Topic: Advancements in the Management of Facial Paralysis

In the 1960s, Noel Thompson pioneered the use of cross-facial nerve grafts to innervate non-vascularised functional muscle transfers to reanimate the paralyzed face. Subsequently, in 1976, Harii introduced the concept of vascularized free functional muscle transfer, a cornerstone for the treatment of long-standing facial paralysis. However, achieving perfect results in all cases continues to elude us. Recently, there has been a renewed interest in enhancing patient outcomes through various methods. Advances have been made in diagnosing the type and location of facial nerve injury by utilizing advanced techniques like ultra-high frequency ultrasound and diffusion tensor MRI imaging. These diagnostic tools, combined with electrophysiology investigations, greatly aid in tailoring treatment plans, particularly in cases of traumatic and iatrogenic injuries. Approaches to improve axonal regeneration through PEG-fusion, intra- and post-operative electrical, dual innervation, and sensory amplification have been hugely encouraging. Understanding the interface and the role of terminal Schwann cells at the neuromuscular junction has proven crucial to successful reinnervation. In cases where partially recovered patients develop synkinesis, strategies have evolved from botulinum toxin injections to selective neurectomies of the responsible nerve branches. Furthermore, alongside many surgical advancements, the standardization of results evaluation has become more important and tools such as eFACE enable surgeons to directly compare outcomes. Adjunct therapies carried out by facial therapists, such as “Mime Therapy”, are invaluable in achieving maximal muscle movement and for patients to re-learn facial movement. Finally, a holistic approach to patient care is increasingly recognized as a vital advancement, encompassing expectation management through psychological counseling and the provision of comprehensive information, including written materials and instructional videos that can be accessed by parents and patients at home.