Facial Nerve Innervation and Facial Palsies

  • Adriaan O. Grobbelaar
  • Alex C. S. Woollard


There are a myriad of causes of facial palsy. Identifying the etiology in each case is of vital importance to the choice of management pathway, either as an emergency or in terms of long-term intervention. Most patients at the time of presentation are convinced that they are suffering from either a stroke (50 %), an intracranial tumor (25 %), or do not know but are nonetheless anxious (25 %) (Peitersen 2002). In a review of the literature, Schaitkin and May identified over 100 possible diagnoses but the overwhelming majority (50–66 %) of cases were Bell’s palsies (Schaitkin et al. 2000). The difficulty of this diagnosis of idiopathic paralysis is that it is one of exclusion. Any case of new onset palsy must be thoroughly examined, and the history, as always, is vital in ascertaining the cause. The onset, progression, concurrent symptoms, and localization all assist the physician in deciding what further investigations are required.


Facial Nerve Herpes Zoster Facial Palsy Stylomastoid Foramen Tympanic Segment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abramson DL, Cohen MM, Mulliken JB (1998) Möbius syndrome: classification and grading system. Plast Reconstr Surg 102(4):961–967PubMedCrossRefGoogle Scholar
  2. Adour KK (2002) Decompression for Bell’s palsy: why I don’t do it. Eur Arch Otorhinolaryngol 259(1):40–47PubMedCrossRefGoogle Scholar
  3. Anderl H (1976) Cross-face nerve transplantation in facial palsy. Proc R Soc Med 69(10):781–783PubMedGoogle Scholar
  4. Asbury AK, Cornblath DR (1990) Assessment of current diagnostic criteria for guillain-barré syndrome. Ann Neurol 27(suppl):S21–S24PubMedCrossRefGoogle Scholar
  5. Bae YC, Zuker RM, Manktelow RT, Wade S (2006) A comparison of commissure excursion following gracilis muscle transplantation for facial paralysis using a cross-face nerve graft versus the motor nerve to the masseter nerve. Plast Reconstr Surg 117(7):2407–2413PubMedCrossRefGoogle Scholar
  6. Bell C (1821) On the nerves; giving an account of some experiments on their structure and functions, which lead to a new arrangement of the system. Philos Trans R Soc Lond 111:398–424CrossRefGoogle Scholar
  7. Berghaus A, Neumann K, Schrom T (2003) The platinum chain: a new upper-lid implant for facial palsy. Arch Facial Plast Surg 5(2):166–170PubMedCrossRefGoogle Scholar
  8. Bird TD, Nicolaus A (1979) Friedreich’s description of peripheral facial nerve paralysis in 1798. J Neurol Neurosurg Psychiatry 42(1):56PubMedCrossRefGoogle Scholar
  9. Bonnet RM (2005) Causes of facial palsies. In: Beurskens CHG (ed) The facial palsies, complementary approaches. Lemma Publishers, UtrechtGoogle Scholar
  10. Bulstrode NW, Harrison DH (2005) The phenomenon of the late recovered Bell’s palsy: treatment options to improve facial symmetry. Plast Reconstr Surg 115(6):1466–1471PubMedCrossRefGoogle Scholar
  11. Cawthorne T (1951) The pathology and surgical treatment of Bell’s palsy. Proc R Soc Med 44(7):565–572PubMedGoogle Scholar
  12. Cawthorne T (1965) Idiopathic facial palsy. Surgery and treatment. Arch Otolaryngol 81:494–496PubMedCrossRefGoogle Scholar
  13. Cocchiarella L, Andersson G (2001) Guides to the evaluation of permanent impairment. American Medical Association, ChicagoGoogle Scholar
  14. Coker NJ, Kendall KA, Jenkins HA, Alford BR (1987) Traumatic intratemporal facial nerve injury: management rationale for preservation of function. Otolaryngol Head Neck Surg 97(3):262–269PubMedGoogle Scholar
  15. Collin R (1993) Epiphora in facial paralysis. Br J Plast Surg 46(2):149–150PubMedCrossRefGoogle Scholar
  16. Gillies H (1934) Experiences with fascia lata grafts in the operative treatment of facial paralysis: (section of otology and section of laryngology). Proc R Soc Med 27(10):1372–1382PubMedGoogle Scholar
  17. Goldfarb D, Sataloff RT (1994) Lyme disease: a review for the otolaryngologist. Ear Nose Throat J 73(11):824–829PubMedGoogle Scholar
  18. Grogan PM, Gronseth GS (2001) Practice parameter: steroids, acyclovir, and surgery for Bell’s palsy (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology 56(7):830–836PubMedCrossRefGoogle Scholar
  19. Harii K, Ohmori K, Torii S (1976) Free gracilis muscle transplantation with microneurovascular anastomosis for the treatment of facial paralysis. Plast Reconstr Surg 57:133–143PubMedCrossRefGoogle Scholar
  20. Harrison DH (2002) The treatment of unilateral and bilateral facial palsy using free muscle transfers. Clin Plast Surg 29(4):539–549PubMedCrossRefGoogle Scholar
  21. Horlock N, Sanders R, Harrison DH (2002) The SOOF lift: its role in correcting midfacial and lower facial asymmetry in patients with partial facial palsy. Plast Reconstr Surg 109(3):839–849, discussion 850–854PubMedCrossRefGoogle Scholar
  22. House JW (1983) Facial nerve grading systems. Laryngoscope 93(8):1056–1069PubMedCrossRefGoogle Scholar
  23. Hunt A (1908) Further contribution to herpetic inflammations of the geniculate ganglion. Am J Med Sci 136:226–232CrossRefGoogle Scholar
  24. Jemec B, Grobbelaar AO, Harrison DH (2000) The abnormal nucleus as a cause of congenital facial palsy. Arch Dis Child 83(3):256–258PubMedCrossRefGoogle Scholar
  25. Jenny AB, Saper CB (1987) Organization of the facial nucleus and corticofacial projection in the monkey: a reconsideration of the upper motor neuron facial palsy. Neurology 37(6):930–939PubMedCrossRefGoogle Scholar
  26. Jonkees LB (1957) Some observations on children with defective hearing. Medicamundi 3(3):73–77PubMedGoogle Scholar
  27. Kataye S (1975) Facial paralysis as described by Avicenna. Ann Otolaryngol Chir Cervicofac 92(1–2):79–82PubMedGoogle Scholar
  28. Krastinova D, Franchi G, Kelly MB, Chabolle F (2002) Rehabilitation of the paralysed or lax lower eyelid using a graft of conchal cartilage. Br J Plast Surg 55(1):12–19PubMedCrossRefGoogle Scholar
  29. Kumar PA (1995) Cross-face reanimation of the paralysed face, with a single stage microneurovascular gracilis transfer without nerve graft: a preliminary report. Br J Plast Surg 48(2):83–88PubMedCrossRefGoogle Scholar
  30. Kumar PA, Hassan KM (2002) Cross-face nerve graft with free-muscle transfer for reanimation of the paralyzed face: a comparative study of the single-stage and two-stage procedures. Plast Reconstr Surg 109(2):451–462, discussion 463–464PubMedCrossRefGoogle Scholar
  31. Labbé D (1997) Lengthening of temporalis myoplasty and reanimation of lips. Technical notes. Ann Chir Plast Esthet 42(1):44–47PubMedGoogle Scholar
  32. Lee V, Currie Z, Collin JRO (2004) Ophthalmic management of facial nerve palsy. Eye (Lond) 18(12):1225–1234CrossRefGoogle Scholar
  33. Levine RE, Shapiro JP (2000) Reanimation of the paralyzed eyelid with the enhanced palpebral spring or the gold weight: modern replacements for tarsorrhaphy. Facial Plast Surg 16(4):325–336PubMedCrossRefGoogle Scholar
  34. MacQuillan A, Horlock N, Grobbelaar A, Harrison D (2004) Arterial and venous anatomical features of the pectoralis minor muscle flap pedicle. Plast Reconstr Surg 113(3):872–876PubMedCrossRefGoogle Scholar
  35. MacQuillan A, Biarda FU, Grobbelaar A (2010) The incidence of anterior belly of digastric agenesis in patients with hemifacial microsomia. Plast Reconstr Surg 126(4):1285PubMedCrossRefGoogle Scholar
  36. Mavrikakis I (2008) Facial nerve palsy: anatomy, etiology, evaluation, and management. Orbit 27(6):466–474PubMedCrossRefGoogle Scholar
  37. May M, Harvey JE, Marovitz WF, Stroud M (1971) The prognostic accuracy of the maximal stimulation test compared with that of the nerve excitability test in Bell’s palsy. Laryngoscope 81(6):931–938PubMedCrossRefGoogle Scholar
  38. May M, Blumenthal F, Klein SR (1983) Acute Bell’s palsy: prognostic value of evoked electromyography, maximal stimulation, and other electrical tests. Am J Otol 5(1):1–7PubMedGoogle Scholar
  39. McCormick DP (1972) Herpes-simplex virus as a cause of Bell’s palsy. Lancet 1(7757):937–939PubMedCrossRefGoogle Scholar
  40. McGovern FH, Konigsmark BW, Sydnor JB (1972) An immunological concept for Bell’s palsy: experimental study. Laryngoscope 82(9):1594–1601PubMedCrossRefGoogle Scholar
  41. McLaughlin CR (1951) Epiphora in facial paralysis. Br J Plast Surg 3:87–95CrossRefGoogle Scholar
  42. McLaughlin CR (1952) Permanent facial paralysis; the role of surgical support. Lancet 2(6736):647PubMedCrossRefGoogle Scholar
  43. Misra A, Grover R, Withey S, Grobbelaar AO, Harrison DH (2000) Reducing postoperative morbidity after the insertion of gold weights to treat lagopthalmos. Ann Plast Surg 45:623–628PubMedCrossRefGoogle Scholar
  44. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N (1996) Bell’s palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med 124(1 pt 1):27–30PubMedGoogle Scholar
  45. O’Brien BM, Pederson WC, Khazanchi RK, Morrison WA, MacLeod AM, Kumar V (1990) Results of management of facial palsy with microvascular free-muscle transfer. Plast Reconstr Surg 86(1):12–22, discussion 23–24PubMedCrossRefGoogle Scholar
  46. Peitersen E (2002) Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol 122:4–30Google Scholar
  47. Piggot TA, Niazi ZBM, Hodgkinson PD (1995) New technique of levator lengthening for the retracted upper eyelid. Br J Plast Surg 48(3):127–131PubMedCrossRefGoogle Scholar
  48. Resende LAL, Weber S (2008) Peripheral facial palsy in the past: contributions from Avicenna, Nicolaus Friedreich and Charles Bell. Arq Neuropsiquiatr 66:765–769PubMedCrossRefGoogle Scholar
  49. Ross BG, Fradet G, Nedzelski JM (1996) Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg 114(3):380–386PubMedCrossRefGoogle Scholar
  50. Scaramella LF (1975) Anastomosis between the two facial nerves. Laryngoscope 85(8):1359–1366PubMedCrossRefGoogle Scholar
  51. Scevola S, Cowan J, Harrison DH (2003) Does the removal of pectoralis minor impair the function of pectoralis major? Plast Reconstr Surg 112(5):1266–1273PubMedCrossRefGoogle Scholar
  52. Schaitkin BM, May M, Klein SR (2000) Office evaluation of the patient with facial palsy: differential diagnosis and prognosis. In: May S (ed) The facial nerve, 2nd edn. Thieme, New YorkGoogle Scholar
  53. Smellie GD (1966) Restoration of the blinking reflex in facial palsy by a simple lid-load operation. Br J Plast Surg 19:279–283PubMedCrossRefGoogle Scholar
  54. Smith JD, Crumley RL, Harker LA (1981) Facial paralysis in the newborn. Otolaryngol Head Neck Surg 89:1021–1024PubMedGoogle Scholar
  55. Takushima A, Harii K, Asato H, Momosawa A (2005) Revisional operations improve results of neurovascular free muscle transfer for treatment of facial paralysis. Plast Reconstr Surg 116(2):371–380PubMedCrossRefGoogle Scholar
  56. Terzis JK, Kalantarian B (2000) Microsurgical strategies in 74 patients for restoration of dynamic depressor muscle mechanism: a neglected target in facial reanimation. Plast Reconstr Surg 105(6):1917–1931, discussion 1932–1934PubMedCrossRefGoogle Scholar
  57. Terzis JK, Karypidis D (2010) Blink restoration in adult facial paralysis. Plast Reconstr Surg 126(1):126–139PubMedCrossRefGoogle Scholar
  58. Terzis JK, Noah ME (1997) Analysis of 100 cases of free-muscle transplantation for facial paralysis. Plast Reconstr Surg 99(7):1905–1921PubMedCrossRefGoogle Scholar
  59. Terzis JK, Noah EM (2002) Möbius and möbius-like patients: etiology, diagnosis, and treatment options. Clin Plast Surg 29(4):497–514PubMedCrossRefGoogle Scholar
  60. Terzis JK, Noah EM (2003) Dynamic restoration in möbius and möbius-like patients. Plast Reconstr Surg 111(1):40–55PubMedCrossRefGoogle Scholar
  61. Terzis JK, Tzafetta K (2009) The “babysitter” procedure: minihypoglossal to facial nerve transfer and cross-facial nerve grafting. Plast Reconstr Surg 123(3):865–876PubMedCrossRefGoogle Scholar
  62. Tulley P, Webb A, Chana JS, Tan ST, Hudson D, Grobbelaar AO, Harrison DH (2000) Paralysis of the marginal mandibular branch of the facial nerve: treatment options. Br J Plast Surg 53(5):378–385PubMedCrossRefGoogle Scholar
  63. Ueda K, Harii K, Yamada A (1994) Long-term follow-up study of browlift for treatment of facial paralysis. Ann Plast Surg 32(2):166–170PubMedCrossRefGoogle Scholar
  64. Urso-Baiarda F, Grobbelaar AO (2009) A comparison of one-versus two-stage surgery in an experimental model of functional muscle transfer with interposed nerve grafting. J Plast Reconstr Aesthet Surg 62(8):1042–1047PubMedCrossRefGoogle Scholar
  65. Verzijl HT, van der Zwaag B, Cruysberg JR, Padberg GW (2003) Möbius syndrome redefined: a syndrome of rhombencephalic maldevelopment. Neurology 61(3):327–333PubMedCrossRefGoogle Scholar
  66. Woollard AC, Harrison DH, Grobbelaar AO (2010) An approach to bilateral facial paralysis. J Plast Reconstr Aesthet Surg 63:1557–1560PubMedCrossRefGoogle Scholar
  67. Zuker RM, Goldberg CS, Manktelow RT (2000) Facial animation in children with mobius syndrome after segmental gracilis muscle transplant. Plast Reconstr Surg 106(1):1–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Institute for Plastic Surgery Research and EducationRoyal Free HospitalLondonUK

Personalised recommendations