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
