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European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 12, pp 3301–3308 | Cite as

Facial nerve repair: the impact of technical variations on the final outcome

  • María Sánchez-OcandoEmail author
  • Javier Gavilán
  • Julio Penarrocha
  • Teresa González-Otero
  • Susana Moraleda
  • José María Roda
  • Luis Lassaletta
Otology
  • 96 Downloads

Abstract

Objectives

To analyze the outcome of facial nerve (FN) reconstruction, the impact of technical variations in different conditions and locations, and the importance of additional techniques in case of suboptimal results.

Study design

Retrospective study.

Setting

University-based tertiary referral center.

Patients

Between 2001 and 2017, reconstruction of the FN was performed on 36 patients with varying underlying diseases.

Interventions

FN repair was performed by direct coaptation (n = 3) or graft interposition (n = 33). Microsurgical sutures were used in 17 patients (47%) and fibrin glue was used in all cases. Additional reinnervation techniques (hypoglossal–facial or masseter–facial transfers) were performed in five patients with poor results after initial reconstruction.

Main outcome measures

FN function was evaluated using the House–Brackmann (HB) and the electronic clinician-graded facial function (eFACE) grading systems. Minimum follow-up was 12 months.

Results

FN reconstruction yielded improvement in 83% of patients, 21 patients (58.3%) achieving a HB grade III. The eFACE median composite, static, dynamic and synkinesis scores were 69.1, 78, 53.2, and 88.2 respectively. A tendency towards better outcome with the use of sutures was found, the difference not being significant. All patients undergoing an additional reinnervation procedure achieved a HB grade III, eFACE score being 74.8.

Conclusions

FN reconstruction offers acceptable functional results in most cases. No significant differences are expected with technical variations, different locations or conditions. In patients with poor initial results, additional reinnervation techniques should be always considered. The eFACE adds substantial information to the most used HB scale.

Keywords

Facial nerve repair CPA tumors Nerve graft Suture anastomosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Malik TH, Kelly G, Ahmed A, Saeed SR, Ramsden R (2005) A comparison of surgical techniques used in dynamic reanimation of the paralyzed face. Otol Neurotol 26:284–291CrossRefGoogle Scholar
  2. 2.
    Gidley PW, Gantz BJ, Rubinstein JT (1999) Facial nerve grafts: from cerebellopontine angle and beyond. Am J Otol 20:781–788PubMedGoogle Scholar
  3. 3.
    Owusu J, Truong L, Kim J (2016) Facial nerve reconstruction with concurrent masseteric nerve transfer and cable grafting. JAMA Facial Plast Surg 18:335–339CrossRefGoogle Scholar
  4. 4.
    Celis-Aguilar E, Lassaletta L, Roda JM, Gavilán J (2013) End-to-side interposed donor grafting as a facial nerve reinforcement technique after vestibular schwannoma surgery. Ann Otol Rhinol Laryngol 122:520–523CrossRefGoogle Scholar
  5. 5.
    House J, Brackmann D (1983) Facial nerve grading systems. Laryngoscope 93:1056–1069CrossRefGoogle Scholar
  6. 6.
    Banks C, Jowett N, Beursken C et al (2017) Worldwide testing of the eFACE facial nerve clinician-graded scale. Plast Recontr Surg 139:491e–498eCrossRefGoogle Scholar
  7. 7.
    Seabra D, Bonnard D, Franco-Vidal V, Liguoro D, Darrouzet V (2015) Stitchless fibrin glue-aided facial nerve grafting after cerebellopontine angle schwannoma removal: technique and results in 15 cases. Otol Neurotol 36:498–502CrossRefGoogle Scholar
  8. 8.
    Prasad SC, Balasubramanian K, Piccirillo E et al (2018) Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases. J Neurosurg 128:631–638CrossRefGoogle Scholar
  9. 9.
    Arriaga MA, Usaf M, Brackmann DE (1992) Facial nerve repair technique in cerebellopontine angle tumor surgery. Am J Otol 13:356–359PubMedGoogle Scholar
  10. 10.
    Stephanian E, Sekhar LN, Janecka IP, Hirsch B (1992) Facial nerve repair by interposition nerve graft: results in 22 patients. Neurosurgery 31(1):73–76PubMedGoogle Scholar
  11. 11.
    Magliulo G, Terranova G, Sepe C, Cordeshi S, Cristofar P (1998) Petrous bone cholesteatoma and facial paralysis. Clin Otolaryngol Allied Sci 23:253–258CrossRefGoogle Scholar
  12. 12.
    Wang Z, Zhang Z, Huang Q, Yang J, Wu H (2013) Long-term facial nerve function following facial reanimation after translabyrinthine vestibular schwannoma surgery: a comparison between sural grafting and VII–XII anastomosis. Exp Ther Med 6:101–104CrossRefGoogle Scholar
  13. 13.
    Amar M, Wishahi H, Zakhary M (1996) Clinical and biochemical studies of bone destruction in cholesteatoma. J Laryngol Otol 110:534–539CrossRefGoogle Scholar
  14. 14.
    Sánchez-Burgos R, González-Otero T, Lassaletta L, Arias J, Navarro I, Burgueño M (2015) Facial nerve reconstruction following radical parotidectomy and subtotal petrosectomy for advance malignant parotid neoplasms. Ann Maxillofac Surg 5:203–207CrossRefGoogle Scholar
  15. 15.
    Bascom DA, Schaitkin BM, May M, Klein S (2000) Facial nerve repair: a retrospective review. Facial Plast Surg 16:309–313CrossRefGoogle Scholar
  16. 16.
    Bento RF, Miniti A (1989) Comparison between fibrin tissue adhesive epineural suture and natural union in intratemporal facial nerve of cats. Acta Otolaryngol 465:1–36CrossRefGoogle Scholar
  17. 17.
    Bento RF, Salomone R, Brito Neto R et al (2008) Partial lesions of the intratemporal segment of the facial nerve: graft versus partial reconstruction. Ann Otol Rhinol Laryngol 117:665–669CrossRefGoogle Scholar
  18. 18.
    Grayeli AB, Mosnier I, Julien N et al (2005) Long-term functional outcome in facial nerve graft by fibrin glue in the temporal bone and cerebellopontine angle. Eur Arch Otorhinolaryngol 262:404–447CrossRefGoogle Scholar
  19. 19.
    Yen T, Driscoll C, Lalwani A (2013) Significance of the House–Brackmann facial nerve grading global score in the setting of differential facial nerve function. Otol Neurotol 24:118–122CrossRefGoogle Scholar
  20. 20.
    Gaudin R, Robinson M, Banks C, Baiungo J, Jowett N, Hadlock T (2016) Emerging vs time-tested methods of facial grading among patients with facial paralysis. JAMA Facial Plast Surg 1(18):251–257CrossRefGoogle Scholar
  21. 21.
    Banks C, Bhama P, Park J, Hadlock C, Hadlock T (2015) Clinician-graded electronic facial paralysis assessment: the eFACE. Plast Reconstr Surg 136:223e–230eCrossRefGoogle Scholar
  22. 22.
    Phillips K, Heiser A, Gaudin R, Hadlock T, Jowett N (2017) Onset of Bell’s palsy in late pregnancy and early puerperium is associated with worse long-term outcomes. Laryngoscope 127:2854–2859CrossRefGoogle Scholar
  23. 23.
    Jowett N, Gaudin RA, Banks CA, Hadlock TA (2017) Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes. Laryngoscope 127:1451–1458CrossRefGoogle Scholar
  24. 24.
    Eaton D, Hirsch B, Mansour O (2007) Recovery of facial nerve function after repair of grafting: our experience with 24 patients. Am J Otol 28:37–41CrossRefGoogle Scholar
  25. 25.
    Volk G, Pantel M, Streppel M, Guntinas-Lichius O (2011) Reconstruction of complex peripheral facial nerve defects by a combined approach using facial nerve interpositional graft and hypoglossal-facial jump nerve suture. Laryngoscope 121:2402–2405CrossRefGoogle Scholar
  26. 26.
    Terzis J, Tzafetta K (2009) The, “babysitter” procedure: minihypoglossal to facial nerve transfer and cross-facial nerve grafting. Plast Reconstr Surg 123:865–876CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • María Sánchez-Ocando
    • 1
    Email author
  • Javier Gavilán
    • 1
  • Julio Penarrocha
    • 1
  • Teresa González-Otero
    • 2
  • Susana Moraleda
    • 3
  • José María Roda
    • 4
  • Luis Lassaletta
    • 1
    • 5
  1. 1.Department of OtorhinolaryngologyLa Paz University Hospital, IdiPAZ Research InstituteMadridSpain
  2. 2.Department of Oral and Maxillofacial SurgeryLa Paz University Hospital, IdiPAZ Research InstituteMadridSpain
  3. 3.Department of Physical Medicine and RehabilitationLa Paz University Hospital, IdiPAZ Research InstituteMadridSpain
  4. 4.Department of NeurosurgeryLa Paz University Hospital, IdiPAZ Research InstituteMadridSpain
  5. 5.Biomedical Research Networking Centre On Rare Diseases (CIBERER)Institute of Health Carlos IIIMadridSpain

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