Vestibular Schwannoma Complicated by Facial Paralysis: Considerations of Techniques and Timing for Facial Reanimation

Purpose of Review To understand the risk factors for facial paralysis following vestibular schwannoma removal and determine the appropriate conditions for and timing of surgical intervention. Recent Findings Intraoperative facial nerve response to stimulation helps identify patients likely to have g...

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Bibliographic Details
Published in:Current otorhinolaryngology reports 2018-06, Vol.6 (2), p.182-188
Main Authors: Hatch, Jonathan, Oyer, Samuel L.
Format: Article
Language:English
Subjects:
Medicine
Medicine & Public Health
OTOLOGY: Facial Nerve Paralysis (P Byrne
Otorhinolaryngology
Section Editor
Topical Collection on OTOLOGY: Facial Nerve Paralysis
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Summary:Purpose of Review To understand the risk factors for facial paralysis following vestibular schwannoma removal and determine the appropriate conditions for and timing of surgical intervention. Recent Findings Intraoperative facial nerve response to stimulation helps identify patients likely to have good facial function ( 0.1 mA). Patients with severe postoperative paralysis (HB V–VI) who fail to improve in the first 7–10 months are unlikely to develop good long-term facial function and surgical intervention may be considered as early as 6–7 months. Hypoglossal nerve transfer improves facial tone and motion; techniques preserving part of the hypoglossal nerve are preferred. Masseter nerve transfer is supplanting the hypoglossal nerve at many centers due to quicker reinnervation, easier activation, and lower morbidity. Summary Facial reanimation with early nerve transfer should be considered for patients with severe paralysis failing to improve over the first 6 months following vestibular schwannoma removal.
ISSN:2167-583X
2167-583X
DOI:10.1007/s40136-018-0201-9