What are the contraindications for facial nerve repair?

Updated: Nov 28, 2018
  • Author: Tang Ho, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Repair of the facial nerve is contraindicated when the motor endplate muscle unit is no longer functional. This occurs after long-standing paralysis in which fibrosis develops along with atrophy of the facial musculature. In such instances, reinnervation is not successful. The motor endplate muscle unit may fuse in cases of long-standing paralysis (ie, >1-1.5 years). Electrophysiologic testing can help determine whether this has occurred.

Advanced patient age is considered a relative contraindication by some. Anecdotal evidence suggests that the results of reinnervation techniques are poorer in elderly patients. The nerve regenerates more slowly, and results ultimately are not as good as those achieved with procedures performed on younger patients.

Planned radiation therapy is not a contraindication to facial nerve repair. Regeneration of nerve function has been demonstrated despite subsequent ablative doses of radiation.

Facial nerve repair may be contraindicated in other situations. These would include instances when the patient’s general health status prevents elective surgery.


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