Facial Reanimation after Acoustic Neuroma Resection: Options and Timing of Intervention

Abstract

Facial paralysis following acoustic neuroma (AN) resection can be devastating, but timely and strategic intervention can minimize the resulting facial morbidity. A central strategy in reanimating the paralyzed face after AN resection is to restore function of the native facial muscles using available facial nerves or repurposed cranial nerves, mainly the hypoglossal or masseter nerves. The timing of reinnervation is the single most influential factor that determines outcomes in facial reanimation surgery. The rate of recovery of facial function in the first 6 months following AN resection may be used to predict ultimate facial function. Patients who show no signs of recovery in the first 6 months, even when their facial nerves are intact, recover poorly and are candidates for early facial reinnervation. With delay, facial muscles become irreversibly paralyzed. Reanimation in irreversible paralysis requires the transfer of functional muscle units such as the gracilis or the temporalis muscle tendon unit.

Keywords

facial paralysis - acoustic neuroma - vestibular schwannoma - reversible paralysis

• References

• 1 Sampath P, Holliday MJ, Brem H, Niparko JK, Long DM. Facial nerve injury in acoustic neuroma (vestibular schwannoma) surgery: etiology and prevention. J Neurosurg 1997; 87 (1) 60-66
• 2 Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve—preservation and restitution of function. Neurosurgery 1997; 40 (4) 684-694 , discussion 694–695
• 3 Wiegand DA, Fickel V. Acoustic neuroma—the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope 1989; 99 (2) 179-187
• 4 Ryzenman JM, Pensak ML, Tew Jr JM. Facial paralysis and surgical rehabilitation: a quality of life analysis in a cohort of 1,595 patients after acoustic neuroma surgery. Otol Neurotol 2005; 26 (3) 516-521 , discussion 521
• 5 Flickinger JC, Kondziolka D, Lunsford LD. Dose and diameter relationships for facial, trigeminal, and acoustic neuropathies following acoustic neuroma radiosurgery. Radiother Oncol 1996; 41 (3) 215-219
• 6 Limb CJ, Long DM, Niparko JK. Acoustic neuromas after failed radiation therapy: challenges of surgical salvage. Laryngoscope 2005; 115 (1) 93-98
• 7 Collar RM, Byrne PJ, Boahene KD. The subzygomatic triangle: rapid, minimally invasive identification of the masseteric nerve for facial reanimation. Plast Reconstr Surg 2013; 132 (1) 183-188
• 8 Rivas A, Boahene KD, Bravo HC, Tan M, Tamargo RJ, Francis HW. A model for early prediction of facial nerve recovery after vestibular schwannoma surgery. Otol Neurotol 2011; 32 (5) 826-833
• 9 Nakamura K, Murakami S, Kozawa T, Yanagihara N. Surgical treatment of synkinesis. Eur Arch Otorhinolaryngol 1994; xx: S380-S382
• 10 Hohman MH, Lee LN, Hadlock TA. Two-step highly selective neurectomy for refractory periocular synkinesis. Laryngoscope 2013; 123 (6) 1385-1388
• 11 Lieber RL, Steinman S, Barash IA, Chambers H. Structural and functional changes in spastic skeletal muscle. Muscle Nerve 2004; 29 (5) 615-627
• 12 Yamamoto Y, Sekido M, Furukawa H, Oyama A, Tsutsumida A, Sasaki S. Surgical rehabilitation of reversible facial palsy: facial—hypoglossal network system based on neural signal augmentation/neural supercharge concept. J Plast Reconstr Aesthet Surg 2007; 60 (3) 223-231
• 13 Klebuc M, Shenaq SM. Donor nerve selection in facial reanimation surgery. Semin Plast Surg 2004; 18 (1) 53-60