Facial Palsy: Diagnostic and Therapeutic Management, An Issue of Otolaryngologic Clinics of North America, Volume 51-6 PDF
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Facial Palsy: Diagnostic and Therapeutic Management Editors TERESA M. O NATE JOWETT TESSA A. HADLOCK OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA www.oto.theclinics.com Consulting Editor SUJANA S. CHANDRASEKHAR December 2018 • Volume 51 • Number 6 Copyright ©2018. Elsevier Inc. All rights reserved. ELSEVIER 1600JohnF.KennedyBoulevard(cid:1)Suite1800(cid:1)Philadelphia,Pennsylvania,19103-2899 http://www.oto.theclinics.com OTOLARYNGOLOGICCLINICSOFNORTHAMERICAVolume51,Number6 December2018ISSN0030-6665,ISBN-13:978-0-323-64215-6 Editor:JessicaMcCool DevelopmentalEditor:SaraWatkins ª2018ElsevierInc.Allrightsreserved. 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FacialPalsy:DiagnosticandTherapeuticManagement Contributors CONSULTING EDITOR SUJANAS.CHANDRASEKHAR,MD,FACS,FAAOHNS PastPresident,AmericanAcademyofOtolaryngology–HeadandNeckSurgery,Partner, ENT&AllergyAssociates,LLP,ClinicalProfessor,DepartmentofOtolaryngology–Head andNeckSurgery,ZuckerSchoolofMedicineatHofstra-Northwell,Hempstead,New York,USA;ClinicalAssociateProfessor,DepartmentofOtolaryngology–HeadandNeck Surgery,IcahnSchoolofMedicineatMountSinai,NewYork,NewYork,USA EDITORS TERESAM.O,MD,MArch,FACS Director,FacialNerveCenter,VascularBirthmarkInstituteofNewYork,Departmentof Otolaryngology–HeadandNeckSurgery,ManhattanEye,Ear,andThroatHospital,Lenox HillHospital,NewYork,NewYork,USA NATEJOWETT,MD AssistantProfessor,DepartmentofOtolaryngology,DivisionofFacialPlasticandRe- constructiveSurgery,MassachusettsEyeandEar,HarvardMedicalSchool,Boston, Massachusetts,USA TESSAA.HADLOCK,MD Chief,DivisionofFacialPlasticandReconstructiveSurgery,Professor,Departmentof Otolaryngology–HeadandNeckSurgery,MassachusettsEyeandEar,HarvardMedical School,Boston,Massachusetts,USA AUTHORS NICHOLASS.ANDRESEN,MD DepartmentofOtolaryngology–HeadandNeckSurgery,JohnsHopkinsSchoolof Medicine,Baltimore,Maryland,USA BABAKAZIZZADEH,MD,FACS AssociateClinicalProfessor,DivisionofHeadandNeckSurgery,DavidGeffenSchoolof MedicineatUCLA,LosAngeles,California,USA;CenterforAdvancedFacialPlastic Surgery,BeverlyHills,California,USA JENNIFERBAIUNGO,PT,MS PhysicalTherapist,FacialPlasticandReconstructiveSurgeryDepartment,Facial NerveCenter,MassachusettsEyeandEar,FacialNerveCenter,Boston,Massachusetts, USA KOFIDEREKBOAHENE,MD Professor,Otolaryngology–HeadandNeckSurgery,JohnsHopkinsSchoolofMedicine, DepartmentofOtorhinolaryngology,TheJohnsHopkinsHospital,Baltimore,Maryland,USA Copyright ©2018. Elsevier Inc. All rights reserved. vi Contributors GREGORYH.BORSCHEL,MD,FACS,FAAP DivisionofPlasticandReconstructiveSurgery,TheHospitalforSickChildren,Toronto, Ontario,Canada PATRICKBYRNE,MD Professor,Otolaryngology–HeadandNeckSurgery,JohnsHopkinsSchoolofMedicine, Baltimore,Maryland,USA MAURAK.COSETTI,MD DepartmentofOtolaryngology–HeadandNeckSurgery,IcahnSchoolofMedicineat MountSinai,NewYorkEyeandEarInfirmaryofMountSinai,NewYork,NewYork,USA LEAHTHANF.DOMESHEK,MD DivisionofPlasticandReconstructiveSurgery,TheHospitalforSickChildren,Toronto, Ontario,Canada JOSEPHR.DUSSELDORP,MBBS,MS,FRACS SeniorLecturer,DepartmentofOtolaryngology–HeadandNeckSurgery,Massachusetts EyeandEar,HarvardMedicalSchool,Boston,Massachusetts,USA;Departmentof PlasticandReconstructiveSurgery,RoyalAustralasianCollegeofSurgeons,Universityof Sydney,Sydney,Australia AARONFAY,MD MassachusettsEyeandEar,Boston,Massachusetts,USA JULIAL.FRISENDA,MD CenterforAdvancedFacialPlasticSurgery,BeverlyHills,California,USA BRUCEJ.GANTZ,MD ProfessorandChair,DepartmentofOtolaryngology–HeadandNeckSurgery,University ofIowaHospitals&Clinics,IowaCity,Iowa,USA TESSAA.HADLOCK,MD Chief,DivisionofFacialPlasticandReconstructiveSurgery,Professor,Departmentof Otolaryngology–HeadandNeckSurgery,MassachusettsEyeandEar,HarvardMedical School,Boston,Massachusetts,USA NATALIEHOMER,MD DepartmentofOphthalmology,MassachusettsEyeandEar,HarvardMedicalSchool, Boston,Massachusetts,USA LISAE.ISHII,MD,MHS Professor,Otolaryngology–HeadandNeckSurgery,JohnsHopkinsSchoolofMedicine, Baltimore,Maryland,USA MASARUISHII,MD,PhD AssociateProfessor,Otolaryngology–HeadandNeckSurgery,JohnsHopkinsSchoolof Medicine,Baltimore,Maryland,USA ANDREWWILLIAMJOSEPH,MD,MPH ClinicalLecturer,DepartmentofOtorhinolaryngology–HeadandNeckSurgery,Divisionof FacialPlasticandReconstructiveSurgery,UniversityofMichiganMedicalSchool,Ann Arbor,Michigan,USA NATEJOWETT,MD AssistantProfessor,DepartmentofOtolaryngology,DivisionofFacialPlasticandRe- constructiveSurgery,MassachusettsEyeandEar,HarvardMedicalSchool,Boston, Massachusetts,USA Copyright ©2018. Elsevier Inc. All rights reserved. Contributors vii VIVIANKAUL,MD DepartmentofOtolaryngology–HeadandNeckSurgery,IcahnSchoolofMedicineat MountSinai,NewYorkEyeandEarInfirmaryofMountSinai,NewYork,NewYork,USA JENNIFERC.KIM,MD AssociateProfessor,DepartmentofOtorhinolaryngology–HeadandNeckSurgery,Divi- sionofFacialPlasticandReconstructiveSurgery,UniversityofMichiganMedicalSchool, AnnArbor,Michigan,USA MARISSAPURCELLILAFER,MD Resident,DepartmentofOtolaryngology–HeadandNeckSurgery,NewYorkUniversity, NewYork,NewYork,USA SURESHMOHAN,MD DepartmentofOtolaryngology–HeadandNeckSurgery,MassachusettsEyeandEar, HarvardMedicalSchool,Boston,Massachusetts,USA JASONC.NELLIS,MD Resident,Otolaryngology–HeadandNeckSurgery,JohnsHopkinsSchoolofMedicine, Baltimore,Maryland,USA TERESAM.O,MD,MArch,FACS Director,FacialNerveCenter,VascularBirthmarkInstituteofNewYork,Departmentof Otolaryngology–HeadandNeckSurgery,ManhattanEye,Ear,andThroatHospital,Lenox HillHospital,NewYork,NewYork,USA JAMESA.OWUSU,MD DepartmentofHeadandNeckSurgery,Mid-AtlanaticPermanenteMedicalGroup, McLean,Virginia,USA ALICIAM.QUESNEL,MD AssistantProfessor,DepartmentofOtolaryngology,Otology,Neurotology,and SkullBaseSurgery,MassachusettsEyeandEar,HarvardMedicalSchool,Boston, Massachusetts,USA MARAWERNICKROBINSON,PT,MS,NCS PhysicalTherapist,FacialPlasticandReconstructiveSurgeryDepartment,FacialNerve Center,MassachusettsEyeandEar,Boston,Massachusetts,USA FELIPESANTOS,MD AssistantProfessor,DepartmentofOtolaryngology,Otology,Neurotology,and SkullBaseSurgery,MassachusettsEyeandEar,HarvardMedicalSchool,Boston, Massachusetts,USA DANIELQ.SUN,MD AssistantProfessor,DepartmentofOtolaryngology–HeadandNeckSurgery,Johns HopkinsUniversitySchoolofMedicine,Baltimore,Maryland,USA MARTINUSM.VANVEEN,MD DepartmentofOtolaryngology–HeadandNeckSurgery,MassachusettsEyeandEar, HarvardMedicalSchool,Boston,Massachusetts,USA;DepartmentofPlasticSurgery, UniversityMedicalCenterGroningen,UniversityofGroningen,Groningen,The Netherlands RONALDM.ZUKER,MD,FRCS,FACS,FAAP DivisionofPlasticandReconstructiveSurgery,TheHospitalforSickChildren,Toronto, Ontario,Canada Copyright ©2018. Elsevier Inc. All rights reserved. FacialPalsy:DiagnosticandTherapeuticManagement Contents Foreword:You’reNeverFullyDressedWithoutaSmile xv SujanaS.Chandrasekhar Preface:FacialPalsy:DiagnosticandTherapeuticManagement xvii TeresaM.O,NateJowett,andTessaA.Hadlock TheImportanceandPsychologyofFacialExpression 1011 LisaE.Ishii,JasonC.Nellis,KofiDerekBoahene,PatrickByrne,andMasaruIshii Facialexpressionisofcriticalimportanceininterpersonalinteractions.Thus, patientswithimpairedfacialexpressionduetofacialparalysisexperience impairedsocialinteractions.Numerousstudieshaveshownthatpatients with facial paralysis and impaired facial expression suffer social conse- quencesasdemonstratedbybeingratednegativelywithregardstoattrac- tiveness, affect display, and other traits. This has been demonstrated subjectively and objectively. Fortunately, reconstructive surgeries that restoretheabilitytoexpressemotioncanrestorenormalcyinthesepatients. AGeneralApproachtoFacialPalsy 1019 NateJowett Managementoffacialpalsycanbedaunting.Thisarticlepresentsacon- ceptualframeworkforclassificationandtherapeuticmanagementoffacial palsy. OutcomeTrackinginFacialPalsy 1033 JosephR.Dusseldorp,MartinusM.vanVeen,SureshMohan,and TessaA.Hadlock Outcome tracking in facial palsy is multimodal, consisting of patient-re- ported outcome measures, clinician-graded scoring systems, objective assessmenttools,andnoveltoolsforlaypersonandspontaneityassess- ment. Patient-reported outcome measures are critical to understanding burdenofdiseaseinfacialpalsyandeffectsofinterventionsfromthepa- tientperspective.Clinician-gradedscoringsystemsareinherentlysubjec- tiveandno1singlesystemsatisfiesallneeds.Objectiveassessmenttools quantifyfacialmovementsbutcanbelaborious.Recentadvancesinfacial recognition technology have enabled automated facial measurements. Novel assessment tools analyze attributes such as spontaneous smile, emotional expressivity, disfigurement, and attractiveness as determined bylaypersons. MedicalManagementofAcuteFacialParalysis 1051 TeresaM.O Acute facial paralysis (FP) describes acute onset of partial or complete weaknessofthefacial musclesinnervatedbythefacialnerve.AcuteFP Copyright ©2018. Elsevier Inc. All rights reserved. x Contents occurswithinafewhourstodays.Thedifferentialdiagnosisisbroad;how- ever, the most common cause is viral-associated Bell Palsy. A compre- hensive history and physical examination are essential in arriving at a diagnosis.MedicaltreatmentforacuteFPdependsonthespecificdiag- nosis;however,corticosteroidsandantiviralmedicationsarethecorner- stoneoftherapy.Lackofrecoveryafter4monthsshouldpromptfurther diagnosticworkup. SurgicalManagementofAcuteFacialPalsy 1077 DanielQ.Sun,NicholasS.Andresen,andBruceJ.Gantz Bell palsy and traumatic facial nerve injury are two common causes of acute facial palsy. Most patients with Bell palsy recover favorably with medical therapy alone. However, those with complete paralysis (House- Brackmann6/6),greaterthan90%degenerationonelectroneurography, andabsentelectromyographyactivitymaybenefitfromsurgical decom- pression via amiddle cranial fossa(MCF) approach.Patients withacute facialpalsyfromtraumatictemporalbonefracturewhomeetthesesame criteriamaybecandidatesfordecompressionviaanMCFortranslabyrin- thineapproachbasedonhearingstatus. ManagementofFlaccidFacialParalysisofLessThanTwoYears’Duration 1093 AndrewWilliamJosephandJenniferC.Kim Flaccidfacialparalysisresultsindisfiguringfacialchanges.Thetreatment offlaccidfacialparalysisiscomplexandtreatmentapproachesshouldbe determined based on duration and the causes of paralysis, status and accessibility ofthe affectedfacial nerve,medical comorbidities, and pa- tient-specific goals. Although primary nerve repair is the preferred treat- ment strategy when possible, nerve substitution procedures are the mainstay of treatment for patients with flaccid facial paralysis of less than2yearsduration. ManagementofLong-StandingFlaccidFacialPalsy:PeriocularConsiderations 1107 NatalieHomerandAaronFay Ineffectiveeyelidclosurecanposeaseriousriskofinjurytotheocularsur- faceandeye.Incasesofeyelidparesis,systematicexaminationoftheeye and ocular adnexa will direct appropriate interventions. Specifically, 4 distinct periorbital regions should be independently assessed: eyebrow, upper eyelid, ocular surface, and lower eyelid. Corneal exposure can lead to dehydration, thinning, scarring, infection, perforation, and blind- ness. Long-term sequelae following facial nerve palsy may also include epiphora,gustatorylacrimation,andsynkinesis. ManagementofLong-StandingFlaccidFacialPalsy:Midface/Smile:Locoregional MuscleTransfer 1119 JamesA.OwusuandKofiDerekBoahene Masseter and temporalis muscle transfer is an effective technique for restoringfacialsymmetryandcommissureexcursioninflaccidfacialparal- ysis.Adherencetotheprinciplesandbiomechanicsofmuscletransferis essentialforachievingoptimalresults.Muscletransferhastheadvantage Copyright ©2018. Elsevier Inc. All rights reserved. Contents xi ofbeingsinglestagedwithfastrecoveryoffunction.Itisparticularlyuseful inpatientswithlowlifeexpectancyormultiplecomorbiditieswhereamore complex,multiplestageproceduremaybedetrimental. FreeGracilisTransferandStaticFacialSuspensionforMidfacialReanimationin Long-StandingFlaccidFacialPalsy 1129 NateJowettandTessaA.Hadlock Videocontentaccompaniesthisarticleathttps://www.oto.theclinics. com/. Thisarticle presentsanapproachto reanimation ofthe midface inlong- standing flaccid facial palsy by means of functional free gracilis transfer andstaticfacialsuspension. ManagementofLong-StandingFlaccidFacialPalsy:StaticApproachestothe Brow,Midface,andLowerLip 1141 MarissaPurcelliLaferandTeresaM.O Chronic flaccid facial paralysis (FFP>2 years) may be approached with staticanddynamictechniques.Ahorizontalzonalassessmentevaluates theupper,middle,andlowerthirdsoftheface.Surgeryistailoredtoanin- dividual’sdeficits,goals,andhealthstatus.Whiledynamicreanimationis the gold standard for rehabilitation, there are cases in which static ap- proachesaremoreappropriateormaybeusedasanadjuncttodynamic techniques.ThisarticlefocusesonthesurgicalmanagementofFFPpri- marilyusingstaticapproachestotheindividualzonesofthefacetocreate restingsymmetry. FacialRehabilitation:EvaluationandTreatmentStrategiesforthePatientwith FacialPalsy 1151 MaraWernickRobinsonandJenniferBaiungo Videocontentaccompaniesthisarticleathttp://oto.theclinics.com/. Thisarticledescribesthemostwidelyusedclinician-gradedandpatient- reportedoutcomemeasures,anddescribesfacialrehabilitationstrategies for acute and chronic facial palsy, and rehabilitation following dynamic facial reanimation surgery. The multimodality rehabilitation of the facial palsy patient is determined by the extent of facial nerve injury, specific functionaldeficits,thepresenceofsynkinesis,andthepatient’sindividual goals. Appropriate intervention, including patient education, soft tissue mobilization, neuromuscular reeducation, and chemodenervation, de- creasesfacialtensionandimprovesfacialmusclemotorcontrol,physical function,facialexpression,andqualityoflife. SurgicalManagementofPostparalysisFacialPalsyandSynkinesis 1169 BabakAzizzadehandJuliaL.Frisenda Videocontentaccompaniesthisarticleathttp://www.oto.theclinics. com/. Modifiedselectiveneurectomyofthedistalbranchesofthebuccal,zygo- matic, and cervical branches of the facial nerve in addition to platysmal Copyright ©2018. Elsevier Inc. All rights reserved. xii Contents myotomyisaneffectivesurgicalprocedureforthetreatmentofpostfacial paralysissynkinesis.Successofthisproceduredependsonidentification of the peripheral facial nerve branches, preservation of zygomatic and marginalmandibularbranchesthatinnervatekeysmilemuscles,andabla- tion of buccal and cervical branches that cause lateral and/or inferior excursionoftheoralcommissure.Resultsarelong-lasting;objectiveim- provements in electronic clinician-graded facial function scale score, House-Brackmannscore,anddecreasedbotulinumtoxin-Arequirements havebeenobserved. EvaluationandManagementofFacialNerveSchwannoma 1179 AliciaM.QuesnelandFelipeSantos Facialnerveschwannomasarebenignperipheralnervesheathtumorsthat arisefromSchwanncells,andmostcommonlypresentwithfacialparesis and/orhearingloss.ComputedtomographyandMRIarecriticaltodiag- nosis. Management decisions are based on tumor size, facial function, and hearing status. Observation is usually the best option in patients withgoodfacialfunction.Forpatientswithpoorfacialfunction,theauthors favorsurgicalresectionwithfacialreanimation.Thereisgrowingevidence to support radiation treatment in patients with progressively worsening moderatefacialparesisandgrowingtumors. ManagementofVestibularSchwannoma(IncludingNF2):FacialNerve Considerations 1193 VivianKaulandMauraK.Cosetti Current consensus on optimal treatment of vestibular schwannoma remainspoorlyestablished;treatmentoptionsincludeobservation,stereo- tacticradiosurgery,microsurgicalresection,medicaltherapy,oracombi- nation of these. Treatment should be individualized and incorporate the multitude of patient- and tumor-specific characteristics known to affect outcome.Treatmentparadigmsforsporadicandneurofibromatosistype 2–related tumors are distinct and decision-making in neurofibromatosis type2isuniquelychallenging.Inallcases,treatmentshouldmaximizetu- morcontrolandminimizefunctionaldeficit. ManagementofBilateralFacialPalsy 1213 LeahthanF.Domeshek,RonaldM.Zuker,andGregoryH.Borschel Bilateralfacial paralysisisarareentitythatoccurs inboth pediatric and adultpatientsandcanhavecongenitaloracquiredcauses.Whenparalysis doesnotresolvewithconservativeormedicalmanagement,surgicalinter- ventionmaybeindicated.Thisarticlepresentstheauthors’preferredtech- nique for facial reanimation in patients with bilateral congenital facial paralysis.Specifically,astagedbilateralsegmentalgracilistransfertoipsi- lateralnervetomasseterisdiscussed. Copyright ©2018. Elsevier Inc. All rights reserved.
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