Skip to main content

Facial Nerve Innervation and Facial Palsies

  • Chapter
  • First Online:
Craniofacial Muscles

Abstract

There are a myriad of causes of facial palsy. Identifying the etiology in each case is of vital importance to the choice of management pathway, either as an emergency or in terms of long-term intervention. Most patients at the time of presentation are convinced that they are suffering from either a stroke (50 %), an intracranial tumor (25 %), or do not know but are nonetheless anxious (25 %) (Peitersen 2002). In a review of the literature, Schaitkin and May identified over 100 possible diagnoses but the overwhelming majority (50–66 %) of cases were Bell’s palsies (Schaitkin et al. 2000). The difficulty of this diagnosis of idiopathic paralysis is that it is one of exclusion. Any case of new onset palsy must be thoroughly examined, and the history, as always, is vital in ascertaining the cause. The onset, progression, concurrent symptoms, and localization all assist the physician in deciding what further investigations are required.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abramson DL, Cohen MM, Mulliken JB (1998) Möbius syndrome: classification and grading system. Plast Reconstr Surg 102(4):961–967

    Article  PubMed  CAS  Google Scholar 

  • Adour KK (2002) Decompression for Bell’s palsy: why I don’t do it. Eur Arch Otorhinolaryngol 259(1):40–47

    Article  PubMed  Google Scholar 

  • Anderl H (1976) Cross-face nerve transplantation in facial palsy. Proc R Soc Med 69(10):781–783

    PubMed  CAS  Google Scholar 

  • Asbury AK, Cornblath DR (1990) Assessment of current diagnostic criteria for guillain-barré syndrome. Ann Neurol 27(suppl):S21–S24

    Article  PubMed  Google Scholar 

  • Bae YC, Zuker RM, Manktelow RT, Wade S (2006) A comparison of commissure excursion following gracilis muscle transplantation for facial paralysis using a cross-face nerve graft versus the motor nerve to the masseter nerve. Plast Reconstr Surg 117(7):2407–2413

    Article  PubMed  CAS  Google Scholar 

  • Bell C (1821) On the nerves; giving an account of some experiments on their structure and functions, which lead to a new arrangement of the system. Philos Trans R Soc Lond 111:398–424

    Article  Google Scholar 

  • Berghaus A, Neumann K, Schrom T (2003) The platinum chain: a new upper-lid implant for facial palsy. Arch Facial Plast Surg 5(2):166–170

    Article  PubMed  Google Scholar 

  • Bird TD, Nicolaus A (1979) Friedreich’s description of peripheral facial nerve paralysis in 1798. J Neurol Neurosurg Psychiatry 42(1):56

    Article  PubMed  CAS  Google Scholar 

  • Bonnet RM (2005) Causes of facial palsies. In: Beurskens CHG (ed) The facial palsies, complementary approaches. Lemma Publishers, Utrecht

    Google Scholar 

  • Bulstrode NW, Harrison DH (2005) The phenomenon of the late recovered Bell’s palsy: treatment options to improve facial symmetry. Plast Reconstr Surg 115(6):1466–1471

    Article  PubMed  CAS  Google Scholar 

  • Cawthorne T (1951) The pathology and surgical treatment of Bell’s palsy. Proc R Soc Med 44(7):565–572

    PubMed  CAS  Google Scholar 

  • Cawthorne T (1965) Idiopathic facial palsy. Surgery and treatment. Arch Otolaryngol 81:494–496

    Article  PubMed  CAS  Google Scholar 

  • Cocchiarella L, Andersson G (2001) Guides to the evaluation of permanent impairment. American Medical Association, Chicago

    Google Scholar 

  • Coker NJ, Kendall KA, Jenkins HA, Alford BR (1987) Traumatic intratemporal facial nerve injury: management rationale for preservation of function. Otolaryngol Head Neck Surg 97(3):262–269

    PubMed  CAS  Google Scholar 

  • Collin R (1993) Epiphora in facial paralysis. Br J Plast Surg 46(2):149–150

    Article  PubMed  CAS  Google Scholar 

  • Gillies H (1934) Experiences with fascia lata grafts in the operative treatment of facial paralysis: (section of otology and section of laryngology). Proc R Soc Med 27(10):1372–1382

    PubMed  CAS  Google Scholar 

  • Goldfarb D, Sataloff RT (1994) Lyme disease: a review for the otolaryngologist. Ear Nose Throat J 73(11):824–829

    PubMed  CAS  Google Scholar 

  • Grogan PM, Gronseth GS (2001) Practice parameter: steroids, acyclovir, and surgery for Bell’s palsy (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology 56(7):830–836

    Article  PubMed  CAS  Google Scholar 

  • Harii K, Ohmori K, Torii S (1976) Free gracilis muscle transplantation with microneurovascular anastomosis for the treatment of facial paralysis. Plast Reconstr Surg 57:133–143

    Article  PubMed  CAS  Google Scholar 

  • Harrison DH (2002) The treatment of unilateral and bilateral facial palsy using free muscle transfers. Clin Plast Surg 29(4):539–549

    Article  PubMed  Google Scholar 

  • Horlock N, Sanders R, Harrison DH (2002) The SOOF lift: its role in correcting midfacial and lower facial asymmetry in patients with partial facial palsy. Plast Reconstr Surg 109(3):839–849, discussion 850–854

    Article  PubMed  Google Scholar 

  • House JW (1983) Facial nerve grading systems. Laryngoscope 93(8):1056–1069

    Article  PubMed  CAS  Google Scholar 

  • Hunt A (1908) Further contribution to herpetic inflammations of the geniculate ganglion. Am J Med Sci 136:226–232

    Article  Google Scholar 

  • Jemec B, Grobbelaar AO, Harrison DH (2000) The abnormal nucleus as a cause of congenital facial palsy. Arch Dis Child 83(3):256–258

    Article  PubMed  CAS  Google Scholar 

  • Jenny AB, Saper CB (1987) Organization of the facial nucleus and corticofacial projection in the monkey: a reconsideration of the upper motor neuron facial palsy. Neurology 37(6):930–939

    Article  PubMed  CAS  Google Scholar 

  • Jonkees LB (1957) Some observations on children with defective hearing. Medicamundi 3(3):73–77

    PubMed  CAS  Google Scholar 

  • Kataye S (1975) Facial paralysis as described by Avicenna. Ann Otolaryngol Chir Cervicofac 92(1–2):79–82

    PubMed  CAS  Google Scholar 

  • Krastinova D, Franchi G, Kelly MB, Chabolle F (2002) Rehabilitation of the paralysed or lax lower eyelid using a graft of conchal cartilage. Br J Plast Surg 55(1):12–19

    Article  PubMed  CAS  Google Scholar 

  • Kumar PA (1995) Cross-face reanimation of the paralysed face, with a single stage microneurovascular gracilis transfer without nerve graft: a preliminary report. Br J Plast Surg 48(2):83–88

    Article  PubMed  CAS  Google Scholar 

  • Kumar PA, Hassan KM (2002) Cross-face nerve graft with free-muscle transfer for reanimation of the paralyzed face: a comparative study of the single-stage and two-stage procedures. Plast Reconstr Surg 109(2):451–462, discussion 463–464

    Article  PubMed  Google Scholar 

  • Labbé D (1997) Lengthening of temporalis myoplasty and reanimation of lips. Technical notes. Ann Chir Plast Esthet 42(1):44–47

    PubMed  Google Scholar 

  • Lee V, Currie Z, Collin JRO (2004) Ophthalmic management of facial nerve palsy. Eye (Lond) 18(12):1225–1234

    Article  CAS  Google Scholar 

  • Levine RE, Shapiro JP (2000) Reanimation of the paralyzed eyelid with the enhanced palpebral spring or the gold weight: modern replacements for tarsorrhaphy. Facial Plast Surg 16(4):325–336

    Article  PubMed  CAS  Google Scholar 

  • MacQuillan A, Horlock N, Grobbelaar A, Harrison D (2004) Arterial and venous anatomical features of the pectoralis minor muscle flap pedicle. Plast Reconstr Surg 113(3):872–876

    Article  PubMed  Google Scholar 

  • MacQuillan A, Biarda FU, Grobbelaar A (2010) The incidence of anterior belly of digastric agenesis in patients with hemifacial microsomia. Plast Reconstr Surg 126(4):1285

    Article  PubMed  CAS  Google Scholar 

  • Mavrikakis I (2008) Facial nerve palsy: anatomy, etiology, evaluation, and management. Orbit 27(6):466–474

    Article  PubMed  Google Scholar 

  • May M, Harvey JE, Marovitz WF, Stroud M (1971) The prognostic accuracy of the maximal stimulation test compared with that of the nerve excitability test in Bell’s palsy. Laryngoscope 81(6):931–938

    Article  PubMed  CAS  Google Scholar 

  • May M, Blumenthal F, Klein SR (1983) Acute Bell’s palsy: prognostic value of evoked electromyography, maximal stimulation, and other electrical tests. Am J Otol 5(1):1–7

    PubMed  CAS  Google Scholar 

  • McCormick DP (1972) Herpes-simplex virus as a cause of Bell’s palsy. Lancet 1(7757):937–939

    Article  PubMed  CAS  Google Scholar 

  • McGovern FH, Konigsmark BW, Sydnor JB (1972) An immunological concept for Bell’s palsy: experimental study. Laryngoscope 82(9):1594–1601

    Article  PubMed  CAS  Google Scholar 

  • McLaughlin CR (1951) Epiphora in facial paralysis. Br J Plast Surg 3:87–95

    Article  Google Scholar 

  • McLaughlin CR (1952) Permanent facial paralysis; the role of surgical support. Lancet 2(6736):647

    Article  PubMed  CAS  Google Scholar 

  • Misra A, Grover R, Withey S, Grobbelaar AO, Harrison DH (2000) Reducing postoperative morbidity after the insertion of gold weights to treat lagopthalmos. Ann Plast Surg 45:623–628

    Article  PubMed  CAS  Google Scholar 

  • Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N (1996) Bell’s palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med 124(1 pt 1):27–30

    PubMed  CAS  Google Scholar 

  • O’Brien BM, Pederson WC, Khazanchi RK, Morrison WA, MacLeod AM, Kumar V (1990) Results of management of facial palsy with microvascular free-muscle transfer. Plast Reconstr Surg 86(1):12–22, discussion 23–24

    Article  PubMed  Google Scholar 

  • Peitersen E (2002) Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol 122:4–30

    Google Scholar 

  • Piggot TA, Niazi ZBM, Hodgkinson PD (1995) New technique of levator lengthening for the retracted upper eyelid. Br J Plast Surg 48(3):127–131

    Article  PubMed  CAS  Google Scholar 

  • Resende LAL, Weber S (2008) Peripheral facial palsy in the past: contributions from Avicenna, Nicolaus Friedreich and Charles Bell. Arq Neuropsiquiatr 66:765–769

    Article  PubMed  Google Scholar 

  • Ross BG, Fradet G, Nedzelski JM (1996) Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg 114(3):380–386

    Article  PubMed  CAS  Google Scholar 

  • Scaramella LF (1975) Anastomosis between the two facial nerves. Laryngoscope 85(8):1359–1366

    Article  PubMed  CAS  Google Scholar 

  • Scevola S, Cowan J, Harrison DH (2003) Does the removal of pectoralis minor impair the function of pectoralis major? Plast Reconstr Surg 112(5):1266–1273

    Article  PubMed  Google Scholar 

  • Schaitkin BM, May M, Klein SR (2000) Office evaluation of the patient with facial palsy: differential diagnosis and prognosis. In: May S (ed) The facial nerve, 2nd edn. Thieme, New York

    Google Scholar 

  • Smellie GD (1966) Restoration of the blinking reflex in facial palsy by a simple lid-load operation. Br J Plast Surg 19:279–283

    Article  PubMed  CAS  Google Scholar 

  • Smith JD, Crumley RL, Harker LA (1981) Facial paralysis in the newborn. Otolaryngol Head Neck Surg 89:1021–1024

    PubMed  CAS  Google Scholar 

  • Takushima A, Harii K, Asato H, Momosawa A (2005) Revisional operations improve results of neurovascular free muscle transfer for treatment of facial paralysis. Plast Reconstr Surg 116(2):371–380

    Article  PubMed  CAS  Google Scholar 

  • Terzis JK, Kalantarian B (2000) Microsurgical strategies in 74 patients for restoration of dynamic depressor muscle mechanism: a neglected target in facial reanimation. Plast Reconstr Surg 105(6):1917–1931, discussion 1932–1934

    Article  PubMed  CAS  Google Scholar 

  • Terzis JK, Karypidis D (2010) Blink restoration in adult facial paralysis. Plast Reconstr Surg 126(1):126–139

    Article  PubMed  CAS  Google Scholar 

  • Terzis JK, Noah ME (1997) Analysis of 100 cases of free-muscle transplantation for facial paralysis. Plast Reconstr Surg 99(7):1905–1921

    Article  PubMed  CAS  Google Scholar 

  • Terzis JK, Noah EM (2002) Möbius and möbius-like patients: etiology, diagnosis, and treatment options. Clin Plast Surg 29(4):497–514

    Article  PubMed  Google Scholar 

  • Terzis JK, Noah EM (2003) Dynamic restoration in möbius and möbius-like patients. Plast Reconstr Surg 111(1):40–55

    Article  PubMed  Google Scholar 

  • Terzis JK, Tzafetta K (2009) The “babysitter” procedure: minihypoglossal to facial nerve transfer and cross-facial nerve grafting. Plast Reconstr Surg 123(3):865–876

    Article  PubMed  CAS  Google Scholar 

  • Tulley P, Webb A, Chana JS, Tan ST, Hudson D, Grobbelaar AO, Harrison DH (2000) Paralysis of the marginal mandibular branch of the facial nerve: treatment options. Br J Plast Surg 53(5):378–385

    Article  PubMed  CAS  Google Scholar 

  • Ueda K, Harii K, Yamada A (1994) Long-term follow-up study of browlift for treatment of facial paralysis. Ann Plast Surg 32(2):166–170

    Article  PubMed  CAS  Google Scholar 

  • Urso-Baiarda F, Grobbelaar AO (2009) A comparison of one-versus two-stage surgery in an experimental model of functional muscle transfer with interposed nerve grafting. J Plast Reconstr Aesthet Surg 62(8):1042–1047

    Article  PubMed  CAS  Google Scholar 

  • Verzijl HT, van der Zwaag B, Cruysberg JR, Padberg GW (2003) Möbius syndrome redefined: a syndrome of rhombencephalic maldevelopment. Neurology 61(3):327–333

    Article  PubMed  Google Scholar 

  • Woollard AC, Harrison DH, Grobbelaar AO (2010) An approach to bilateral facial paralysis. J Plast Reconstr Aesthet Surg 63:1557–1560

    Article  PubMed  Google Scholar 

  • Zuker RM, Goldberg CS, Manktelow RT (2000) Facial animation in children with mobius syndrome after segmental gracilis muscle transplant. Plast Reconstr Surg 106(1):1–8

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adriaan O. Grobbelaar .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

Grobbelaar, A.O., Woollard, A.C.S. (2012). Facial Nerve Innervation and Facial Palsies. In: McLoon, L., Andrade, F. (eds) Craniofacial Muscles. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4466-4_15

Download citation

Publish with us

Policies and ethics