Facial Paralysis after Trauma: A Simplified Method to Find and Repair the Facial Nerve

Yavuz Uyar, Berk Gürpınar*, Ahmet Arslanoğlu, Zıya Saltürk, Tolgar Lütfı Kumral, Yavuz Atar, Kamıl Akdag, Belgın Tutar and Güler Berkıten

Facial Paralysis after Trauma: A Simplified Method to Find and Repair the Facial Nerve.

This study aims to identify the digastric nerve as an alternative to access the facial nerve in case of post-traumatic facial nerve paralysis.

Eleven peripheric facial paralysis cases between 2005-2016 following trauma to the parotid gland are presented. Initial emergency treatments were done elsewhere but all returned back to treat facial paralysis after 11-18 months to our institute. The digastric nerve was identified and a facial-hypoglossal nerve anastomosis was performed.

Pre-operative House-Brackmann scores were 6 for all cases. Post-operative scores were between 3 and 4. Pre-operative needle electromyography revealed no motor unit action potentials; after 7 months post-operatively, we had motor unit action potentials in every case.

In cases of trauma and secondary approaches of the parotid gland, a safe step for finding the facial nerve is to find the digastric nerve and follow it through the main trunk.

The facial nerve lies beneath the parotid gland and a thick glandular capsule serves as a protection against blunt trauma. The mandible is the second barrier for protection. The force required
to injure the parotid gland is mostly more than the force required to fracture the mandible or temporomandibular joint (TMJ). In severe cases, the soft tissues are usually more affected than the
adjacent structures, making surgical intervention necessary.

Blunt trauma or gunshot injuries to the parotid gland may cause acute or delayed facial paralysis. Delayed treatment of the nerve is almost always difficult because the scar formation prevents visual identification or stimulation of the facial nerve or its branches.

Otolaryngol Open J. 2018; 4(1): 1-5. doi: 10.17140/OTLOJ-4-144

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