Guidelines for Complications of Cancer Treatment Vol VIII Part B

IV - Moderately severe dysfunction (obvious anddisfiguring asymmetry, significant synkinesis).V - Severe dysfunction (barely perceptible motion).VI - Total paralysis (no movement).ManagementFactors deciding management:Presence of a proximal healthy and viable nerve stumpAbility to identify and isolate distal nerve branchesTime elapsed since surgery.Functional status of facial muscles.Facial nerve rehabilitation:If facial nerve is structurally intact – Observe. Facial nerve regeneration after Walleriandegeneration may take months to. Post operatively corneal protection maybe necessary.Static procedures like tarsorraphy / gold weight implantsmaybe required at a later date to protect the cornea.After transection – Immediate repair gives bestresults.1. End to end anastomosis – In the presence of adequateproximal and distal stump a tension free anastomosiscan be achieved.The nerve endings are freshened, and sutures of 8-0 / 9-0 nylon are used, with 2 or 3 sutures applied to theepineurium.228