Outcome of different facial nerve reconstruction techniques

• Published in: Brazilian journal of otorhinolaryngology 2016-11, Vol.82 (6), p.702-709
• Main Authors: Mohamed, Aboshanif, Omi, Eigo, Honda, Kohei, Suzuki, Shinsuke, Ishikawa, Kazuo
• Format: Article
• Language: English
• Subjects: Acoustic neuroma; Adolescent; Adult; Aged; Aged, 80 and over; Anastomose término-lateral; End-to-side anastomosis; Facial nerve; Facial Nerve - surgery; Facial Paralysis - surgery; Female; Humans; Hypoglossal nerve; Hypoglossal Nerve - surgery; Male; Middle Aged; Nerve reconstruction; Nervo facial; Nervo hipoglosso; Neuroma acústico; Original; OTORHINOLARYNGOLOGY; Reconstructive Surgical Procedures; Reconstrução de nervos; Recovery of Function; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Young Adult
• ISSN: 1808-8694; 1808-8686; 1808-8686
• DOI: 10.1016/j.bjorl.2015.12.010

There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique. Não existe uma técnica de reconstrução do nervo facial que garanta a recuperação da função facial até o grau III. Avaliar a eficácia e segurança de diferentes técnicas de reconstrução do nervo facial. Ao todo, 22 pacientes foram submetidos a reconstrução do nervo facial (enxerto com interposição do nervo facial em 11 pacientes e com transferência do nervo hipoglosso facial em 11 pacientes). Todos os pacientes apresentavam função facial de grau VI (de acordo com a classificação de House-Brackmann – HB) causada por trauma ou pela ressecção de um tumor. A reconstrução do nervo principal foi efetuada, exceto em sete pacientes, nos quais a reconstrução foi realizada entre duas semanas a quatro meses após a cirurgia inicial. O período de acompanhamento foi de, no mínimo, dois anos. Para a técnica de enxerto com i