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Facial Plast Surg 2024; 40(04): 450-458
DOI: 10.1055/a-2318-6989
Original Article

Rethinking Oncologic Facial Nerve Reconstruction in the Acute Phase Through Classification of the Level of Injury

Jessica M. Winter 
1   Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
2   Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
,
Eleonora O.F. Dimovska
1   Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
2   Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
,
Chieh-Han John Tzou
3   Plastic and Reconstructive Surgery, Hospital of Divine Savior and Sigmund Freud University, Vienna, Austria
4   Faculty of Medicine, Sigmund Freud University of Vienna, Vienna, Austria
5   Facial Palsy Center, TZOU MEDICAL, Vienna, Austria
,
Andres Rodriguez-Lorenzo
1   Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
2   Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
› Author Affiliations Funding The study was generously funded by the Swedish Research Council for Clinical Research in Medicine (Avtal om Läkarutbildning och Forskning [ALF]).
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Abstract

Early facial nerve reconstruction should be offered in every patient with oncological resections of the facial nerve due to the debilitating functional and psychosocial consequences of facial nerve palsy. Oncologic pathology or oncologic resection accounts for the second most common cause of facial nerve palsy. In the case of these acute injuries, selecting an adequate method for reconstruction to optimize functional and psychosocial well-being is paramount. Authors advocate consideration of the level of injury as a framework for approaching the viable options of reconstruction systematically. Authors breakdown oncologic injuries to the facial nerve in three levels in relation to their nerve reconstruction methods and strategies: Level I (intracranial to intratemporal), Level II (intratemporal to extratemporal and intraparotid), and Level III (extratemporal and extraparotid). Clinical features, common clinical scenarios, donor nerves available, recipient nerve, and reconstruction priorities will be present at each level. Additionally, examples of clinical cases will be shared to illustrate the utility of framing acute facial nerve injuries within injury levels. Selecting donor nerves is critical in successful facial nerve reconstruction in oncological patients. Usually, a combination of facial and nonfacial donor nerves (hybrid) is necessary to achieve maximal reinnervation of the mimetic muscles. Our proposed classification of three levels of facial nerve injuries provides a selection guide, which prioritizes methods for function nerve reconstruction in relation of the injury level in oncologic patients while prioritizing functional outcomes.

Keywords

facial nerve classification - facial paralysis injury - nerve - reconstruction - surgical oncology


Publication History

Accepted Manuscript online:
03 May 2024

Article published online:
03 June 2024

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