title: Facial nerve trauma: evaluation and considerations in management.
abstract: The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors.forename: Eli
authors.initials: E
authors.lastname: Gordin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lee
authors.affiliation: Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas ; Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Yadranko
authors.initials: Y
authors.lastname: Ducic
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Demetri
authors.initials: D
authors.lastname: Arnaoutakis
keywords: facial nerve injury; facial paralysis rehabilitation; facial reanimation; facial sling; free tissue transfer; hypoglossal-facial nerve transfer; intratemporal facial nerve trauma; temporalis tendon transposition