Surgical management of the facial nerve in craniofacial trauma and long-standing facial paralysis: cadaver study and clinical presentations.
OBJECTIVE
Examination of the extratemporal branches of the facial nerve reveals several branching patterns of the facial nerve, indicating the variability in the course of the nerve. Due to such variance, injury to this nerve often accompanies facial trauma and surgical dissection for the repair of facial bone injuries, and it may result in high morbidity.


METHODS
A study of 12 fresh cadavers was performed to 1) review the variability in location of the extratemporal branches of the facial nerve, 2) identify the soft tissue injuries in which the facial nerve is at risk, and 3) discuss surgical options for repair. The authors identified the zygomatic and buccal and the extratemporal branches of the facial nerve. Among the five extratemporal branches, there is a significant crossover between all, except the temporal and the mandibular branches. This indicates that dissection should proceed with great caution, since injury to the temporal and marginal mandibular branches is unlikely to resolve spontaneously. The management of injuries within one year and those of longer duration is discussed.


CONCLUSIONS
Two of the 5 major branches of the extratemporal facial nerve have a high morbidity following injury. Repair should be performed within the first 72 hours. Graft, if required, should be placed in 9 to 12 months.
Gosain
A K
AK
Department of Plastic Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
Matloub
H S
HS
D000293:Adolescent; D002102:Cadaver; D002648:Child; D004210:Dissection / Q000009:adverse effects; D005147:Facial Bones / Q000293:injuries / Q000601:surgery; D005151:Facial Injuries / Q000601:surgery*; D005154:Facial Nerve / Q000473:pathology / Q000601:surgery*; D020220:Facial Nerve Injuries / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008340:Mandibular Nerve / Q000473:pathology; D009055:Mouth / Q000294:innervation; D016067:Nerve Transfer; D010525:Peripheral Nerves / Q000637:transplantation; D017695:Soft Tissue Injuries / Q000601:surgery; D013703:Temporal Muscle / Q000294:innervation; D013997:Time Factors; D015050:Zygoma / Q000294:innervation