Management of the Facial Nerve in the Oncologic Setting

Purpose of Review: The purpose of this paper is to review the management of facial nerve paralysis in the oncologic setting. The head and neck cancer patient poses unique challenges due to their advanced age and need for radiation therapy. There is currently a paucity of data to guide surgical management of facial nerve injuries in this patient population. Recent Findings: Facial nerve grafting and facial nerve transfers are the mainstay of treatment for reconstruction of the facial nerve after tumor resection. The nerve to masseter and the partial hypoglossal nerve are important nerve transfers to consider in the immediate setting in the cancer population given the challenges with secondary nerve procedures due to surgical scarring and the delayed timing due to need for radiation. Other recent innovations include harnessing the power of chimeric flaps to provide soft tissue coverage and provide motor function with a muscle component or increase speed and strength of nerve regeneration with a vascularized nerve graft. The anterolateral thigh free flap (ALT) is already widely used to restore volume after parotid resections. The vastus lateralis muscle can be used as a functional muscle transfer, and the motor nerve to the vastus lateralis muscle can be harvested as a vascularized nerve graft along with the ALT flap. Other soft tissue and muscle combinations include the profunda artery perforator flap for soft tissue resurfacing and the gracilis muscle flap for dynamic reanimation. Summary: Immediate surgical intervention for reconstruction of the facial nerve is the key to optimizing outcomes in the head and neck cancer patient. Use of soft tissue free flaps for wound closure and volume replacement combined with vascularized nerve or functional muscle transfer holds promise for improving quality of life in patients with cancer that compromises facial nerve function.