Facial Nerve Injury

This chapter focuses on the clinical and surgical management of facial nerve palsy that occurs as a consequence of injury during resection of a vestibular schwannoma. If the facial nerve is damaged during cerebellopontine angle (CPA) tumor resection, a first attempt to repair it at the skull base should be made. Because this is commonly infeasible, a nerve transfer—scheduled as an elective procedure after the patient has completely recovered from the resection procedure—is mandatory. Hemihypoglossal, masseter, and cross-facial nerve transfers are the techniques most widely used. The authors’ preferred technique is hemihypoglossal nerve transfer, and the surgical technique is described. By contrast, when the facial nerve is preserved during surgery, but complete facial palsy develops afterward, postoperative rehabilitation should be started and continued for up to 1 year. If, however, facial palsy persists beyond 1 year, then the patient should be offered the option of a nerve transfer.