General Management Goals

General treatment for patients with facial palsy is concerned mainly with protection of the eye from exposure keratitis, especially when an ipsilateral CN V deficit exists. During the day, artificial tears should be used frequently to keep the eye moist. Sunglasses are worn outside. Areas with air contaminated by excessive particulate matter or noxious fumes (e.g., construction sites, textile factories) should be avoided. To protect the cornea while asleep, ophthalmic ointment is instilled. Then, either the eyelid is carefully taped shut or a moisture chamber is used. Other measures to protect the eye are room humidifiers, tape for lid support, and soft contact lenses. Any corneal abrasion or infection should be treated immediately to avoid possible visual complications. If there is deterioration in visual function, ophthalmology consultation is needed.

Specific treatments for facial palsy are aimed at the underlying etiology. Consultation with the appropriate specialist is necessary for facial palsy caused by tumors, cholesteatoma, skull base osteomyelitis, or middle ear infection. Infectious, metabolic, collagen vascular, or toxic causes should be corrected as required by the particular disease. Prompt surgical consultation is needed for patients with facial nerve paralysis after either blunt or penetrating trauma. y

For the patient with a permanent facial paralysis despite medical and surgical treatment, many surgical options are available to improve facial function and appearance. These include static sling procedures with fascia lata or alloplastic strips, dynamic procedures with temporalis or masseter transposition, hypoglossal-facial nerve anastomosis, cross-facial nerve grafting, free muscle grafts, and microvascular free nerve-muscle grafts. '331 In addition, the placement of gold weights or springs within the upper eyelid, canthoplasty, and lower lid shortening can help with eye closure. Associated procedures include brow or face lift, entropion or ectropion repair, and lip transposition. y

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