Surgery of the facial nerve is required in patients who have experienced acute disruption or transection of the nerve from an accident, facial nerve disorders, trauma, resection during extirpation of tumors, or inadvertent division during surgery. The most critical factor in achieving good postoperative facial function is early identification and repair done by a neurologist.The procedure can be performed as long as there is vital muscle left to rescue the paralysed part of the face. It should be noted that repaired nerve fibres recover at a rate of 1 mm/day, meaning an injury of 10 cm may take 3-4 months (or longer) until muscle function is restored. Improvement in function may be expected for a period of up to 2 years. Facial nerve reconstruction is done using two distinct methods, both of which are performed under general anesthesia due to the sensitive nature of nerve repair. The first method is direct repair, and entails the surgical attachment of the two severed ends of a nerve. This is only possible when the severed nerve section has not sustained a loss of neural tissue. For this procedure, a tiny incision may be made near the damage site, or possibly in the upper neck behind the ear. The two ends of the nerve are connected using microsurgery, and the incision closed, allowing the nerve cells to regenerate and become functional once more. A dressing may be applied to the area following the procedure, and a drain used if necessary to remove excess fluid buildup. Some swelling and facial nerve pain may occur in the first few days, and should diminish in a few weeks. Bruising is also possible, and should diminish in 5-10 days. The procedure may be done as an outpatient but may sometimes require hospitalizations of 1-3 days. Prescription or over-the-counter pain medication may be used as needed to manage any pain or discomfort.
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