What is the role of surgery in the treatment of congenital facial paralysis?

Updated: Jan 07, 2019
  • Author: Alan D Bruns, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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In general, more than 90% of traumatic facial nerve palsies recover spontaneously and thus surgery is not warranted; [31] no controlled study has shown an improved outcome following surgical nerve exploration and decompression. With surgery, the risk of an iatrogenic injury is high. However, surgical exploration may be considered in infants with poor prognostic factors that include a unilateral complete paralysis present at birth, hemotympanum, displaced fracture of the temporal bone, absence of voluntary and evoked motor unit response in all muscles innervated by the facial nerve by 3-5 days of life, and no improvement by 5 weeks of age. [31, 42]

Conversely, no procedures are available that can enable an infant to develop normal function of the facial nerve when the palsy is developmental in origin. Facial reanimation's goal is to minimize asymmetries and improve function. Surgical exploration in the newborn with facial paralysis is controversial. Issues regarding timing of facial rehabilitation are complex. The factors that are involved include ability of the infant to tolerate a surgical procedure, the unknown potential for recovery, and whether early surgical intervention can prevent future psychosocial problems for the child.

In addressing developmental and unresolved traumatic facial paralysis, some medical professionals advocate initial surgery during preschool to avoid the psychosocial problems associated with a physical abnormality. However, waiting until adolescence when facial growth is mature and the child is able to understand the risks and benefits of surgery also has merit. [10]

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