Patients with chronic facial palsy first need an exact classification of the palsy etiology. A standardised clinical examination, if necessary MRI imaging and an electromyographic examination allow a determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy an individual surgical concept using three main categories is developed: a) early reconstruction of extratemporal reconstruction, b) early reconstruction of proximal lesions or impossibility of extratemporal reconstruction or c) late reconstruction or congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardised evaluation of the therapeutic result is recommended on the one hand to evaluate the necessity for adjuvant procedures and on the other hand as a tool of quality management and to develop new techniques in this field of relatively of infrequent surgery. Principally, controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies.
Georg Thieme Verlag KG Stuttgart, New York.