What are the recommended initial management steps for a patient with a laceration involving the facial nerve?

Initial management steps for a patient with a facial nerve laceration include:

• Perform a thorough assessment of the peripheral nerve function to identify the involved nerve and the extent of functional deficit, including sensory and motor evaluation.
• Document neurovascular status carefully, noting sensibility and motor function using standard grading systems, and repeat assessments with time stamps.
• Consider early surgical consultation to determine if prompt surgical intervention is necessary.
• Start rehabilitation therapy early to maintain range of movement and regain function; this may include splinting, passive and active exercises, pain management, and sensory interventions.
• Regularly monitor for signs of nerve recovery and adjust therapy accordingly.
• If no signs of recovery are evident by 6 weeks or recovery is not as expected, consider nerve conduction studies or specialist referral to guide prognosis and further management.
• Be aware of the risk of tissue viability issues due to sensory or motor loss and manage accordingly.
• Consider psychological support due to the potential long-term impact on body image and mood, ensuring access to multidisciplinary rehabilitation services including psychological expertise.

These steps align with general principles for managing peripheral nerve injuries after trauma and emphasize early assessment, documentation, rehabilitation, and multidisciplinary care.

References: NICE NG211