Post Traumatic Facial Paralysis Treatment Options and Strategies

Facial palsy is a socially incapacitating sequel to head injuries, occurring in 1.5% of such patients. This ugly aftermath of middle cranial base fractures is seen in 70% of transverse fractures and 30% of longitudinal petrosal fractures. A thorough knowledge on diagnosis, treatment and prognosis of facial nerve injuries is essential. The saving face (pun intended) with regard to post injury facial paresis is that 75% of facial injuries recover spontaneously. Treatment of facial nerve injuries depends on two principal factors : onset of facial weakness (acute or delayed) and extent of facial weakness. Early onset and/or complete facial palsy indicate disruption of continuity of the nerve, ruling out the possibility of spontaneous recovery. A delayed onset and/or partial paresis of the nerve suggests secondary swelling or compression of the nerve which is more likely to recover spontaneously. In the former category, early facial nerve exploration is mandated. Facial EMG is unhelpful in the acute phase as denervation potentials take at least 3 weeks to develop. The facial muscles are the most active of all the muscle groups in the body and when denervated, they rapidly atrophy and involute. Hence, every patient of facial nerve injury should be started on percutaneous facial stimulation and vigorous passive facial physiotherapy. Surgical treatment options for facial nerve injuries include direct repair or repair with a nerve graft when both ends are available. Dynamic facial reanimation procedures include facio-hypoglossal or faciophrenic anastomosis, and static reanimation procedures like fascia lata sling and temporalis muscle transposition, or gold coin implantation into the upper lid. These are reserved for facial nerve injuries more than two years old where there is no hope of natural regeneration This paper is based on our experience with 10 patients of traumatic facial palsy following petrous fractures.