Recent Advances in Facial Palsy Management

Dear Colleagues,

Facial palsy is a debilitating symptom arising from a variety of etiologies. These range from Bell’s palsy and the Ramsay–Hunt syndrome to strokes and sometimes cancers. Since the time of Sir Charles Bell, we now have a greater understanding of nerve anatomy and physiology, which has improved our understanding of this condition. The advent of plastic surgery has further improved our ability to manage facial palsy, but this is one-dimensional as it only offers a treatment alternative for those with flaccid paralysis using static slings and muscle transfers.

Nevertheless, the explosion of knowledge in the 21st century in the fields of supermicrosurgery, nanotechnology, robotics, transplantation surgery and the coming cybernetic age have opened new vistas in facial palsy. A greater collaborative effort across multiple specialties and the inclusion of allied heath specialties, such as facial therapy and psychology, has also significantly contributed to better treatment paradigms. In this Special Issue, we explore the next set of challenges in the field of facial palsy. These are as follows:

(i) While early recovery after Bell’s palsy presents with no long-term sequelae, delayed recovery increases the risk of synkinesis and the development of non-flaccid facial paresis. How can we mitigate this with better medication and what are the prognosticators that we can use to identify late responders?

(ii) Do motor endplates completely degenerate beyond 18 to 24 months post-onset, and if not, what aspect of these specific organs can regenerate with the help of an external neural source?

(iii) Motor endplate innervation (MEPI) is the key to understanding the way that facial mimetic muscles work. More detailed anatomical studies are necessary to look at innervation patterns within these muscles.

(iv) Is there a role for the use of regenerative peripheral nerve interfaces (RPNIs) or direct muscle neurotization in augmenting the motor endplates within facial muscles?

(v) What is the future for facial reanimation surgery: transplantation or cybernetics? Do these have implications in parallel components of facial functions such as eye transplantations?

In this Special Issue, we look at the exciting prospects in the field of facial surgery. Thank you.

Dr. Ruben Yap Kannan
Guest Editor

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• facial palsy
• transplantation
• facial cybernetics
• facial therapy
• nerve supermicrosurgery