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Xu YD, Yang HD, Zheng YQ, Chen SJ, Ji SF. Malformation of the external ear and facial paralysis caused by megatemperature hydro-aluminum. Acta Otolaryngol 2009; 129:580-4. [PMID: 18720076 DOI: 10.1080/00016480802311023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present a case of right lateral auricle contracture malformation, auricular canal atresia, and complete facial paralysis (House-Brackmann grade VI) caused by a megatemperature hydro-aluminum injury at work. The diastrophic auricle and auricular canal atresia were reshaped. The complete facial paralysis was reanimated to House-Brackmann grade III after surgical hypoglossal-facial end-to-end anastomosis. These outcomes indicate that hypoglossal-facial end-to-end anastomosis is an effective surgical option for successful reanimation of complete facial paralysis.
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Tos P, Artiaco S, Papalia I, Marcoccio I, Geuna S, Battiston B. Chapter 14 End‐to‐Side Nerve Regeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:281-94. [DOI: 10.1016/s0074-7742(09)87014-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Siemionow M, Brzezicki G. Chapter 8: Current techniques and concepts in peripheral nerve repair. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:141-72. [PMID: 19682637 DOI: 10.1016/s0074-7742(09)87008-6] [Citation(s) in RCA: 277] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite the progress in understanding the pathophysiology of peripheral nervous system injury and regeneration, as well as advancements in microsurgical techniques, peripheral nerve injuries are still a major challenge for reconstructive surgeons. Thorough knowledge of anatomy, pathophysiology, and surgical reconstruction is a prerequisite of proper peripheral nerve injury management. This chapter reviews the currently available surgical treatment options for different types of nerve injuries in clinical conditions. In overview of direct nerve repair, various end-to-end coaptation techniques and the role of end-to-side repair for proximal nerve injuries is described. When primary repair cannot be performed without undue tension, nerve grafting or tubulization techniques are required. Current gold standard for bridging nerve gaps is nerve autografting. However, disadvantages of this approach, such as donor site morbidity and limited length of available graft material encouraged the search for alternative means of nerve gap reconstruction. Nerve allografting was introduced for repair of extensive nerve injuries. Tubulization techniques with natural or artificial conduits are applicable as an alternative for bridging short nerve defects without the morbidities associated with harvesting of autologous nerve grafts. Achieving better outcomes depends both on the advancements in microsurgical techniques and introduction of molecular biology discoveries into clinical practice. The field of peripheral nerve research is dynamically developing and concentrates on more sophisticated approaches tested at the basic science level. Future directions in peripheral nerve reconstruction including, tolerance induction and minimal immunosuppression for nerve allografting, cell based supportive therapies and bioengineering of nerve conduits are also reviewed in this chapter.
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Affiliation(s)
- Maria Siemionow
- Cleveland Clinic, Department of Plastic Surgery, Cleveland, Ohio 44195, USA
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van de Graaf RC, IJpma FF, Nicolai JPA. Facial Reanimation by Means of the Hypoglossal Nerve. Neurosurgery 2008; 63:E820. [DOI: 10.1227/01.neu.0000325686.45344.d7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Reflections on the development of facial nerve crossover anastomosis. Acta Neurochir (Wien) 2008; 150:739-40. [PMID: 18597056 DOI: 10.1007/s00701-008-1613-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Large intraparotid facial nerve schwannoma: Case report and Review of the Literature. Int J Oral Maxillofac Surg 2008; 37:679-81. [DOI: 10.1016/j.ijom.2008.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 11/12/2007] [Accepted: 01/31/2008] [Indexed: 11/23/2022]
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Tubbs RS, Shaffer WA, Loukas M, Shoja MM, Oakes WJ. The long thoracic nerve as a donor for facial nerve reanimation procedures: cadaveric feasibility study. J Neurosurg 2008; 108:1225-9. [PMID: 18518732 DOI: 10.3171/jns/2008/108/6/1225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Injury of the facial nerve with resultant facial muscle paralysis may result in other significant complications such as corneal ulceration. To the authors' knowledge, neurotization to the facial nerve using the long thoracic nerve (LTN), a nerve used previously for neurotization to other branches of the brachial plexus, has not been explored previously.
Methods
In an attempt to identify an additional nerve donor candidate for facial nerve neurotization, 8 adult human cadavers (16 sides) underwent dissection of the LTN, which was passed deep to the clavicle and axillary neurovascular bundle. The facial nerve was localized from the stylomastoid foramen onto the face, and the distal cut end of the previously dissected LTN was tunneled to this location. Measurements were made of the length and diameter of the LTN. Long thoracic nerve innervation to the first and second digitations of the serratus anterior was maintained on all sides.
Results
All specimens were found to have an LTN with more than enough length to be tunneled superiorly, tension-free to the extracranial facial nerve. Connections remained tensionless with left and right head rotation of up to 45°. The mean length of this part of the LTN was 18 cm with a range of 15–22 cm. The overall mean diameter of this nerve was 2.5 mm. No evidence of injury to the surrounding neurovascular structures was identified on gross examination.
Conclusions
To the authors' knowledge, the LTN has not been previously examined as a donor nerve for facial nerve reanimation procedures. Based on the results of this cadaveric study, the use of the LTN may be considered for such surgical maneuvers.
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Affiliation(s)
- R. Shane Tubbs
- 1Section of Pediatric Neurosurgery, Children's Hospital, Birmingham
- 2Department of Cell Biology, University of Alabama at Birmingham
| | | | - Marios Loukas
- 4Department of Anatomical Sciences, St. George's University, Grenada
- 5Department of Education and Development, Harvard Medical School, Boston, Massachusetts; and
| | - Mohammadali M. Shoja
- 6Tuberculosis and Lung Diseases Research Center, Tabriz Medical University, Tabriz, Iran
| | - W. Jerry Oakes
- 1Section of Pediatric Neurosurgery, Children's Hospital, Birmingham
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Lassaletta L, González T, Casas P, María Roda J, Moraleda S, Gavilán J. Anastomosis hipoglosofacial intratemporal hemiterminoterminal. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73279-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Guntinas-Lichius O, Hundeshagen G, Paling T, Angelov DN. Impact of different types of facial nerve reconstruction on the recovery of motor function: an experimental study in adult rats. Neurosurgery 2008; 61:1276-83; discussion 1283-5. [PMID: 18162908 DOI: 10.1227/01.neu.0000306107.70421.a4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Poor functional recovery after facial nerve reconstruction is characterized by mass movements and synkinesis. Major reasons are axonal sprouting from the regenerating axons leading to misdirected reinnervation and hyperinnervation as well as polyinnervation of the mimic muscle end plates. We analyzed whether or not the type of nerve reconstruction influenced these pathological phenomena. METHODS The experiments were performed on 48 adult rats divided into four groups. One group served as an intact control and the experimental groups were subjected to facial-facial nerve repair (FFN), facial nerve interpositional grafting, and hypoglossal-facial nerve repair (HFN), with 12 subjects in each group. Two months later, functional recovery was measured by biometrical motion analysis of whisking. Retrograde fluorescence labeling of the brainstem motoneurons was used to quantify the degree of collateral axonal branching at the lesion site. Fluorescence histochemistry of sections through the levator labii superioris muscle was performed to quantify the degree of polyinnervation after surgery. RESULTS The type of nerve reconstruction significantly influenced the regeneration. The whisking amplitude did not recover completely regardless of the type of reconstruction. The angular velocity and angular acceleration of the vibrissal hairs showed a full recovery after facial nerve interpositional grafting and HFN, whereas these parameters remained decreased after FFN. Significantly less collateral branching and polyinnervation of the end plates were determined after grafting and HFN than after FFN. CONCLUSION No type of immediate facial nerve reconstruction results in a full recovery in the rat. However, the morphological and functional recovery was significantly better after grafting and HFN than after FFN.
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Tubbs RS, Louis RG, Wartmann CT, Loukas M, Shoja MM, Ardalan MR, Oakes WJ. Suprascapular nerve as a donor for extracranial facial nerve reanimation procedures: a cadaveric feasibility study. J Neurosurg 2008; 108:145-8. [PMID: 18173324 DOI: 10.3171/jns/2008/108/01/0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Facial nerve injury with resultant facial muscle paralysis is disfiguring and disabling. To the authors' knowledge, neurotization of the facial nerve using a branch of the brachial plexus has not been previously performed. METHODS In an attempt to identify an additional nerve donor candidate for facial nerve neurotization, 5 fresh adult human cadavers (10 sides) underwent dissection of the suprascapular nerve distal to the suprascapular notch where it was transected. The facial nerve was localized from the stylomastoid foramen onto the face, and the cut end of the suprascapular nerve was tunneled to this location. Measurements were made of the length and diameter of the supra-scapular nerve. In 2 of these specimens prior to transection of the nerve, a nerve-splitting technique was used. RESULTS All specimens were found to have a suprascapular nerve with enough length to be tunneled, tension free, superiorly to the extracranial facial nerve. Connections remained tensionless with left and right head rotation of up to 45 degrees . The mean length of this part of the suprascapular nerve was 12.5 cm (range 11.5-14 cm). The mean diameter of this nerve was 3 mm. A nerve-splitting technique was also easily performed. No gross evidence of injury to surrounding neurovascular structures was identified. CONCLUSIONS To the authors' knowledge, the suprascapular nerve has not been previously explored as a donor nerve for facial nerve reanimation procedures. Based on the results of this cadaveric study, the authors believe that use of the suprascapular nerve may be considered for surgical maneuvers.
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Affiliation(s)
- R Shane Tubbs
- Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
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Lassaletta L, González T, Casas P, María Roda J, Moraleda S, Gavilán J. Hemi-Hypoglossal-Facial Intratemporal Side to Side Anastomosis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Flores LP. Surgical results of the Hypoglossal-Facial nerve Jump Graft technique. Acta Neurochir (Wien) 2007; 149:1205-10; discussion 1210. [PMID: 17978883 DOI: 10.1007/s00701-007-1412-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 04/24/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Hypoglossal-Facial nerve crossover has appeared as a surgical option for those scenarios where the facial nerve is injured in its intracranial course, but the conventional technique unequivocally leads to twelfth cranial nerve deficit. In recent years a number of different surgical approaches have been introduced with a view to avoiding the complete section of the hypoglossal nerve, such as the Jump Graft technique. This paper aims to present the results of the Hypoglossal-Facial nerve Jump Graft technique in relation to facial musculature reanimation capability and hemitongue function preservation. METHODS A retrospective analysis of the records of eight patients submitted to Hypoglossal-Facial nerve Jump Graft technique was performed. The surgical approach was characterised by the interposition of a short graft sutured to the distal stump of the transected facial nerve and sutured end-to-side to the hypoglossi, with cutting of only a third of the diameter of the latter. FINDINGS The facial nerve injuries were secondary to temporal bone trauma in five cases and to cerebellopontine angle tumour surgery in three. Grafts were harvested from the greater auricular nerve in six patients and from the sural nerve in two. The results of facial reanimation demonstrated facial symmetry and improvement in the facial tone in all cases, and classified as House-Brackmann grade IV in three (37.5%) and grade III in five (62.5%) patients. There was no incidence of definitive hemitongue atrophy and no patient complaint of swallowing or speech difficulty. CONCLUSIONS The modification of the conventional technique of Hypoglossal-Facial nerve anastomosis by means of sectioning one third of the hypoglossal nerve area does not lead to dysfunction of this nerve and the surgical results in terms of facial reanimation are satisfactory.
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Affiliation(s)
- L P Flores
- Unit of Neurosurgery, Hospital de Base do Distrito Federal Brasília, Distrito Federal, Brazil.
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63
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Campero A, Socolovsky M. Facial reanimation by means of the hypoglossal nerve: anatomic comparison of different techniques. Neurosurgery 2007; 61:41-9; discussion 49-50. [PMID: 17876232 DOI: 10.1227/01.neu.0000289710.95426.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The goal of this study was to determine the various anatomical and surgical relationships between the facial and hypoglossal nerves to define the required length of each for a nerve transfer, either by means of a classical hypoglossal-facial nerve anastomosis or combined with any of its variants developed to reduce tongue morbidities. METHODS Five adult cadaver heads were bilaterally dissected in the parotid and submaxillary regions. Two clinical cases are described for illustration. RESULTS The prebifurcation extracranial facial nerve is found 4.82 +/- 0.88 mm from the external auditory meatus, 5.31 +/- 1.50 mm from the mastoid tip, 15.65 +/- 0.85 mm from the lateral end of C1, 17.19 +/- 1.64 mm from the border of the mandible condyle, and 4.86 +/- 1.29 mm from the digastric muscle. The average lengths of the mastoid segment of the facial nerve and the prebifurcation extracranial facial nerve are 16.35 +/- 1.21 mm and 18.93 +/- 1.41 mm, respectively. The average distance from the bifurcation of the facial nerve to the hypoglossal nerve turn is 31.56 +/- 2.53 mm. For a direct hypoglossal-facial nerve anastomosis, a length of approximately 19 mm of the hypoglossal nerve is required. For the interposition nerve graft technique, a 35 mm-long graft is required. For the technique using a longitudinally dissected hypoglossal nerve, an average length of 31.56 mm is required. Exposure of the facial nerve within the mastoid process drilling technique requires 16.35 mm of drilling. CONCLUSION This study attempts to establish the exact graft, dissection within the hypoglossal nerve, and mastoid drilling requirements for hypoglossal to facial nerve transfer.
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Affiliation(s)
- Alvaro Campero
- Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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Guntinas-Lichius O, Hundeshagen G, Paling T, Streppel M, Grosheva M, Irintchev A, Skouras E, Alvanou A, Angelova SK, Kuerten S, Sinis N, Dunlop SA, Angelov DN. Manual stimulation of facial muscles improves functional recovery after hypoglossal–facial anastomosis and interpositional nerve grafting of the facial nerve in adult rats. Neurobiol Dis 2007; 28:101-12. [PMID: 17698365 DOI: 10.1016/j.nbd.2007.07.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 06/19/2007] [Accepted: 07/01/2007] [Indexed: 11/24/2022] Open
Abstract
The facial nerve in humans is often prone to injuries requiring surgical intervention. In the best case, nerve reconstruction is achieved by a facial-facial anastomosis (FFA), i.e. suture of the proximal and distal stumps of the severed facial nerve. Although a method of choice, FFA rarely leads to a satisfactory functional recovery. We have recently devised and validated, in an established experimental paradigm in rats, a novel strategy to improve the outcome of FFA by daily manual stimulation (MS) of facial muscles. This treatment results in full recovery of facial movements (whisking) and is achieved by reducing the proportion of functionally detrimental poly-innervated motor end-plates. Here we asked whether MS could also be beneficial after two other commonly used surgical methods of clinical facial nerve reconstruction namely hypoglossal-facial anastomosis (HFA) and interpositional nerve grafting (IPNG) which, however, seem to have a poorer outcome compared to FFA. Compared to FFA, daily MS for 2 months after HFA and IPGN did not completely restore function but, nevertheless, significantly improved the amplitude of whisker movements by 50% compared with untreated animals. Functional improvement was associated with a reduction in the proportion of polyinnervated end-plates. MS did not reduce the extent of axonal branching at the lesion site nor the subsequent misdirected axonal regrowth to inappropriate targets. Our data show that a simple approach leading to improved quality of muscle fiber reinnervation is functionally beneficial after different types of clinically relevant surgical interventions.
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Abstract
Patients with permanent facial palsies cannot hide their conditions. As a consequence, these patients suffer from massive psychological stress. To achieve satisfactory reconstruction of mimic function, experience with a variety of surgical techniques and adjuvant nonsurgical treatments is necessary. This report provides information on the present repertoire of surgical and conservative options, emphasizing their fields of indications, limitations, and possible combinations.
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Affiliation(s)
- O Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenkranke, Friedrich-Schiller-Universität Jena.
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66
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Fernandez E, Doglietto F, Ciampini A, Lauretti L. Hypoglossal-facial anastomosis. J Neurosurg 2007; 107:244-5; author reply 245-6. [PMID: 17639903 DOI: 10.3171/jns-07/07/0244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this paper was to report on further experience with a new technique for reanimation of the facial nerve. This procedure allows a straight end-to-side hypoglossal–facial anastomosis without interruption of the 12th cranial nerve or the need for graft interposition. It is technically demanding and time consuming but offers an effective, reliable, and extraordinarily quick means of reinnervating the facial muscles, including the orbicularis oculi muscle, thus avoiding the need for a gold weight in the eyelid or a fascial sling.
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Abstract
An intraparotid facial nerve schwannoma is often not recognised in pre-treatment work-up and frequently results in subsequent significant postoperative morbidity. We have evaluated the literature regarding pre-treatment work-up and facial nerve function outcome. Two of our own cases are presented. A minority of the intraparotid schwannomas can be removed by resection while preserving facial nerve integrity and function. In the event of preoperative facial nerve dysfunction, tumour resection and subsequent nerve repair should be considered. If resection of an intraparotid facial nerve schwannoma cannot be performed with preservation of facial nerve integrity and function, a wait-and-see policy seems justified due to the indolent behaviour of the tumour and moderate results of facial nerve reconstruction.
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Affiliation(s)
- A Kreeft
- Department of Otolaryngology/Head and Neck Surgery, University Hospital, Utrecht, The Netherlands
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Surgical rehabilitation of reversible facial palsy: Facial–hypoglossal network system based on neural signal augmentation/neural supercharge concept. J Plast Reconstr Aesthet Surg 2007; 60:223-31. [DOI: 10.1016/j.bjps.2006.05.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 04/30/2006] [Accepted: 05/31/2006] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW Facial paralysis often has a significant emotional impact on patients. Along with the myriad of new surgical techniques in managing facial paralysis comes the challenge of selecting the most effective procedure for the patient. This review delineates common surgical techniques and reviews state-of-the-art techniques. RECENT FINDINGS The options for dynamic reanimation of the paralyzed face must be examined in the context of several patient factors, including age, overall health, and patient desires. The best functional results are obtained with direct facial nerve anastomosis and interpositional nerve grafts. In long-standing facial paralysis, temporalis muscle transfer gives a dependable and quick result. Microvascular free tissue transfer is a reliable technique with reanimation potential whose results continue to improve as microsurgical expertise increases. Postoperative results can be improved with ancillary soft tissue procedures, as well as botulinum toxin. SUMMARY The paper provides an overview of recent advances in facial reanimation, including preoperative assessment, surgical reconstruction options, and postoperative management.
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Affiliation(s)
- James R Tate
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, 95817, USA
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Rebol J, Milojković V, Didanovic V. Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve. Acta Neurochir (Wien) 2006; 148:653-7; discussion 657. [PMID: 16493524 DOI: 10.1007/s00701-006-0736-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 12/15/2005] [Indexed: 10/25/2022]
Abstract
The technique of facial nerve repair with side-to-end hypoglossal-facial anastomosis is presented and evaluated in five patients who were operated on for facial nerve paralysis after acoustic schwannoma surgery, or had cranial base trauma. The end-to-end hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing and speaking. In this new technique, the facial nerve is mobilised in the temporal bone, transected at the second genu and transposed to the hypoglossal nerve where a tensionless side-to-end anastomosis is performed. The hypoglossal nerve is transected in oblique fashion to about one third of its circumference. We were able to achieve a tensionless anastomosis in all patients. The idea is to bring about re-innervation of the previously denervated tissue via a collateral sprouting of axons of the donor nerve through the site of coaptation without sacrificing the innervation of the donor nerve's original targets. With side-to-end hypoglossal-facial anastomosis, two patients attained a House- Brackmann grade of III (one of them with independent movement of eyelids and mouth); one achieved grade IV, another grade V and grade VI. No patient had hemilingual atrophy nor any problems associated with swallowing or chewing.
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Affiliation(s)
- J Rebol
- Department of Otorhinolaryngology and Cervicofacial Surgery, Maribor University Hospital, Maribor, Slovenia.
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Guntinas-Lichius O, Streppel M, Stennert E. Postoperative functional evaluation of different reanimation techniques for facial nerve repair. Am J Surg 2006; 191:61-7. [PMID: 16399108 DOI: 10.1016/j.amjsurg.2005.05.054] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 05/15/2005] [Accepted: 05/15/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND The facial nerve function after facial-facial nerve anastomosis, grafting, hypoglossal-facial nerve anastomosis, hypoglossal-facial interpositional jump nerve anastomosis, or a combined approach was analyzed. METHODS Facial function was assessed after operation using a 7-point visual analog scale (VAS) and by electromyography (EMG) in 53 patients. The final result was judged by May's facial nerve grading system. RESULTS Voluntary EMG activity occurred on average 4.52 +/- 1.31 months after operation. Initial facial movements were visible after 5.41 +/- 1.80 months. Facial function related to the VAS finally reached 44% of normal value. The result was judged May's grade I in 13%, grade II in 34%, grade III in 28%, and grade IV in 25% of patients. A significant difference in outcome between different reconstruction types was not seen. Age over 60 years was related to worse outcome. CONCLUSIONS A correct selection of the best method in the individual situation presumed, all analyzed facial reanimation techniques seem to lead nearly similar and satisfactory results.
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Affiliation(s)
- Orlando Guntinas-Lichius
- Clinic of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, D-50924 Koeln, Cologne, Germany
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Guntinas-Lichius O. Free vascularized nerve grafting for immediate facial nerve reconstruction. Laryngoscope 2005; 115:1705; author reply 1705-6. [PMID: 16148725 DOI: 10.1097/01.mlg.0000167929.04927.e6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schipper J, Arndt S, Maier W, Spetzger U, Ridder GJ. [Paralyzed face. Ansa-cervicalis-nervi-hypoglossi]. Chirurg 2004; 76:47-53. [PMID: 15205750 DOI: 10.1007/s00104-004-0883-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION For 100 years hypoglossal-facial nerve anastomosis (HFA) has been a common surgical procedure for reanimation of paralyzed mimic muscles of the face after axotomy of the facial nerve. However, the denervation and subsequent scarred degeneration of the target muscles of the hypoglossal nerve often results in unfavorable late effects for speech and swallowing. Therefore, the ansa cervicalis nervi hypoglossi-facial nerve anastomosis (ACHFA) can be an alternative to avoid such late effects. As a branch of the hypoglossal nerve the ansa cervicalis innervates the infrahyoidal muscles. Neck dissection surgery proved that resection of the ansa cervicalis causes no side effects for swallowing because of several nerve anastomoses to the cervical plexus. PATIENTS AND METHOD We compared our clinical results of eight cases following a delayed ACHFA with our own experiences after HFA and results from the literature. RESULTS We found a reanimation rate lower than usually seen after HFA only in the target muscles of the forehead. This may be caused by a reduced neuronal plasticity of the ansa cervicalis. However, in the target muscles of the other two facial nerve branches we observed the same good results one would expect after HFA. There were no late side effects for swallowing and speech though.
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Affiliation(s)
- J Schipper
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg.
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Guntinas-Lichius O. The facial nerve in the presence of a head and neck neoplasm: assessment and outcome after surgical management. Curr Opin Otolaryngol Head Neck Surg 2004; 12:133-41. [PMID: 15167051 DOI: 10.1097/00020840-200404000-00014] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The face is the mirror of personality. Facial expression is the most important part of verbal and nonverbal communication. Patients with head and neck neoplasm and facial palsy are more stigmatized by the latter than by the tumor itself. Facial nerve reconstruction in such a patient is a great challenge. This review gives an overview of the assessment of facial palsy, surgical reconstruction, and postoperative treatment. RECENT FINDINGS MRI, CT, and electromyography are indispensable tools in the assessment of preoperative facial palsy in patients with head and neck neoplasm. When part of the facial nerve has to be sacrificed during surgery, the best functional results are achieved with direct facial nerve suture, interposition graft, or by a hypoglossal-facial nerve interposition jump anastomosis. The latter is the best choice when the reanimation is planned between 6 months and 2 years after tumor surgery. In any case, the eye is best rehabilitated with upper lid loading. Temporalis muscle transposition gives fast and good results for the restoration of the corner of the mouth after radical surgery. Reanimation by free muscle transfer for head and neck cancer patients is rarely indicated. Botulinum toxin treatment is an excellent postoperative aid for refining the result; the optimal modality of postoperative physiotherapy is still unclear. SUMMARY Surgical reanimation of the face in head and neck patients has reached a high standard. Strategies to decrease misdirected reinnervation after nerve suture have to be established in clinical practice for further improvement of facial rehabilitation.
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Abstract
Thomasz Drobnik is considered to have been the first to operate on the facial nerve. The original report of this operation has unfortunately never been found. Because Drobnik's procedure has generally been considered to be the first documented facial nerve repair in history, it is interesting to explore Drobnik's background and the veracity of this claim. Three sources were studied: (1) literature on facial nerve repair; (2) L'état actuel de la chirurgie nerveuse, the oldest known reference to Drobnik's operation; and (3) some biographies of Drobnik. It is concluded that Thomasz Drobnik was not the first to operate on the facial nerve in 1879. Instead, the first was Sir Charles Balance, of London, England, in 1895.
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Affiliation(s)
- Robert C van de Graaf
- Department of Plastic Surgery, University Hospital Groningen, Groningen, The Netherlands.
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Abstract
Treatment of facial nerve injuries depends upon a detailed understanding of its anatomic course, accurate clinical examination, and timely and appropriate diagnostic studies. Reconstruction depends upon the extent of injury, the availability of the proximal stump. and the time since injury and duration of muscle denervation. Although no alternative is perfect, these techniques, in combination with static and ancillary procedures. can protect the eye, prevent drooling, restore the smile, and improve facial symmetry. New techniques (including single-stage free tissue transfers and bioengineered nerve grafts), further research on the characteristics of the facial musculature, and methods of preserving the neuromuscular junction will undoubtedly manifest themselves as further refinements of established surgical techniques.
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Affiliation(s)
- Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 17424, East Pavilion, Box 8238, One Barnes-Jewish Hospital Plaza, Saint Louis, MO 63110, USA
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