59 yo, 6 mo s/p R lateral temporal bone resection / parotidectomy / neck dissection for invasive SCCA of the ear canal, followed by chemo / RT.

Chorda tympani was noted to be grossly involved by the tumor and resected. The facial nerve was decompressed – patient experienced post operative weakness (see photo) which evolved into paralysis at 4 weeks.

There has been no clinical recovery to date (6 months post op). Surveillance imaging for cancer was negative at ~ 6 months. EMG at 6 mo showed no evidence of reinnervation (attached).

Please comment on optimal management in this patient given the above. THANKS