Functional results after facial reanimation in iatrogenic facial palsy

BACKGROUND: Iatrogenic facial nerve injury is a common cause of long-standing facial palsy. This study aimed to assess functional results after facial reanimation in iatrogenic facial palsy and to determine correlating patient factors. METHODS: The data of 128 iatrogenic facial palsy patients were analyzed for this case series. Inclusion criteria for assessment of facial function by three-dimensional video analysis were preoperative and postoperative (>18 months) video sets for facial marker tracking, which were available in 63 patients. Demographic factors and treatment concepts were analyzed and correlations to functional outcomes calculated. RESULTS: One hundred and twenty-eight patients with iatrogenic facial palsy underwent facial reanimation procedures and were included in this study. The mean duration of facial palsy was 7.8 years. The most common procedures leading to iatrogenic facial palsy were acoustic neuroma resection (29.7%), parotidectomy (21.1%), and brainstem/cerebellopontine angle tumor resection (21.1%). Selected functional results were significantly improved after facial reanimation surgery. The mean lagophthalmos during eyelid closure reduced from 7.3 +/- 4.1 mm to 5.4 +/- 4 mm (p < .001). The function of the mouth was significantly improved, both statically (static asymmetry: 10.3 +/- 7.6 mm preoperatively, 0.8 +/- 9.5 mm postoperatively; p < .001), and during smile movement ("Dynamic Symmetry Index": 0.16 preoperatively, 0.39 postoperatively; p < .001). The mean duration of facial palsy correlated with postoperative smiling function (r = .358, p = .011). CONCLUSION: Facial reanimation significantly improves facial function in iatrogenic facial palsy. Early referral to a facial nerve center is crucial as duration of facial palsy influences functional outcomes.