1999; 21 (05) 814-816
  • 41 Baugh RF, Basura GJ, Ishii LE. et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg 2013; 149 (03, Suppl): S1-S27
  • 42 de Almeida JR, Al Khabori M, Guyatt GH. et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA 2009; 302 (09) 985-993
  • 43 McAllister K, Walker D, Donnan PT, Swan I. Surgical interventions for the early management of Bell's palsy. Cochrane Database Syst Rev 2013; (10) CD007468
  • 44 Hato N, Yamada H, Kohno H. et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol 2007; 28 (03) 408-413
  • 45 Perry CM, Faulds D. Valaciclovir. A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in herpesvirus infections. Drugs 1996; 52 (05) 754-772
  • 46 Wagstaff AJ, Faulds D, Goa KL. Aciclovir. A reappraisal of its antiviral activity, pharmacokinetic properties and therapeutic efficacy. Drugs 1994; 47 (01) 153-205
  • 47 Gagyor I, Madhok VB, Daly F. et al. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2015; CD001869 (11) CD001869
  • 48 Adour KK, Ruboyianes JM, Von Doersten PG. et al. Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial. Ann Otol Rhinol Laryngol 1996; 105 (05) 371-378
  • 49 Cadavid D, Auwaerter PG, Rumbaugh J, Gelderblom H. Antibiotics for the neurological complications of Lyme disease. Cochrane Database Syst Rev 2016; 12: CD006978
  • 50 Wormser GP, Dattwyler RJ, Shapiro ED. et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43 (09) 1089-1134
  • 51 Clark JR, Carlson RD, Sasaki CT, Pachner AR, Steere AC. Facial paralysis in Lyme disease. Laryngoscope 1985; 95 (11) 1341-1345
  • 52 Halperin JJ, Shapiro ED, Logigian E. et al; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2007; 69 (01) 91-102
  • 53 Ellefsen B, Bonding P. Facial palsy in acute otitis media. Clin Otolaryngol Allied Sci 1996; 21 (05) 393-395
  • 54 Redaelli de Zinis LO, Gamba P, Balzanelli C. Acute otitis media and facial nerve paralysis in adults. Otol Neurotol 2003; 24 (01) 113-117
  • 55 Makeham TP, Croxson GR, Coulson S. Infective causes of facial nerve paralysis. Otol Neurotol 2007; 28 (01) 100-103
  • 56 Brach JS, VanSwearingen JM. Physical therapy for facial paralysis: a tailored treatment approach. Phys Ther 1999; 79 (04) 397-404
  • 57 Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2011; CD006283 (12) CD006283
  • 58 Diels HJ. Facial paralysis: is there a role for a therapist?. Facial Plast Surg 2000; 16 (04) 361-364
  • 59 Diels HJ, Combs D. Neuromuscular retraining for facial paralysis. Otolaryngol Clin North Am 1997; 30 (05) 727-743
  • 60 Skouras E, Merkel D, Grosheva M. et al. Manual stimulation, but not acute electrical stimulation prior to reconstructive surgery, improves functional recovery after facial nerve injury in rats. Restor Neurol Neurosci 2009; 27 (03) 237-251
  • 61 Beurskens CH, Heymans PG. Positive effects of mime therapy on sequelae of facial paralysis: stiffness, lip mobility, and social and physical aspects of facial disability. Otol Neurotol 2003; 24 (04) 677-681
  • 62 Pereira LM, Obara K, Dias JM, Menacho MO, Lavado EL, Cardoso JR. Facial exercise therapy for facial palsy: systematic review and meta-analysis. Clin Rehabil 2011; 25 (07) 649-658
  • 63 Manikandan N. Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial. Clin Rehabil 2007; 21 (04) 338-343
  • 64 Chen N, Zhou M, He L, Zhou D, Li N. Acupuncture for Bell's palsy. Cochrane Database Syst Rev 2010; (08) CD002914
  • 65 Foecking EM, Fargo KN, Coughlin LM, Kim JT, Marzo SJ, Jones KJ. Single session of brief electrical stimulation immediately following crush injury enhances functional recovery of rat facial nerve. J Rehabil Res Dev 2012; 49 (03) 451-458
  • 66 Coulson SE, O'dwyer NJ, Adams RD, Croxson GR. Expression of emotion and quality of life after facial nerve paralysis. Otol Neurotol 2004; 25 (06) 1014-1019
  • 67 Fu L, Bundy C, Sadiq SA. Psychological distress in people with disfigurement from facial palsy. Eye (Lond) 2011; 25 (10) 1322-1326
  • 68 Nellis JC, Ishii M, Byrne PJ, Boahene KDO, Dey JK, Ishii LE. Association among facial paralysis, depression, and quality of life in facial plastic surgery patients. JAMA Facial Plast Surg 2017; 19 (03) 190-196
  • 69 Lindsay RW, Robinson M, Hadlock TA. Comprehensive facial rehabilitation improves function in people with facial paralysis: a 5-year experience at the Massachusetts Eye and Ear Infirmary. Phys Ther 2010; 90 (03) 391-397
  • 70 Dimit R, Gire A, Pflugfelder SC, Bergmanson JP. Patient ocular conditions and clinical outcomes using a PROSE scleral device. Cont Lens Anterior Eye 2013; 36 (04) 159-163
  • 71 Conley J. Hypoglossal crossover–122 cases. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol 1977;84(4 Pt 1): ORL-763-8
  • 72 Gavron JP, Clemis JD. Hypoglossal-facial nerve anastomosis: a review of forty cases caused by facial nerve injuries in the posterior fossa. Laryngoscope 1984; 94 (11 Pt 1): 1447-1450
  • 73 Kunihiro T, Kanzaki J, Yoshihara S, Satoh Y, Satoh A. Hypoglossal-facial nerve anastomosis after acoustic neuroma resection: influence of the time anastomosis on recovery of facial movement. ORL J Otorhinolaryngol Relat Spec 1996; 58 (01) 32-35
  • 74 Wu P, Chawla A, Spinner RJ. et al. Key changes in denervated muscles and their impact on regeneration and reinnervation. Neural Regen Res 2014; 9 (20) 1796-1809
  • 75 Borschel GH, Kawamura DH, Kasukurthi R, Hunter DA, Zuker RM, Woo AS. The motor nerve to the masseter muscle: an anatomic and histomorphometric study to facilitate its use in facial reanimation. J Plast Reconstr Aesthet Surg 2012; 65 (03) 363-366
  • 76 Stennert E. I. Hypoglossal facial anastomosis: its significance for modern facial surgery. II. Combined approach in extratemporal facial nerve reconstruction. Clin Plast Surg 1979; 6 (03) 471-486
  • 77 Slattery III WH, Cassis AM, Wilkinson EP, Santos F, Berliner K. Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve. Otol Neurotol 2014; 35 (03) 509-513
  • 78 May M, Sobol SM, Mester SJ. Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy. Otolaryngol Head Neck Surg 1991; 104 (06) 818-825
  • 79 Peng GL, Azizzadeh B. Cross-facial nerve grafting for facial reanimation. Facial Plast Surg 2015; 31 (02) 128-133
  • 80 Razfar A, Lee MK, Massry GG, Azizzadeh B. Facial paralysis reconstruction. Otolaryngol Clin North Am 2016; 49 (02) 459-473
  • 81 Undavia S, Azizzadeh B. Facial Reanimation With Free Tissue Transfer. In: Facial Paralysis: A Comprehensive Rehabilitative Approach. San Diego, CA: Plural Publishing; 2014: 209-230
  • 82 Azizzadeh B, Pettijohn KJ. The gracilis free flap. Facial Plast Surg Clin North Am 2016; 24 (01) 47-60
  • 83 Rivas A, Boahene KD, Bravo HC, Tan M, Tamargo RJ, Francis HW. A model for early prediction of facial nerve recovery after vestibular schwannoma surgery. Otol Neurotol 2011; 32 (05) 826-833
  • 84 Alex JC, Nguyen DB. Multivectored suture suspension: a minimally invasive technique for reanimation of the paralyzed face. Arch Facial Plast Surg 2004; 6 (03) 197-201
  • 85 Liu YM, Sherris DA. Static procedures for the management of the midface and lower face. Facial Plast Surg 2008; 24 (02) 211-215
  • 86 Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol 1979; 97 (11) 2192-2196
  • 87 Joseph SS, Joseph AW, Douglas RS, Massry GG. Periocular reconstruction in patients with facial paralysis. Otolaryngol Clin North Am 2016; 49 (02) 475-487
  • 88 Yoo DB, Griffin GR, Azizzadeh B, Massry GG. The minimally invasive, orbicularis-sparing, lower eyelid recession for mild to moderate lower eyelid retraction with reduced orbicularis strength. JAMA Facial Plast Surg 2014; 16 (02) 140-146
  • 89 Boahene KD. Dynamic muscle transfer in facial reanimation. Facial Plast Surg 2008; 24 (02) 204-210
  • 90 Gillies H. Experiences with fascia lata grafts in the operative treatment of facial paralysis: (section of otology and section of laryngology). Proc R Soc Med 1934; 27 (10) 1372-1382
  • 91 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report. Plast Reconstr Surg 1976; 57 (02) 133-143
  • 92 Harii K, Asato H, Yoshimura K, Sugawara Y, Nakatsuka T, Ueda K. One-stage transfer of the latissimus dorsi muscle for reanimation of a paralyzed face: a new alternative. Plast Reconstr Surg 1998; 102 (04) 941-951
  • 93 McLaughlin CR. Permanent facial paralysis; the role of surgical support. Lancet 1952; 2 (6736): 647-651
  • 94 Shindo M. Facial reanimation with microneurovascular free flaps. Facial Plast Surg 2000; 16 (04) 357-359
  • 95 O'Brien BM, Franklin JD, Morrison WA. Cross-facial nerve grafts and microneurovascular free muscle transfer for long established facial palsy. Br J Plast Surg 1980; 33 (02) 202-215
  • 96 Coert JH, Dellon AL. Clinical implications of the surgical anatomy of the sural nerve. Plast Reconstr Surg 1994; 94 (06) 850-855
  • 97 Edgerton MT. Surgical correction of facial paralysis: a plea for better reconstructions. Ann Surg 1967; 165 (06) 985-998
  • 98 Tan ST. Anterior belly of digastric muscle transfer: a useful technique in head and neck surgery. Head Neck 2002; 24 (10) 947-954
  • 99 Watanabe Y, Sasaki R, Agawa K, Akizuki T. Bidirectional/double fascia grafting for simple and semi-dynamic reconstruction of lower lip deformity in facial paralysis. J Plast Reconstr Aesthet Surg 2015; 68 (03) 321-328
  • 100 Azizzadeh B. Selective neurectomy with platysmal myotomy for partial facial paralysis. International Facial Nerve Symposium. 2017 Los Angeles, CA
  • 101 Cabin JA, Massry GG, Azizzadeh B. Botulinum toxin in the management of facial paralysis. Curr Opin Otolaryngol Head Neck Surg 2015; 23 (04) 272-280