By Mark K. Wax, MD
Facial paralysis is a devastating process. Normal facial function is of paramount importance in both cosmesis and how individuals are perceived by others. It also plays a role in natural physiological processes. When the facial nerve—which provides animation to the muscles of the face—is paralyzed, there are severe cosmetic, psychological, as well as physiologic sequelae. The facial plastic surgeon has the ability to play a unique role in both the reconstruction and the rehabilitation of the adverse effects of facial paralysis. Management paradigms for the multitude of issues that face these patients involve a team approach—not only facial plastic surgeons, but also speech pathologists, physiotherapists, social workers, family, and so forth. The facial plastic surgeon stands at the epicenter, able to direct the care of the patient to these different specialists.
Facial paralysis can be caused by many different disease processes. It may be temporary or it may be permanent. A fundamental understanding of the different pathological and physiological processes is important in the diagnosis and management of these patients, as temporary facial paralysis requires a different management paradigm than permanent facial paralysis.
Perhaps the most crucial initial actions are making a firm diagnosis and ensuring that no damage comes as a sequelae of not having normal facial nerve function. Eye protection is a primary concern. Protection of the globe is maintained by the normal function of the upper and lower eyelids and when these are not functioning due to facial paralysis, the issue must be addressed immediately. Inability to eat or drink because of paralysis of the lower face or a lack of will secondary to depression or the psychological effects of the paralysis must also be addressed immediately. Facial Paralysis: A Comprehensive Rehabilitative Approach addresses many of these issues with a focus on understanding the cosmetic, functional, and psychological consequences of facial paralysis. While surgical reconstruction of the various defects is well described and plays a fundamental role in the management of patients with facial paralysis, it is but one of the many tools required to manage these patients.
This text describes the different surgical paradigms and approaches for the various subsites of the face and is organized by each anatomic site of the face, which allows for an in-depth discussion of a multitude of surgical techniques for the specific area as well as the individual needs of the patient—including long-term effects and morbidity.
Management of the patient with facial paralysis is a multidisciplinary endeavor. Through integrating these different professions and areas of expertise, the patient with facial paralysis can be managed in a succinct fashion with the potential to obtain an optimal outcome.
About the Author
Mark K. Wax, MD, FACS, FRCS(C), is a professor in the departments of Otolaryngology-Head and Neck Surgery and Oral-Maxillo Facial Surgery at Oregon Health and Sciences University. He is also the residency program director and the director of the microvascular and reconstructive surgery fellowship. Dr. Wax is a past president of the American Head and Neck Society (AHNS) and has been instrumental in the founding of a reconstructive committee for AHNS. As the co-coordinator for education for the American Academy of Otolaryngology-Head and Neck Surgery, he was responsible for the educational activities of the largest otolaryngology society in the United States. For more than a decade, Dr. Wax has had an interest in reconstructive surgery. He has more than 200 publications in the field and has been invited to present lectures on reconstruction in many different venues.