1624 - Facial Nerve Paralysis Following Sinonasal Carcinoma: Rehabilitation and Reanimation Strategies

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

EA

Erik Anderson, DO

Resident Physician
HonorHealth PM&R Residency Program
Scottsdale, Arizona, United States

Co-Author(s)

NK

Nandita Keole, MD

Physiatrist, Cancer Rehabilitation Physician
Mayo Clinic Arizona
Scottsdale, Arizona, United States

Submitter(s)

EA

Erik Anderson, DO

HonorHealth PM&R Residency Program
San Ramon, California, United States

Case Diagnosis: Facial nerve paralysis following HPV-associated sinonasal carcinoma

Case Description: A 75-year-old male developed left facial paralysis in fall 2023 due to HPV-associated sinonasal carcinoma. He underwent tumor resection in June 2024 followed by adjuvant therapy. Impairments included oral incompetence affecting speech and nutrition, incomplete eye closure, and loss of expressive smile. EMG on June 28, 2024, revealed multiple cranial neuropathies with absent left facial motor responses. Rehabilitation emphasized swallowing therapy and facial retraining. By March 2025, deficits persisted in CN VII and XII with dysarthria and chewing difficulty, at which time physiatry was consulted. The p</span>atient was interested in a symmetric smile. Subsequent EMG showed progressive neuropathy. Given >2 years since nerve involvement and severe muscle atrophy, dynamic reanimation was not feasible.

Discussions: Malignancy-related facial paralysis poses unique challenges, including delayed diagnosis, poor recovery potential, and elevated recurrence risk. Static procedures can restore symmetry at rest, while dynamic options (nerve transfers, cross-facial grafts, free muscle transfers) aim to reestablish movement but fail in up to 26% of cancer-related cases and often require revision. Suitability depends on residual motor units, duration since onset, muscle viability, oncologic stability, and patient priorities. EMG provides objective confirmation of denervation, prognosis, and candidacy for surgical intervention. Clear prognostic counseling aligns treatment with functional and psychosocial needs.

Conclusions: Early physiatric input with EMG-informed prognosis supports individualized rehabilitation and surgical planning for reanimation procedures in malignancy-associated cranial neuropathies.