Microsurgical Repair of the Facial Nerve

Abstract

Objective: To report a series of 18 patients who underwent microsurgical repair of the facial nerve using different techniques and to discuss the indications and results of facial reinnervation procedures. Methods: Eighteen patients with post-surgical facial palsy underwent facial reinnervation using different techniques.’These included classic hypoglossal-facial anastomosis in 13 cases, one-stage hemihypoglossal-intratemporal facial nerve anastomosis and translabyrinthine removal of residual intracanalar acoustic schwannoma in 3, hemihypoglossal-facial nerve anastomosis in one, and neurotization of facial muscles through a nerve graft in one. Results: The facial muscle function improved in all patients, up to grade III in 7 cases (39 %), grade IV in 9 (50 %) and grade V in 2 (11 %). The tongue atrophy was minimal in 70.5 %, moderate in 17.5 % and severe in 12 %. The outcome was better in younger patients (less than 40 years of age) and in those with a lesser grade of preoperative facial impairment. Conclusions: The classic hypoglossal-facial anastomosis is the technique of choice in most cases. The use of the intratemporal facial nerve is indicated when removal of an intracanalar residual schwannoma must also be performed. The neurotization of the facial muscles through a nerve graft may be used when there is no distal trunk of the facial nerve avaible for the anastomosis.

Zusammenfassung

Ziel: Es wird über eine Serie von 18 Patienten mit mikrochirurgischer Rekonstruktion des Fazialisnerven mit verschiedenen Techniken berichtet. Die Indikationen und Ergebnisse der Reinervationsprozeduren werden dargestellt. Methoden: 18 Patienten mit postoperativer Fazialislähmung wurden mit verschiedenen Techniken einer Fazialis-Reinervationsprozedur zugeführt. Diese schlossen ein die klassische hypoglosso-faziale Anastomose in 13 Fällen, die einseitige hemihypoglossale-intratemporale Fazialisnerv-Anastomose mit translabyrinthärer Entfernung von residualen intrakanalikulären Akustikusneurinomen in 3 Fällen, die hemihypoglosso-faziale Nervenanastomose in 1 Fall und die Reinervierung von Gesichtsmuskeln durch ein Nerventransplantat in einem weiteren Fall. Resultate: Die Gesichtsmuskelfunktion verbesserte sich bei allen Patienten, auf Grad III in 7 Fällen (39 %), auf Grad IV in 9 Fällen (50 %) und auf Grad V in 2 Fällen (11 %). Die Muskelatrophie war minimal in 70,5 %, mittelgradig in 17,5 % und schwer in 12 % der Fälle. Das Ergebnis war bei jungen Patienten unter 40 Jahren besser, ebenso bei jenen mit einem geringeren präoperativen Schweregrad des Fazialisausfalls. Schlussfolgerungen: Die klassische hypoglosso-faziale Anastomose ist die Technik der Wahl in den meisten Fällen. Der Einsatz des intratemporalen Fazialisnerven ist dann indiziert, wenn gleichzeitig die Entfernung von intrakanalikulärem Restschwannom durchgeführt werden muss. Die Reinervierung der Gesichtsmuskulatur durch ein Nerventransplantat kann dann benutzt werden, wenn kein distaler Nervenstamm für die Anastomose zur Verfügung steht.

Key words

Hypoglossal-facial anastomosis - facial palsy - acoustic schwannoma - facial nerve

Schlüsselwörter

Hypoglosso-faziale Anastomose - Fazialisparese - Akustikusneurinom - Nervus facialis

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