A 32-year-old has complete irreversible facial palsy 18 months after vestibular-schwannoma surgery. There is no usable proximal facial-nerve stump and the target muscles show poor spontaneous movement. What is the central reconstructive principle?
Late facial paralysis requires an individual strategy; nerve transfer, cross-face grafting and free-muscle transfer have different indications and cannot be chosen solely from the cause of palsy.
A. Expect decompression to restore function after 18 months: There is no described reversible compression and prolonged denervation changes the options.
B. Use steroids as definitive treatment: They do not restore established denervated facial function.
C. Choose reanimation based on denervation duration, muscle viability and the patient’s priority for eye protection, symmetry and smile: Late facial paralysis requires an individual strategy; nerve transfer, cross-face grafting and free-muscle transfer have different indications and cannot be chosen solely from the cause of palsy.
D. Offer only static suspension without discussion: Static and dynamic options should be considered against the patient’s goals.
E. Promise a normal spontaneous smile with any nerve transfer: Reanimation requires realistic counselling about retraining and outcomes.
If denervation were recent and a viable proximal stump available, direct repair or nerve grafting may be preferable.
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