Guidelines for Complications of Cancer Treatment Vol VIII Part B

The functional status of the facial muscles needs to be accessedwith EMG studies: Voluntary potentials – Facial nerve intact – Reanimationnot attempted unless facial function does not return for18 months. If, after 18 months, voluntary potentials arepresent, but no apparent facial function –”sub clinicalinnervation” – Transection and reinnervation surgery iswarranted. Nascent and polyphasic potentials – Seen during activephase of reinnervation – Reanimation surgerycontraindicated till end result is apparent. Fibrillation potentials – Denervated muscle –Reanimation procedure warranted. Electric silence – Muscles has undergone denervationatrophy – Nerve grafting or transfer futile – Muscletransfer indicated.Reanimation procedures: Depends on the presence of a viable proximal and distalnerve stumps. Proximal and distal branches available – Interpositiongrafts. Only distal branches available – cross facial nerve graftsor Hypoglossal- facial nerve anastomosis as describedearlier. Muscle transposition – When no significant facialmusculature exists for reinnervation.Static/cosmetic procedures: Done along with reanimation procedures while awaitingnerve regeneration. Patients unable or unwilling to undergo muscletransposition surgery.230