What is the role of neurorrhaphy 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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Answer

The best situation for repair of the facial nerve is when primary reanastomosis is possible between the transected ends; however, this is an uncommon occurrence in congenital paralysis. In developmental paralysis, a fibrotic remnant of the nerve or total absence of the nerve and traumatic paralysis is often caused by a crush injury rather than transection. Nerve ends may need to be débrided before anastomosis with 8-0 or 9-0 nylon sutures. The primary recommendation today is to use an epineurial repair because suture placement with fascicular or perineurial repair is difficult and may injure the axons. [43] The key factor in neurorrhaphy is reapproximation without tension.


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