Question: A 72 year old male is involved in an automobile accident. He was an unrestrained passenger in the back seat and struck his head on the side window, resulting in a 4 cm laceration of the right cheek just in front of the ear. The resident evaluating him in the emergency department notes that he is unable to elevate the upper lip and nasal ala on the affected side. You suspect that facial nerve branches in this area are injured—how should they be managed?

a) Primary closure, followed by re-exploration and neurorraphy in 2 weeks

b) Immediate operative exploration with neurorraphy of all involved branches

c) Immediate operative exploration without neurorraphy as the branches injured will be too small to save

d) Neurorraphy of masseteric branch of V3 to lower division of VII

[Answer will be posted with next week's new question]

Answer to last week's question, “Plan B” (August 24, 2020)

D - Malleovestibulopexy.