‘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 ‘tough vues | igrandavough stare,