‘Chaptor 75: Management of Soft Tissue Inju
Primary neual repair provides thebest chance forreuen
‘of facial nerve function. This can performed withthe oper
ating microscope using 8-0 10 10-0 monofilament nylon
suiure, Teosion-fee closure ofthe epineural layer should
be performed, although some authors recommend per
neural repair saving the potential advantage of reducing
‘ynldnesis and mass facial movement (34-36).
‘When a iension-free direct repair is not possible,
‘able (iniposition) grafing is advisable The vat of
‘great auricular sural, and medial antebrachial cutanzous
nerves offers the best option for achieving volitional facial
‘movement (37),
‘When facial nerve repair i not possible, facial eanima-
tion procedures can be performed ata later date
Complications
‘Complications inthe seting of facial nerve injury include
inability to repair the nerve injury facial nene paras,
synkinesis, ane) mass facial movement. Often unprevent
able, the sisk of complications can be reduced with early
recognition and management. Late complications indude
‘comeal injury fom inability to attain complete eye clesure
‘with associated dry eye and keratopathy In addition oral
incompetence, bow ptosis, and dysarthria may result
Auricle
‘ae ear typically protrudes from the head at an angle of
25 1030 degrees with 15 degrees of incline This prominent
postion opens the ear to frequent lacerations and shear
ing forces leading to avulsions. The external ear corssts
‘of the auricle and EAC. The skin is uighdly adherent over
the compliant cartilaginous fame af the ear comered
by perichondrium. The surface anatomy of the ear ofers
a complex topography making replication and reconsiruc
tion dificult (Fig 75.12). Even if early repair is insted
severe traumatic auricular injuries may require muliple
procedures for reconsiniction (38).
Evaluation
amination should star with inspection of the BAG as
lacerations at this ste can potentially lead to EAC scasing
and stenosis, The FAC should be cleaned of any debs ot
blood. Integrity ofthe tympanic membrane should becon-
firmed and hearing loss idendiied. Tuning fork examina
tion is an appropriate inal measure and an audiometric
lesting can be periormed if hearing loss i concern
Baamination of the postaurcular region for evidence
‘of mastoid tendemess or eecaymosis (Bates sign) con
mas) (42). Unrecognized hematoma can result in canlage
Joss, necrosis and formation of neocanilage and fibres
ving the ear a caullower ear deformiy, Ihis deformay
‘an be disfiguring and lificalt to manage: with repeic
requiring surgical excision of the neocariage and ibreis
Evacuate hoatoma an placa beta wih trough are
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