Treatment of facial paralysis in multidisciplinary units

Complex cases of facial paralysis must be treated in multidisciplinary units made up of different specialists and led by an otolaryngologist. This is recommended by the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) within the framework of its 68th Congress that will be held in Madrid from 10 to 12 November. There are currently two Facial Paralysis Units of this type in Spain with a consolidated track record, one in Madrid and the other in Barcelona. Multidisciplinary and specialized units would prevent patients from spending several years without obtaining a solution. Facial paralysis is an injury to the facial nerve that causes the total or partial loss of voluntary muscle movement of the face. Its most common cause is Bell’s palsy, also called idiopathic. It is a disease of probable viral origin, which in most cases recovers spontaneously, in 30% of cases, with some sequelae. It can appear at any age, affecting men and women equally. Other causes may be the chickenpox virus, stroke, skull base tumors, tumors originating from the facial nerve, head trauma with a fractured rock, ear infections, or iatrogenesis after surgery of the ear, parotid or skull base. A recent review of studies published in the Journal of Multidisciplinary Healthcare warns that to optimize patient outcomes, professionals involved in the management of facial paralysis must collaborate within comprehensive multidisciplinary teams, due to the functional and psychosocial impact of this pathology. Reference centers with specialized multidisciplinary teams can offer the patient all the existing therapeutic options, from the simplest to the most complex, through a wide range of complementary and rehabilitation techniques. Dr. Luis Lassalleta, president of the Otoneurology Commission of the SEORL-CCC, indicates that when complex cases are treated by individual specialists, “they adapt the pathology to the techniques they know, while treatment in referral units it allows selecting the most appropriate technique / s for each case, often carried out by different professionals ”. The otorhinolaryngologist must lead these units, since his knowledge of the facial nerve, from its exit from the brainstem to its terminal branches in the parotid, is key to guiding diagnosis and treatment. How to treat facial palsy Bell’s palsy cases are treated with oral corticosteroids and most recover their facial function completely. In contrast, a surgical, traumatic, or infectious injury to the facial nerve often requires a determined surgical approach. When a severe nerve injury occurs, facial function is never fully restored, and the passage of time decreases the chances of reinnervation. In this way, if the specialist does not have enough knowledge or experience, he will not face the problem and the result will be much worse than if he focuses correctly and on time. For those patients with still viable facial musculature, that is, with less than 1 or 2 years of paralysis, the facial nerve is reconstructed directly or with a nerve graft. If this is not possible, other donor nerves are used, such as the hypoglossal nerve, the masseteric nerve, or the contralateral facial nerve. If the paralysis is established, it takes more than 1 or 2 years of evolution and the facial muscles are no longer viable, muscle transpositions or microvascular grafts are required depending on the age, characteristics and preferences of each person. In this sense, the most innovative thing is the combination of several reinnervation techniques, in which the best results are obtained by combining several nerves, and this is only possible in Multidisciplinary Facial Paralysis Units. On the other hand, a recent study by Johns Hopkins University otolaryngologists and published in Plastic Sugery concludes that the minimally invasive temporal tendon transfer technique offers an immediate, predictable and symmetrical return of smile function. This technique is useful in patients with long-standing paralysis who cannot benefit from reinnervation techniques. In addition, after surgery, it will be necessary to complement it with specific rehabilitation of facial neuromuscular reeducation, often combined with botulinum toxin. On the other hand, in most cases, complementary aesthetic and eye procedures are followed to improve blinking and avoid corneal problems. See more: .

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