الفهرس 
Anatomy of the Facial NerveOnly 14 pages are availabe for public view
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Abstract
Head and neck surgeons faced with acute or chronic
facial palsy demanding surgical repair need a broad spectrum of
surgical tools in order to ensure optimal treatment of the
patient. Following the diagnostic recommendations and the
classification presented in this review may help to find the
optimal strategy of modern facial nerve rehabilitation for the
individual patient with severe facial palsy (Volk et al, 2010).
Facial nerve anatomy can be divided into its intracranial,
intratemporal, and extratemporal components. To distinguish
between various clinical diagnoses, a basic understanding of the
intracranial and intratemporal anatomy is required. A sound
knowledge of the anatomy of the extratemporal facial nerve is
also critical to enable safe dissection through the planes of the
face during rhytidectomy, parotidectomy, facial trauma, and
many other craniofacial procedures. It is also important to
remember that the facial nerve is not just a pure voluntary
motor nerve but comprises parasympathetic, general sensory,
and special sensory components as well. Notably, the facial
nerve has numerous interconnections with other cranial,
parasympathetic, and sympathetic nerves along its course,
which helps to explain many of the referred pain syndromes
encountered in head and neck pathology and also why residual
function exists following an apparently denervating facial nerve
injury (Myckatyn and Mackinnon, 2004).
1
Summary
Facial paralysis is either congenital or acquired, and of
varying severity, which leads to an asymmetrical or absent
facial expression. It is an important disability both from the
aesthetic and functional points of view (Bianchi et al, 2011).
Peripheral facial palsy is the most common pathology of
the cranial nerves and one of the commonest causes of facial
paralysis is trauma (accidental or surgical), which accounts for
approximately 23% of facial paralysis cases. Sharp injuries,
penetrating wounds, avulsions and burns are some accidental
causes of facial nerve injury. Also, iatrogenic injury to the facial
nerve is one of the most feared complications when performing
surgery (as in parotid gland manipulation).other causes are
congenital palsy, infections and neoplasms (Kosins et al, 2007).
Although facial paralysis is a clinical sign and not a
disease, it mandates a thorough diagnostic evaluation and
coordinated treatment plan. The loss of the ability to move the
face has both social and functional consequences for the patient.
Functionally, patients present with unilateral or bilateral loss of
voluntary and non-voluntary facial muscle movements. Signs
and symptoms can include an asymmetric smile, synkinesis,
abnormal blink, change in taste and facial pain. Arrangements
must be made for physical therapy, speech therapy or
occupational therapy as needed. At times, resolution of
paralysis is incomplete or non-existent (Yamamoto et al, 2007).
2
Summary
Progress continues in the development of a well-defined,
objective, and reproducible system for evaluating facial nerve
function. Among conventional approaches, those that maximize
use of objective measurements while allowing efficient
application, such as the Nottingham scale, may offer some
refinement beyond that available with the House-Brackmann
scale. Computer-based systems offer a method for continuous,
quantitative assessment of nerve function but at the present time
require specialized equipment and considerable investment of
time on the part of the clinician. Contracture, synkinesis, and
hemifacial spasm all may influence cosmetic and functional
results significantly, but these considerations are not uniformly
incorporated into computer-based systems. Streamlining of
technology and increased availability should eventually make
such approaches practical for use in the clinic (Brenner and
Neely, 2004).
The treatment of long-standing facial paralysis has
challenged plastic surgeons for centuries, and still the ultimate
goal of normality of the paralysed hemi-face with symmetry at
rest as well as the generation of a spontaneous symmetrical
smile with corneal protection has not yet fully been reached.
The majority of patients should be treated in specialised units
and in multidisciplinary teams where the combined skills of
plastic surgeons, opthalmologists, otolaryngologists,
paediatricians, psychologists and physiotherapists are centred
3
Summary
and where patients can be followed up for a number of years
(Ghali et al, 2011).
The reconstructive surgeon has a wide array of surgical
treatment options for management of the patient with facial
paralysis. An organized, thoughtful approach is necessary when
evaluating patients with facial paralysis to ensure that no
obvious treatment choices are overlooked. For acute facial
paralysis, the main surgical therapies are facial nerve
decompression and facial nerve repair. For facial paralysis of
intermediate duration, nerve transfer procedures are
appropriate. For chronic facial paralysis, treatment typically
requires regional or free muscle transfer. It is important to
remember that static techniques of facial reanimation can be
used for acute, intermediate, or chronic facial paralysis as these
techniques are often important adjuncts to the overall
management strategy (Mehta, 2009).