Outcomes of facial nerve reconstructive surgery

Czech version

Authors: J. Lazák ¹; J. Betka ¹; Z. Čada ²; M. Chovanec ³; J. Kraus ⁴; J. Plzák ¹; E. Zvěřina ¹; Z. Fík ¹
Authors‘ workplace: Klinika otorinolaryngologie, a chirurgie hlavy a krku, 1. LF UK, a FN Motol ¹; Klinika ušní, nosní a krční, 2. LF UK a FN Motol ²; Otorinolaryngologická klinika, 3. LF UK a FN Královské Vinohrady ³; Klinika dětské neurologie, 2. LF UK a FN Motol ⁴
Published in: Cesk Slov Neurol N 2022; 85(5): 382-388
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn2022382

Overview

Introduction: A facial nerve lesion causes serious health complications and leads to a general deterioration of the quality of life. A facial nerve lesion relatively often occurs as a complication of surgery of the parotid gland and skull base tumors. Non-surgical methods focus mainly on long-term rehabilitation of facial muscles and prevention of eye complications due to lagophthalmos. Surgical methods allow reconstruction of the facial nerve during its intracranial course, as well as after exiting the temporal bone. Methods: We retrospectively analyzed the results of facial nerve reconstruction techniques performed for a unilateral facial nerve lesion after 1 year and with an interval of at least 2 years after anastomosis. The etiology of paresis, interval between the onset of lesion and reconstructive surgery, length of follow-up and reconstruction technique were evaluated. Facial nerve function was assessed using the House-Brackmann classification. Results: The cohort contained a total of 73 patients; facial nerve function was assessed in 53 of them. Iatrogenic lesions due to vestibular schwannoma removal predominated. The primary reconstruction of the facial nerve prevailed over postponed operations. Direct anastomosis with an interposition of the autologous graft from the great auricular nerve followed by a sural nerve graft achieved the best functional results after 1 year. The best results with an interval of at least 2 years were achieved in direct end-to-end anastomoses without graft, in which the reconstruction did not fail in either case. In the case of an interposition of the autologous graft from the great auricular nerve, it has been shown that facial nerve function worsens with the length of the graft. This correlation was not observed in grafts from the sural nerve. No statistically significant difference was found between the resulting function of the facial nerve and the reconstruction technique, sex, age and interval between the onset of lasion and reconstruction. Conclusion: Reconstructive surgeries resulted in improved facial nerve function in 98 % of patients. 70% of patients with an interval of at least 2 years after the surgery achieved HB grade III.

Keywords:

Facial nerve – reconstruction – schwannoma – paresis – House-Brackmann – hypoglosso-facial anastomosis

Sources

1. Campero A, Socolovsky M. Facial reanimation by means of the hypoglossal nerve: anatomic comparison of different techniques. Neurosurgery 2007; 61 (3 Suppl): 41–49. doi: 10.1227/01.neu.0000289710.954 26.19.

2. Mifková A, Živicová V, Chovanec M et al. Osteomyelitis centrální části lební baze. Otorinolaryngol Foniatr 2018; 67 (1): 32–35.

3. Gezercan Y, Acik V, Arslan B et al. The efficiency of micro-vascular decompression versus micro-vascular decompression with partial sensory rhizotomy for classical trigeminal neuralgia – a retrospective analysis of 58 patients. Cesk Slov Neurol N 2020; 83/116 (5): 544–549. doi: 10.14735/amcsnn2020544.

4. Samii M, Alimohamadi M, Khouzani RK et al. Comparison of direct side-to-end and end-to-end hypoglossal-facial anastomosis for facial nerve repair. World Neurosurg 2015; 84 (2): 368–375. doi: 10.1016/j.wneu.2015.03.029.

5. Vachata P, Sameš M. Lícní nerv: anatomie, patologie, léčba. Praha: Mladá Fronta 2016.

6. Malik TH, Kelly G, Ahmed A et al. A comparison of surgical techniques used in dynamic reanimation of the paralyzed face. Otol Neurotol 2005; 26 (2): 284–291. doi: 10.1097/00129492-200503000-00028.

7. Dott NM. Facial nerve reconstruction by Graft bypassing the Petrous bone. Arch Otolaryngol 1963; 78: 426–428. doi: 10.1001/archotol.1963.00750020438003.

8. Darrouzet V, Dutkiewicz J, Chambrin A et al. Hypoglosso-facial anastomosis: results and technical development towards end-to-side anastomosis with rerouting of the intra-temporal facial nerve (modified May technique). Rev Laryngol Otol Rhinol (Bord) 1997; 118 (3): 203–210.

9. May M, Sobol SM, Mester SJ. Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy. Otolaryngol Head Neck Surg 1991; 104 (6): 818–825. doi: 10.1177/019459989110400609.

10. Fik Z, Kraus J, Cada Z et al. Hemihypoglossal-facial nerve anastomosis: results and electromyographic characterization. Eur Arch Otorhinolaryngol 2022; 279 (1): 467–479. doi: 10.1007/s00405-021-06893-4.

11. Scaramella LF. Anastomosis between the two facial nerves. Laryngoscope 1975; 85 (8): 1359–1366. doi: 10.1288/00005537-197508000-00012.

12. Gaber A, Taher MF, Wahed MA. Quantifying facial paralysis using the Kinect v2. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015: 2497–2501. doi: 10.1109/EMBC.2015. 7318899.

13. Hohman MH, Hadlock TA. Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center. Laryngoscope 2014; 124 (7): E283–E293. doi: 10.1002/lary.24542.

14. Fík Z, Chovanec M, Zvěřina Z et al. Funkce lícního nervu po mikrochirurgické léčbě vestibulárního schwannomu. Cesk Slov Neurol N 2017; 80/113 (5): 545–551. doi: 10.14735/amcsnn2017545.

15. Ozmen OA, Falcioni M, Lauda L et al. Outcomes of facial nerve grafting in 155 cases: predictive value of history and preoperative function. Otol Neurotol 2011; 32 (8): 1341–1346. doi: 10.1097/MAO.0b013e31822e9 52d.

16. Condie D, Tolkachjov SN. Facial nerve injury and repair: a practical review for cutaneous surgery. Dermatol Surg 2019; 45 (3): 340–357. doi: 10.1097/DSS.00000 00000001773.

17. Stephanian E, Sekhar LN, Janecka IP et al. Facial nerve repair by interposition nerve graft: results in 22 patients. Neurosurgery 1992; 31 (1): 73–76. doi: 10.1227/00006123-199207000-00010.

18. Dziedzic TA, Kunert P, Marchel A. Hemihypoglossal-facial nerve anastomosis for facial nerve reanimation: case series and technical note. World Neurosurg 2018; 118: e460–e467. doi: 10.1016/j.wneu.2018.06. 217.

19. Sanchez-Ocando M, Gavilan J, Penarrocha J et al. Facial nerve repair: the impact of technical variations on the final outcome. Eur Arch Otorhinolaryngol 2019; 276 (12): 3301–3308. doi: 10.1007/s00405-019-056 38-8.

20. Brown PD, Eshleman JS, Foote RL et al. An analysis of facial nerve function in irradiated and unirradiated facial nerve grafts. Int J Radiat Oncol Biol Phys 2000; 48 (3): 737–743. doi: 10.1016/s0360-3016 (00) 00721-5.

21. Guntinas-Lichius O, Streppel M, Stennert E. Postoperative functional evaluation of different reanimation techniques for facial nerve repair. Am J Surg 2006; 191 (1): 61–67. doi: 10.1016/j.amjsurg.2005.05.054.

22. Prasad SC, Balasubramanian K, Piccirillo E et al. Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases. J Neurosurg 2018; 128 (2): 631–638. doi: 10.3171/2016.9.JNS16997.

23. Wang Z, Zhang Z, Huang Q et al. 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 2013; 6 (1): 101–104. doi: 10.3892/etm.2013.1120.

24. Eaton DA, Hirsch BE, Mansour OI. Recovery of facial nerve function after repair or grafting: our experience with 24 patients. Am J Otolaryngol 2007; 28 (1): 37–41. doi: 10.1016/j.amjoto.2006.06.009.

25. Ramos DS, Bonnard D, Franco-Vidal V et al. Stitchless fibrin glue-aided facial nerve grafting after cerebellopontine angle schwannoma removal: technique and results in 15 cases. Otol Neurotol 2015; 36 (3): 498–502. doi: 10.1097/MAO.0000000000000408.

26. Arriaga MA, Brackmann DE. Facial nerve repair techniques in cerebellopontine angle tumor surgery. Am J Otol 1992; 13 (4): 356–359.

27. Bozorg Grayeli A, Mosnier I, Julien N et al. Long- -term functional outcome in facial nerve graft by fibrin glue in the temporal bone and cerebellopontine angle. Eur Arch Otorhinolaryngol 2005; 262 (5): 404–407. doi: 10.1007/s00405-004-0829-6.

28. Humphrey CD, Kriet JD. Nerve repair and cable grafting for facial paralysis. Facial Plast Surg 2008; 24 (2): 170–176. doi: 10.1055/s-2008-1075832.

29. Werner C, D’Antoni AV, Iwanaga J et al. A comprehensive review of the great auricular nerve graft. Neurosurg Rev 2021; 44 (4): 1987–1995. doi: 10.1007/s10143-020-01426-9.

30. Lee MC, Kim DH, Jeon YR et al. Functional outcomes of multiple sural nerve grafts for facial nerve defects after tumor-ablative surgery. Arch Plast Surg 2015; 42 (4): 461–468. doi: 10.5999/aps.2015.42.4.461.

31. Hayakawa N, Matsumine H, Fujii K et al. Facial nerve regeneration with bioabsorbable collagen conduits filled with collagen filaments: an experimental study. Regen Ther 2021; 18: 302–308. doi: 10.1016/j.reth.2021.08.006.

32. di Summa PG, Kingham PJ, Campisi CC et al. Collagen (NeuraGen®) nerve conduits and stem cells for peripheral nerve gap repair. Neurosci Lett 2014; 572: 26–31. doi: 10.1016/j.neulet.2014.04.029.

33. Mauch JT, Bae A, Shubinets V et al. A systematic review of sensory outcomes of digital nerve gap reconstruction with autograft, allograft, and conduit. Ann Plast Surg 2019; 82 (4S Suppl 3): S247–S255. doi: 10.1097/SAP.0000000000001851.

34. Dabiri S, Khorsandi Ashtiani M, Moharreri M et al. Results of end-to-side hypoglossal-facial nerve anastomosis in facial paralysis after skull base surgery. Iran J Otorhinolaryngol 2020; 32 (110): 133–138. doi: 10.22038/ijorl.2019.36294.2194.

35. Tomáš R, Klener J. Hemihypoglossofaciální anastomóza – tři kazuistiky. Cesk Slov Neurol N 2015; 78/111 (5): 585–590.

36. Husseman J, Mehta RP. Management of synkinesis. Facial Plast Surg 2008; 24 (2): 242–249. doi: 10.1055/s-2008-1075840.

37. Kan-Suen PU, Ching-Shan-Wong JS, Hoi-Ting So K. Acupuncture as part of iatrogenic facial nerve palsy rehabilitation-first report. World Neurosurg 2020; 140: e343–e347. doi: 10.1016/j.wneu.2020.05.079.

38. Sun ZH, Tian YP, Tan YF et al. Effectiveness of kinesio taping on peripheral facial paralysis: a protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99 (46): e23090. doi: 10.1097/MD.0000000 000023090.

39. Volk GF, Thielker J, Moller MC et al. Tolerability of facial electrostimulation in healthy adults and patients with facial synkinesis. Eur Arch Otorhinolaryngol 2020; 277 (4): 1247–1253. doi: 10.1007/s00405-020-05818-x.

40. Heydenrych I. The treatment of facial asymmetry with botulinum toxin: current concepts, guidelines, and future trends. Indian J Plast Surg 2020; 53 (2): 219–229. doi: 10.1055/s-0040-1715189.