• Archives of Craniofacial Surgery
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• v.25 no.1
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• pp.1-10
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• 2024

The facial nerve stimulates the muscles of facial expression and the parasympathetic nerves of the face. Consequently, facial nerve paralysis can lead to facial asymmetry, deformation, and functional impairment. Facial nerve palsy is most commonly idiopathic, as with Bell palsy, but it can also result from a tumor or trauma. In this article, we discuss traumatic facial nerve injury. To identify the cause of the injury, it is important to first determine its location. The location and extent of the damage inform the treatment method, with options including primary repair, nerve graft, cross-face nerve graft, nerve crossover, and muscle transfer. Intracranial proximal facial nerve injuries present a challenge to surgical approaches due to the complexity of the temporal bone. Surgical intervention in these cases requires a collaborative approach between neurosurgery and otolaryngology, and nerve repair or grafting is difficult. This article describes the treatment of peripheral facial nerve injury. Primary repair generally offers the best prognosis. If primary repair is not feasible within 6 months of injury, nerve grafting should be attempted, and if more than 12 months have elapsed, functional muscle transfer should be performed. If the affected nerve cannot be utilized at that time, the contralateral facial nerve, ipsilateral masseter nerve, or hypoglossal nerve can serve as the donor nerve. Other accompanying symptoms, such as lagophthalmos or midface ptosis, must also be considered for the successful treatment of facial nerve injury.

• Archives of Craniofacial Surgery
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• v.25 no.2
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• pp.99-103
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• 2024

Because facial nerve injuries affect the quality of life, leaving them untreated can have devastating effects. The number of patients with traumatic and iatrogenic facial nerve paralysis is considerably high. Early detection and prompt treatment during the acute injury phase are crucial, and immediate surgical treatment should be considered when complete facial nerve injury is suspected. Symptom underestimation by patients and clinical misdiagnosis may delay surgical intervention, which may negatively affect outcomes and in some cases, impair the recovery of the injured facial nerve. Here, we report two cases of facial nerve injury that were treated with nerve grafts during the subacute phase. In both cases, subacute facial nerve grafting achieved significant improvements. These cases highlight surgical intervention in the subacute phase using nerve grafts as an appropriate treatment for facial nerve injuries.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.4
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• pp.447-457
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• 1994

Authors have studied retrospectively the facial nerve injury after TMJ surgery through the preauricular approach routine. The study material used was 4 patients of all 113 patients who were diagnosed as internal derangement and have been operated from March 1989 to February 1991 in Youngdong severance hospital, and were induced postoperatived facial nerve injury. The patient group who had the postoperative injured facial nerve was recognized degree of injury using the diagnostic method, Electromyography(EMG) and Nerve conduction test(NCT) which are used widely at present and was treated as conservative care and we identified the recovery time as the same method. The results as follows : 1. The meticulous care and precious surgical technique are needed in both operation and postoperation. During the TMJ surgery, the excessive retraction of the flap and frequent use of nerve stimulator and electric surgical knife should be avoided as possible and postoperative hematoma and swelling should be minimized. 2. The 4 patients were experienced with the postoperative facial nerve injury of all 133 patients who had been operated the TMJ surgery through the routine preauricular approach on our hospital. And the incidence of postoperative facial nerve injury happened was about 0.3% and its incidence was relatively low comparing with any other previous reports. 3. EMG and NCT were considered as useful methods which can diagnose the nerve injury objectively and identified the effect of treatment and recovery time. 4. The faical nerve-injured patients who were induced postoperatively after TMJ surgery, were diagnosed as second-degree nere injury through the EMG and NCT. And the patient group was treated well as conservative physical therapy for about 2 to 4 months.

• Archives of Plastic Surgery
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• v.49 no.4
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• pp.501-509
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• 2022

Background Acute facial nerve iatrogenic or traumatic injury warrants rapid management with the goal of reestablishing nerve continuity within 72 hours. However, reconstructive efforts should be performed up to 12 months from the time of injury since facial musculature may still be viable and thus facial tone and function may be salvaged. Methods Data of all patients who underwent facial nerve repair following iatrogenic or traumatic injury were retrospectively collected and assessed. Paralysis etiology, demographics, operative data, postoperative course, and outcome were examined. Results Twenty patients underwent facial nerve repair during the years 2004 to 2019. Data were available for 16 of them. Iatrogenic injury was the common category (n = 13, 81%) with parotidectomy due to primary parotid gland malignancy being the common surgery (n = 7, 44%). Nerve repair was most commonly performed during the first 72 hours of injury (n = 12, 75%) and most of the patients underwent nerve graft repair (n = 15, 94%). Outcome was available for 12 patients, all of which remained with some degree of facial paresis. Six patients suffered from complete facial paralysis (50%) and three underwent secondary facial reanimation (25%). There were no major operative or postoperative complications. Conclusion Iatrogenic and traumatic facial nerve injuries are common etiologies of acquired facial paralysis. In such cases, immediate repair should be performed. For patients presenting with facial paralysis following previous surgery or trauma, nerve repair should be considered up to at least 6 months of injury. Longstanding paralysis is best treated with standard facial reanimation procedures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.5
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• pp.346-348
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• 2003

A facial nerve palsy is described in a patient who underwent IVRO for the correction of a facial asymmetry and anterior openbite. A possible mechanism of facial nerve injury is discussed.

• Journal of Acupuncture Research
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• v.29 no.6
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• pp.23-34
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• 2012

Objectives : This study was performed to define clinical character of peripheral facial nerve injury. Methods : 36 patients was identified with peripheral facial nerve injury among 1128 patients who visited the Facial Palsy Center in Kyung Hee University Hospital at Gang-dong between January 2010 and November 2011. We reviewed the medical records including gender, age, cause, symptom, period of treatment, and axonal loss. Results : Most common cause of peripheral facial nerve injury was iatrogenic surgery, followed by direct trauma, neoplastic disorders. Patients with facial nerve injury commonly complain about facial palsy(ipsilateal or bilateral), followed by paresthesia, facial spasm, facial pain, auricular pain. Peripheral facial nerve injury group showed worse electrophysiological pattern and younger onset age compared with Bell's palsy group. Conclusion : This study was designed for 36 patients and further studies are necessary.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.4
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• pp.308-316
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• 2006

Objectives Despite considerable advances in technique, experience and skill, the precise place of surgery in the treatment of facial nerve injury remains uncertain. We designed a facial nerve crush injury model in rats and evaluated the recovery of crushed nerve which is the most common injury type of facial nerve using adenovirus vector mediated in vivo gene transfer of Brain derived neurotrophic factor(BDNF). Materials and methods In 48 Sprague Dawley rats, we made a facial nerve crush injury model to main trunk before the furcation, and injected a $10^{11}$pfu adenoviral BDNF in experimental group(BDNF adenoviral injection group; ad-BDNF) and $3{\mu}l$ saline in control group(Saline injection group; saline). After a period of regeneration from 10 to 40 days, nerve regeneration was evaluated with functioinal test (vibrissae and ocular movement), electrophysiologic study(threshold, peak voltage, conduction velocity) and histomorphometric study of axon density. Results Vibrissae and ocular movement, threshold and conduction velocity improved as time elapse in both group, however axon density was increased significantly only in experimental group. Functional test in 10 days and 20 days showed no difference between experimental group and control group. Vibrissae movement, threshold, conduction velocity and axon density in 30 days revealed that the regeneration in quality of experimental group was significantly superior to that of control group. Conclusion In general, there is tendency for nerve regeneration in experimental group (BDNF-adenovirus injection group) during 40 days, functional recovery was detected successfully after facial nerve crush in 30 days postoperatively.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.16 no.4
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• pp.428-437
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• 1994

Optic nerve injury serious enough to result in blindness had been reported to occur in 3% of facial fractures. When blindness is immediate and complete, the prognosis for even partial recovery is poor. Progressive or incomplete visual loss may be ameliorated either by large dosage of steroid or by emergency optic nerve decompression, depending on the mechanism of injury, the degree of trauma to the optic canal, and the period of time that elapses between injury and medical intervention. We often miss initial assessment of visual function in management of facial fracture patients due to loss of consciousness, periorbital swelling and emergency situations. Delayed treatment of injuried optic nerve cause permanent blindness due to irreversible change of optic nerve. But by treating posttraumatic optic nerve injuries aggressively, usable vision can preserved in a number of patients. The following report concerns three who suffered visual loss due to optic nerve injury with no improvement after steroid therapy and/or optic nerve decompression surgery.

• Journal of Korean Neurosurgical Society
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• v.56 no.1
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• pp.11-15
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• 2014

Objective : Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve. Methods : We prospectively collected data from 11 patients with VS, who underwent preoperative DTT for facial nerve. Imaging results were correlated with intraoperative findings. Postoperative DTT was performed at postoperative 3 month. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) facial nerve grading system. Results : Facial nerve courses on preoperative tractography were entirely correlated with intraoperative findings in all patients. Facial nerve was located on the anterior of the tumor surface in 5 cases, on anteroinferior in 3 cases, on anterosuperior in 2 cases, and on posteroinferior in 1 case. In postoperative facial nerve tractography, preservation of facial nerve was confirmed in all patients. No patient had severe facial paralysis at postoperative one year. Conclusion : This study shows that DTT for preoperative identification of facial nerve in VS surgery could be a very accurate and useful radiological method and could help to improve facial nerve preservation.

• Journal of Acupuncture Research
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• v.41 no.2
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• pp.121-128
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• 2024

This study presents a case of facial nerve injury that occurred after parotidectomy for a benign tumor of the parotid gland that improved with integrated Korean medicine (IKM). On June 24, 2023, the patient presented with facial nerve injury based on a facial nerve conduction study after parotidectomy, with a score of five on Yanagihara's unweighted grading system (Y-system) and a grade of five on the House-Brackmann facial grading scale (H-B scale). During the 15 days of admission, IKM treatments, including acupuncture, pharmacopuncture, moxibustion, herbal steam therapy, physiotherapy, herbal medicine, and thread embedding acupuncture treatment, were performed. After treatment, the strength of the orbicularis oculi, orbicularis oris, and masticatory muscles improved, with a Y-system score of 17 and an H-B scale of III. In conclusion, the findings of this study confirm the applicability and effectiveness of IKM in the treatment of facial paralysis following parotidectomy.