Outcomes of facial nerve reconstructive surgery

Česká verzia

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 place of work: 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 the journal: Cesk Slov Neurol N 2022; 85(5): 382-388
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn2022382

Summary

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

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