Surgical rehabilitation of facial paralysis in the head and neck patient

This thesis explores comprehensive surgical rehabilitation of facial paralysis in the head and neck oncology and reconstructive population, integrating health economic, diagnostic, and technical innovations across the patient journey. It begins by defining the societal perception of the burden of facial palsy, quantifying health utility loss associated with varying patterns of paralysis, and demonstrating the substantial quality of life gains achievable with successful facial reanimation. These data establish a bench mark for future cost-effectiveness studies into facial paralysis, facial palsy and facial reanimation. Building on this foundation, the thesis addresses early guideline-driven management of acute facial nerve palsy, clarifying indications for imaging, medical therapy, and referral to specialist centers to reduce avoidable delays, misdiagnosis, and optimise candidates for later reconstructive surgery. The thesis introduces and evaluates novel approaches to midface and smile reconstruction in the context of head and neck surgery. The thesis evaluates a minimal nasolabial incision technique for modifying the nasolabial fold and achieving static facial suspension in patients with flaccid paralysis. This is a versatile option to restore static midface resting symmetry with improvements in quality of life. Free gracilis muscle transfer following advanced parotid malignancy resection is analysed as a complex reanimation strategy, demonstrating that meaningful smile restoration are achievable even in heavily treated, irradiated fields. A buccal space approach to midface free flap reconstruction is described, facilitating improved vessel identification in the buccal space. This enables reduced pedicle length requirements, while minimising visible scarring for midface free flap reconstruction. The work then focuses on risk factors for lower eyelid malposition, focusing on lower eyelid position, tone, and dynamic function. A review and stepwise approach to the management of chemosis, a frequent complication of lower eyelid surgery or lower eyelid malposition. Collectively, this body of work positions surgical rehabilitation of facial paralysis in the head and neck patient as a multidisciplinary, outcomes driven enterprise that spans acute management, precise regional assessment, and tailored combinations of static and dynamic reconstruction to enhance quality of life.