Facial Paralysis: A Comprehensive Rehabilitative Approach

Review by L Flood
Middlesborough, UK

I confess that I start most reviews of any textbook by just flicking through it and scanning the pictures. The quality of the images immediately impressed me here. Despite a multi-author input, these are consistently relevant, they have much novelty and they are reproduced to a very high standard. I keep going back to Fig 5.2 which shows a facial neuroma, before and after mastoid-approach excision. Nice photography here. There are many views of the nerve in various degrees of separation or grafting, in the parotid and, again, the clarity of the illustrations is remarkable.  For once, we are largely spared those black boxes over the eyes which can ruin such textbooks. Two pictures did alarm me at first. 11.6 is said to just illustrate the site of an intraoral incision to access the temporalis, but, at the tip of the retractor is something else I would want to biopsy urgently. I am sure my fears are groundless though.  Fig 9.1 portrays the attachment of the lateral canthal tendon in the orbit, but through a horrific extent of dissection and exposure. Reading the legend, it then dawned on me this was a cadaver dissection!

Right, I must then read the text more carefully! Every such book starts with the basic science, but even that shows novelty here. How many of us can associate the various facial reflexes with their respective brainstem pathways? Did you know that the facial nerve fibres occupy as much as 83% of the cross sectional area at the meatal foramen of the internal canal, but only 23% in the tympanic and 64% in the mastoid segments? The second chapter looks at various aetiologies, but gives a nice brief overview of electrophysiologic testing. Under complications of facial paralysis, we will all think about the cornea, but may overlook epiphora, nasal valve collapse and synkinesis.

Medical management cleverly concentrates more on non-surgical interventions eg eye protection, physiotherapy and treatment of depression than on polypharmacy of Bell’s palsy. The authors understandably remain on the fence for combination of antivirals with steroids. Nimodipine, a calcium channel blocker is new to me, but if evidence develops, who knows?

Now, the rest of the book is what makes for a unique piece of work. It is a surgical manual, covering every procedure imaginable, in restoration of the paralysed face. There are chapters on Nerve repair, on grafting, management of the upper and then lower eyelid, the lips, the nasal valve. A final (and really clever) additional chapter drifts off subject, into correction or avoidance of that soft tissue defect, the hollow so prevalent after parotidectomy. Fig 13.2 is described as showing “an acceptable” cosmetic result. Well, let’s say that the scar is just visible and most of us would be pleased with this outcome.

There are several books currently in print on facial palsy. This is particularly good at showing the role of the cosmetic and reconstructive surgeon in restoration of function, or at least, cosmesis. An inspiring book and an excellent read.

Amazon Link: Facial Paralysis: A Comprehensive Rehabilitative Approach
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