Affiliations: Division of Plastic and Maxillofacial Surgery,
Children's Hospital, Los Angeles, CA, USA | Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
Note: [] Corresponding author: Andre Panossian, MD, Facial Paralysis
Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS #96, Los
Angeles, CA 90027, USA. Tel.: +1 323 361 2154; Fax: +1 323 361 4106; E-mail: apanossian@chla.usc.edu
Abstract: Facial paralysis remains a vexing problem in the treatment of
posterior cranial fossa tumors in children. Fortunately, current techniques are
available to reconstruct the paralyzed face in restoring balance, symmetry, and
amelioration of functional sequelae. The restoration of structure and function
of the paralyzed face is tantamount to proper social integration and
psychosocial rehabilitation. In addition, the facial nerve is important in
preventing drying of the eyes, drooling, and speech abnormalities, among other
functions. The most visible evidence of facial paralysis is stark asymmetry,
especially with animation. This is perhaps the most troubling aspect of facial
paralysis and the one that leads to the greatest amount of psychosocial stress
for the child and family members. Management strategies include early and late
intervention. Early reconstructive goals focus on preservation and
strengthening of intact motor end plates through native stimulatory pathways.
Late reconstructive efforts are centered on surgically reconstructing
permanently lost function based on each third of the face. Use of adjunct
modalities such as chemical or surgical denervation and myectomies are also
critical tools in restoring symmetry. Physical therapy plays a large role in
both early and late facial nerve paralysis in optimizing cosmetic and
functional outcome.
