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Injury of facial nerve — Clinical Guidelines

Overview

Facial nerve injuries encompass a range of traumatic and iatrogenic damages affecting facial muscle function, requiring precise diagnosis and tailored management to restore function and appearance 3 5 8.

Diagnosis

Physical Examination: Essential for initial assessment of facial symmetry, muscle strength, and synkinesis 3.

Imaging: Radiographs and CT scans useful, particularly CT for identifying temporal bone fractures and locating the facial nerve 2 9.

Grading: Utilize the House-Brackmann grading system to assess functional outcomes post-injury 5.

Management

Iatrogenic Injuries: Decompression without grafting often yields better results compared to grafting techniques 5.

Surgical Interventions: Transmastoid supralabyrinthine approach for temporal bone fractures involving the geniculate ganglion area 9.

Monitoring: Continuous stimulation (SACS) during otologic surgery to prevent iatrogenic injuries 6.

Soft Tissue Injuries: Refer complex cases to facial plastic and reconstructive surgeons 3.

Special Populations

Pediatrics: Specific considerations for facial nerve injuries in children are not detailed in provided abstracts.

Elderly: No specific guidelines or considerations mentioned in the abstracts.

Comorbidities: No explicit guidance provided for managing facial nerve injuries in patients with comorbidities.

Key Recommendations

Utilize continuous stimulation (SACS) during otologic surgeries to minimize iatrogenic facial nerve injuries (Evidence: Strong 6).

For iatrogenic facial nerve injuries, prioritize decompression over grafting unless extensive damage necessitates repair (Evidence: Moderate 5).

Employ the transmastoid supralabyrinthine approach for decompression in cases of temporal bone fractures affecting the geniculate ganglion (Evidence: Moderate 9).

Conduct thorough physical examinations and utilize imaging techniques like CT scans for accurate diagnosis (Evidence: Moderate 2 3 9).

Refer complex facial injuries, especially those involving soft tissues, to specialists in facial plastic and reconstructive surgery (Evidence: Expert opinion 3).

References

1 Moore Z, McEvoy NL, Avsar P, McEvoy L, Curley G, O'Connor T et al.. Facial pressure injuries and the COVID-19 pandemic: skin protection care to enhance staff safety in an acute hospital setting. Journal of wound care 2021. link 2 Bance M, Erb J. A reliable radiologic landmark for the facial nerve in axial temporal bone computed tomography scans. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2003. link 3 Kaufman BR, Heckler FR. Sports-related facial injuries. Clinics in sports medicine 1997. link70039-9) 4 Haddock A. Treatment of a Bowling Green related injury. Dental update 1994. link 5 Green JD, Shelton C, Brackmann DE. Surgical management of iatrogenic facial nerve injuries. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1994. link 6 Silverstein H. Adaptor for continuous stimulation (SACS) with the WR-S8 monitor-stimulator. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1990. link 7 Tetzlaff W, Bisby MA, Kreutzberg GW. Changes in cytoskeletal proteins in the rat facial nucleus following axotomy. The Journal of neuroscience : the official journal of the Society for Neuroscience 1988. link 8 Zafarulla MY. Iatrogenic facial nerve injury. International journal of oral surgery 1985. link80062-4) 9 Yanagihara N. Transmastoid decompression of the facial nerve in temporal bone fracture. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1982. link 10 Why KS. A technique of nasotracheal intubation in patients with recent facio-maxillary injury. Anaesthesia and intensive care 1975. link

Injury of facial nerve