The facial nerve in the presence of a head and neck neoplasm: assessment and outcome after surgical management.
OBJECTIVE
The face is the mirror of personality. Facial expression is the most important part of verbal and nonverbal communication. Patients with head and neck neoplasm and facial palsy are more stigmatized by the latter than by the tumor itself. Facial nerve reconstruction in such a patient is a great challenge. This review gives an overview of the assessment of facial palsy, surgical reconstruction, and postoperative treatment.


RESULTS
MRI, CT, and electromyography are indispensable tools in the assessment of preoperative facial palsy in patients with head and neck neoplasm. When part of the facial nerve has to be sacrificed during surgery, the best functional results are achieved with direct facial nerve suture, interposition graft, or by a hypoglossal-facial nerve interposition jump anastomosis. The latter is the best choice when the reanimation is planned between 6 months and 2 years after tumor surgery. In any case, the eye is best rehabilitated with upper lid loading. Temporalis muscle transposition gives fast and good results for the restoration of the corner of the mouth after radical surgery. Reanimation by free muscle transfer for head and neck cancer patients is rarely indicated. Botulinum toxin treatment is an excellent postoperative aid for refining the result; the optimal modality of postoperative physiotherapy is still unclear.


CONCLUSIONS
Surgical reanimation of the face in head and neck patients has reached a high standard. Strategies to decrease misdirected reinnervation after nerve suture have to be established in clinical practice for further improvement of facial rehabilitation.
Guntinas-Lichius
Orlando
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Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Germany. orlando.guntinas@uni-koeln.de
D000714:Anastomosis, Surgical; D004576:Electromyography; D005154:Facial Nerve / Q000601:surgery; D005158:Facial Paralysis / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007002:Hypoglossal Nerve / Q000637:transplantation; D008279:Magnetic Resonance Imaging; D009416:Nerve Regeneration; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome