Laura H Christopher1, William H Slattery2,3,4, Erin J Smith5, Babak Larian6,7, Babak Azizzadeh8,9. 1. House Ear Clinic, 2100 West Third Street, Los Angeles, CA, 90057, USA. lchristopher@houseclinic.com. 2. House Ear Clinic, 2100 West Third Street, Los Angeles, CA, 90057, USA. 3. University of California, Los Angeles, USA. 4. University of Southern California, 2100 West Third Street, Los Angeles, CA, 90057, USA. 5. Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, USA. 6. Center for Advanced Head & Neck Surgery, Beverly Hills, CA, USA. 7. Clinical Chief of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, USA. 8. Facial Paralysis Institute, Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, USA. 9. Division of Head and Neck Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Abstract
INTRODUCTION: The course of the facial nerve through the cerebellopontine angle, temporal bone, and parotid gland puts the nerve at risk in cases of malignancy. In contrast to Bell's palsy, which presents with acute facial paralysis, malignancies cause gradual or fluctuating weakness. METHODS: We review malignancies affecting the facial nerve, including those involving the temporal bone, parotid gland, and cerebellopontine angle, in addition to metastatic disease. Intraoperative management of the facial nerve and long term management of facial palsy are reviewed. RESULTS: Intraoperative management of the facial nerve in cases of skull base malignancy may involve extensive exposure, mobilization, or rerouting of the nerve. In cases of nerve sacrifice, primary neurorrhaphy or interposition grafting may be used. Cranial nerve substitution, gracilis free functional muscle transfer, and orthodromic temporalis tendon transfer are management options for long term facial paralysis. CONCLUSION: Temporal bone, parotid gland, and cerebellopontine angle malignancies pose a tremendous risk to the facial nerve. When possible, the facial nerve is preserved. If the facial nerve is sacrificed, static and dynamic reanimation strategies are used to enhance facial function.
INTRODUCTION: The course of the facial nerve through the cerebellopontine angle, temporal bone, and parotid gland puts the nerve at risk in cases of malignancy. In contrast to Bell's palsy, which presents with acute facial paralysis, malignancies cause gradual or fluctuating weakness. METHODS: We review malignancies affecting the facial nerve, including those involving the temporal bone, parotid gland, and cerebellopontine angle, in addition to metastatic disease. Intraoperative management of the facial nerve and long term management of facial palsy are reviewed. RESULTS: Intraoperative management of the facial nerve in cases of skull base malignancy may involve extensive exposure, mobilization, or rerouting of the nerve. In cases of nerve sacrifice, primary neurorrhaphy or interposition grafting may be used. Cranial nerve substitution, gracilis free functional muscle transfer, and orthodromic temporalis tendon transfer are management options for long term facial paralysis. CONCLUSION: Temporal bone, parotid gland, and cerebellopontine angle malignancies pose a tremendous risk to the facial nerve. When possible, the facial nerve is preserved. If the facial nerve is sacrificed, static and dynamic reanimation strategies are used to enhance facial function.