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Zumbusch F, Schlattmann P, Guntinas-Lichius O. Facial nerve reconstruction for flaccid facial paralysis: a systematic review and meta-analysis. Front Surg 2024; 11:1440953. [PMID: 39104714 PMCID: PMC11298393 DOI: 10.3389/fsurg.2024.1440953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives To determine the functional outcome after facial nerve reconstruction surgery in patients with flaccid facial paralysis. Methods A systematic review and meta-analysis was performed on studies reporting outcomes after direct facial nerve suture (DFS), facial nerve interpositional graft suture (FIGS), hypoglossal-facial nerve suture (HFS), masseteric-facial nerve suture (MFS), and cross-face nerve suture (CFS). These studies were identified from PubMed/MEDLINE, Embase, and Web of Science databases. Two independent reviewers performed two-stage screening and data extraction. A favorable result was defined as a final House-Brackmann grade I-III and is presented as a ratio of all patients in percentage. Pooled proportions were calculated using random-effects models. Results From 4,932 screened records, 54 studies with 1,358 patients were included. A favorable result was achieved after DFS in 42.67% of the patients [confidence interval (CI): 26.05%-61.12%], after FIGS in 66.43% (CI: 55.99%-75.47%), after HFS in 63.89% (95% CI: 54.83%-72.05%), after MFS in 63.11% (CI: 38.53%-82.37%), and after CFS in 46.67% (CI: 24.09%-70.70%). There was no statistically significant difference between the techniques (Q = 6.56, degrees of freedom = 4, p = 0.1611). Conclusions The established facial nerve reconstruction techniques including the single nerve cross-transfer techniques produce satisfactory results in most of the patients with permanent flaccid facial paralysis. An international consensus on standardized outcome measures would improve the comparability of facial reanimation techniques.
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Affiliation(s)
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
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Dandinarasaiah M, Grinblat G, Keshavamurthy VB, Di Rubbo VM, Alessandra R, Lauda L, Sanna M. Characteristics and Management of Facial Nerve Schwannomas and Hemangiomas. Otol Neurotol 2024; 45:83-91. [PMID: 37853739 DOI: 10.1097/mao.0000000000004033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To characterize facial nerve (FN) schwannomas (FNSs) and FN hemangiomas (FNHs) and their clinical features and management strategies, and to describe the results of cable nerve grafting after FN sectioning during tumor removal. METHODS This retrospective study included 84 FNS cases and 42 FNH cases managed between July 1989 and July 2020 at a quaternary referral center for skull base pathology. Clinical details, locations, management, and results of cable nerve grafting at 1 year and during an average period of 3.12 years were evaluated. Sural nerve interpositioning was performed for patients who experienced FN paralysis for less than 1 year and underwent nerve sectioning during tumor removal. RESULTS FNSs more often involved multiple segments compared with FNHs. The cerebellopontine angle and the mastoid segments were involved in 16 (19.1%) and 34 (40.5%) FNS cases, respectively; however, the cerebellopontine angle and the mastoid segments were involved in 0 and 7 (16.7%) FNH cases, respectively. Sectioned nerves of 99 patients (78.6%) were restored using interposition cable grafting. At the last follow-up evaluation, 56.3% of FNSs and 60.7% of FNHs attained House-Brackmann (HB) grade III. Lower preoperative HB grades were associated with poorer postoperative outcomes. For FNSs, the mean HB grades were 4.13 at 1 year postoperatively and 3.75 at the last follow-up evaluation ( p = 0.001); however, for FNHs, the mean HB grades were 4.04 postoperatively and 3.75 at the last follow-up evaluation. Therefore, extradural coaptation yielded better outcomes. CONCLUSION FNSs can occur along any part of the FN along its course, and FNHs are concentrated around the area of geniculate ganglion. The results of cable inter positioning grafts are better in patients with preoperative FN-HB-III or less when compared with higher grades. The outcome of the interpositioning continues to improve even after 1 year in extradural coaptation.
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Affiliation(s)
| | | | | | - Vittoria M Di Rubbo
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Russo Alessandra
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
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3
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Parrino D, Franchella S, Frigo AC, Mazzoni A, Marioni G, Zanoletti E. Facial nerve sacrifice in lateral approaches to the skull base: Simultaneous reconstruction by graft interposition. Am J Otolaryngol 2022; 43:103210. [PMID: 34536918 DOI: 10.1016/j.amjoto.2021.103210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/05/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the outcome of facial nerve (FN) cable graft interposition in lateral skull base surgery. MATERIALS AND METHODS A group of 16 patients who underwent FN graft interposition procedure was retrospectively considered. Postoperative FN function was evaluated using the House-Brackmann (HB) grading system, the Sunnybrook Facial Grading System (SFGS), the Facial Disability Index (FDI) and the Oral Functioning Scale (OFS) questionnaires. RESULTS 56.2% of patients had a good postoperative FN outcome (HB grade II-III). Postoperative electromyography (EMG) showed re-innervation potentials in 60% of patients; median age of these patients was significantly lower compared to who did not manifest re-innervation (p = 0.039). CONCLUSION FN primary reconstruction remains the advisable rehabilitative option when the nerve is interrupted during lateral skull base surgeries, allowing to satisfactory postoperative results in more than half of patients. EMG confirmed the restoring of nerve conduction and it was more frequent in younger patients. The SFGS, the FDI and the OFS are important tools especially in the setting of a rehabilitation program.
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Wang WJ, Zhu WD, Tremp M, Chen G, Wang ZY, Wu H, Wang W. Facial reanimation with interposition nerve graft or masseter nerve transfer: a comparative retrospective study. Neural Regen Res 2021; 17:1125-1130. [PMID: 34558541 PMCID: PMC8552848 DOI: 10.4103/1673-5374.324862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve. However, no comparative study of these two procedures has yet been reported. In this two-site, two-arm, retrospective case review study, 32 patients were included. Of these, 17 patients (eight men and nine women, mean age 42.1 years) underwent interposition nerve graft after tumor extirpation or trauma between 2003 and 2006 in the Ear Institute, School of Medicine, Shanghai Jiao Tong University, China, and 15 patients (six men and nine women, mean age 40.6 years) underwent masseter-to-facial nerve transfer after tumor extirpation or trauma between November 2010 and February 2016 in Shanghai Ninth People's Hospital, China. More patients achieved House-Brackmann III recovery after masseter nerve repair than interposition nerve graft repair (15/15 vs. 12/17). The mean oral commissure excursion ratio was also higher in patients who underwent masseter nerve transfer than in patients subjected to an interposition nerve graft. These findings suggest that masseter nerve transfer results in strong oral commissure excursion, avoiding obvious synkinesis, while an interposition nerve graft provides better resting symmetry. This study was approved by the Institutional Ethics Committee, Shanghai Ninth People's Hospital, China (approval No. SH9H-2019-T332-1) on December 12, 2019.
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Affiliation(s)
- Wen-Jin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Dong Zhu
- Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases; Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mathias Tremp
- Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland
| | - Gang Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhao-Yan Wang
- Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases; Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Wu
- Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases; Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hostettler IC, Jayashankar N, Bikis C, Wanderer S, Nevzati E, Karuppiah R, Waran V, Kalbermatten D, Mariani L, Marbacher S, Guzman R, Madduri S, Roethlisberger M. Clinical Studies and Pre-clinical Animal Models on Facial Nerve Preservation, Reconstruction, and Regeneration Following Cerebellopontine Angle Tumor Surgery-A Systematic Review and Future Perspectives. Front Bioeng Biotechnol 2021; 9:659413. [PMID: 34239858 PMCID: PMC8259738 DOI: 10.3389/fbioe.2021.659413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background and purpose: Tumorous lesions developing in the cerebellopontine angle (CPA) get into close contact with the 1st (cisternal) and 2nd (meatal) intra-arachnoidal portion of the facial nerve (FN). When surgical damage occurs, commonly known reconstruction strategies are often associated with poor functional recovery. This article aims to provide a systematic overview for translational research by establishing the current evidence on available clinical studies and experimental models reporting on intracranial FN injury. Methods: A systematic literature search of several databases (PubMed, EMBASE, Medline) was performed prior to July 2020. Suitable articles were selected based on predefined eligibility criteria following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Included clinical studies were reviewed and categorized according to the pathology and surgical resection strategy, and experimental studies according to the animal. For anatomical study purposes, perfusion-fixed adult New Zealand white rabbits were used for radiological high-resolution imaging and anatomical dissection of the CPA and periotic skull base. Results: One hundred forty four out of 166 included publications were clinical studies reporting on FN outcomes after CPA-tumor surgery in 19,136 patients. During CPA-tumor surgery, the specific vulnerability of the intracranial FN to stretching and compression more likely leads to neurapraxia or axonotmesis than neurotmesis. Severe FN palsy was reported in 7 to 15 % after vestibular schwannoma surgery, and 6% following the resection of CPA-meningioma. Twenty-two papers reported on experimental studies, out of which only 6 specifically used intracranial FN injury in a rodent (n = 4) or non-rodent model (n = 2). Rats and rabbits offer a feasible model for manipulation of the FN in the CPA, the latter was further confirmed in our study covering the radiological and anatomical analysis of perfusion fixed periotic bones. Conclusion: The particular anatomical and physiological features of the intracranial FN warrant a distinguishment of experimental models for intracranial FN injuries. New Zealand White rabbits might be a very cost-effective and valuable option to test new experimental approaches for intracranial FN regeneration. Flexible and bioactive biomaterials, commonly used in skull base surgery, endowed with trophic and topographical functions, should address the specific needs of intracranial FN injuries.
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Affiliation(s)
- Isabel C Hostettler
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Narayan Jayashankar
- Department of Oto-Rhino-Laryngology, Nanavati Super Speciality Hospital, Mumbai, India
| | - Christos Bikis
- Department of Biomedical Engineering, Biomaterials Science Center, University of Basel, Allschwil, Switzerland.,Integrierte Psychiatrie Winterthur - Zürcher Unterland, Winterthur, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Kantonsspital Luzern, Lucerne, Switzerland
| | - Ravindran Karuppiah
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Daniel Kalbermatten
- Department of Plastic Surgery, University Hospital Geneva, Geneva, Switzerland.,Department of Surgery, Biomaterials and Neuro Tissue Bioengineering, University of Geneva, Geneva, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Biomedicine, Brain Ischemia and Regeneration, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| | - Srinivas Madduri
- Department of Surgery, Biomaterials and Neuro Tissue Bioengineering, University of Geneva, Geneva, Switzerland.,Department of Biomedicine, Brain Ischemia and Regeneration, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia.,Department of Neurosurgery, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, Center for Bioengineering and Regenerative Medicine, University of Basel, Basel, Switzerland
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6
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Hemihypoglossal-facial nerve anastomosis: results and electromyographic characterization. Eur Arch Otorhinolaryngol 2021; 279:467-479. [PMID: 34036422 DOI: 10.1007/s00405-021-06893-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The facial nerve surgery belongs to the basic procedures during lateral skull base approaches. Its damage has serious medical and psychological consequences, and therefore mastery of reconstruction and correction techniques should belong to the repertoire of skull base surgeons. The goal of this study was to demonstrate usefulness of electromyographic follow-up in facial nerve reconstruction. MATERIAL AND METHODS A total of 16 patients underwent hemihypoglossal-facial anastomosis between 2005 and 2017. Most of the primary lesions came from vestibular schwannoma surgery. All patients were examined with electromyography and scored according to the House-Brackmann and IOWA grading scales. Function of the tongue has been evaluated. RESULTS Ten patients achieved definitive House-Brackmann grade 3 score (62.5%). We did not observe any association with the patient's age, previous irradiation and the etiology of the damage. Electromyography showed pathological spontaneous activity after the first surgery. Incipient regeneration potentials were detected in 4-17 months (average 7.6) and reached maximum in 6.5-18 months (average 16). Electromyographic assessment of the effect of tongue movement showed better mimic voluntary activity by swallowing or by moving the tongue up. There was no relationship between the start of activity and the interval to achieving maximal activity. CONCLUSION Hemihypoglossal-facial nerve anastomosis is a safe procedure and it is an optimal solution for cases lacking a proximal stump or in the case of reconstruction in the second stage. Electromyography can predict initial reinnervation activity after reconstructive procedures. During subsequent follow-up it can help to discover insufficiently recovering patients, however clinical characteristics are crucial.
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7
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Urban MJ, Eggerstedt M, Varelas E, Epsten MJ, Beer AJ, Smith RM, Revenaugh PC. Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis. Facial Plast Surg Aesthet Med 2021; 24:10-17. [PMID: 33635144 DOI: 10.1089/fpsam.2020.0523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Hypoglossal and masseteric nerve transfer are currently the most popular cranial nerve transfer techniques for patients with facial paralysis. The authors performed a systematic review and meta-analysis to compare functional outcomes and adverse effects of these procedures. Methods: A review of online databases was performed to include studies with four or more patients undergoing hypoglossal or masseter nerve transfer without muscle transfer or other cranial nerve transposition. Facial nerve outcomes, time to reinnervation, and adverse events were pooled and studied. Results: A total of 71 studies were included: 15 studies included 220 masseteric-facial transfers, and 60 studies included 1312 hypoglossal-facial transfers. Oral commissure symmetry at rest was better for hypoglossal transfer (2.22 ± 1.6 mm vs. 3.62 ± 2.7 mm, p = 0.047). The composite Sunnybrook Facial Nerve Grading Scale was better for masseteric transfer (47.7 ± 7.4 vs. 33.0 ± 6.4, p < 0.001). Time to first movement (in months) was significantly faster in masseteric transfer (4.6 ± 2.6 vs. 6.3 ± 1.3, p < 0.001). Adverse effects were rare (<5%) for both procedures. Conclusions: Both nerve transfer techniques are effective for facial reanimation, and the surgeon should consider the nuanced differences in selecting the correct procedure for each patient.
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Affiliation(s)
- Matthew J Urban
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Eggerstedt
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eleni Varelas
- Rush University Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Madeline J Epsten
- Rush University Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam J Beer
- Rush University Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan M Smith
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter C Revenaugh
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Eravcı FC, Karaloğlu F, Tutar H, Bakkal FK, Tutar VB, Karamert R. Evaluation of VIIth-XIIth cranial nerve anastomosis results by age. J Laryngol Otol 2020; 134:1-4. [PMID: 32036794 DOI: 10.1017/s0022215120000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate VIIth-XIIth cranial nerve (hypoglossal-facial nerve) anastomosis results by age. METHOD A total of 34 patients who attended a follow-up visit in 2016, aged 20-63 years, were enrolled. The House-Brackmann facial nerve function grading system and the Facial Clinimetric Evaluation scale were applied. RESULTS Regarding post-anastomosis facial nerve function, in the group aged 40 years or less, 14 patients (78 per cent) had House-Brackmann grade III and 4 patients (22 per cent) had House-Brackmann grade IV facial nerve function post-anastomosis. In the group aged over 40 years, nine patients (56 per cent) had House-Brackmann grade III and seven patients (44 per cent) had House-Brackmann grade IV facial nerve function post-anastomosis. There was a statistically significant difference between the two groups in mean facial movement domain scores (p = 0.02). Analysis between age and facial movement score in all 34 patients demonstrated a moderate negative correlation (Pearson correlation coefficient: -0.38) and statistical significance (p = 0.02). CONCLUSION Facial reanimation yielded better results in younger than in older patients.
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Affiliation(s)
- F C Eravcı
- Department of Otorhinolaryngology, Ankara City Hospital, , Turkey
- Department of Otorhinolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - F Karaloğlu
- Department of Otorhinolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
- FK Private Practice in Otorhinolaryngology, Ankara, Turkey
| | - H Tutar
- Department of Otorhinolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - F K Bakkal
- Department of Otorhinolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
- Department of Otorhinolaryngology, Usak University Education and Research Hospital, Turkey
| | - V B Tutar
- Department of Otorhinolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
- Otorhinolaryngology, Ankara Gölbaşı Şehit Ahmet Özsoy State Hospital, Turkey
| | - R Karamert
- Department of Otorhinolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Ricciardi L, Stifano V, Pucci R, Stumpo V, Montano N, Della Monaca M, Lauretti L, Olivi A, Valentini V, Sturiale CL. Comparison between VII-to-VII and XII-to-VII coaptation techniques for early facial nerve reanimation after surgical intra-cranial injuries: a systematic review and pooled analysis of the functional outcomes. Neurosurg Rev 2020; 44:153-161. [PMID: 31912333 DOI: 10.1007/s10143-019-01231-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/05/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The surgical injury of the intracranial portion of the facial nerve (FN) is a severe complication of many skull base procedures, and it represents a relevant issue in terms of patients' discomfort, social interactions, risk for depression, and social costs. The aim of this study was to investigate the surgical and functional outcomes of the most common facial nerve rehabilitation techniques. The present study is a systematic review of the pertinent literature, according to the PRISMA guidelines. Two different online medical databases (PubMed, Scopus) were screened for studies reporting the functional outcome, measured by the House-Brackman (HB) scale, and complications, in FN early reanimation, following surgical injuries on its intracranial portion. Data on the VII-to-VII and XII-to-VII coaptation, the surgical technique, the use of a nerve graft, the duration of the deficit, and complications were collected and pooled. The XII-to-VII end-to-side coaptation seems to provide higher chances for functional restoration (HB 1-3) than the VII-to-VII (68.8% vs 60.6%), regardless of the duration of the palsy deficit, the use or not of a nerve graft, and the use of stitches or glues. However, its complication rate was as high as 28.6%, and a second procedure is then often needed. The XII-to-VII side-to-end coaptation is the most effective in providing a functional outcome (HB 1-3), even though it is associated to a higher complication rate. Further trials are needed to better investigate this relevant topic, in terms of health-related social costs and patients' quality of life.
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Affiliation(s)
- Luca Ricciardi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy.
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Resi Pucci
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Vittorio Stumpo
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Della Monaca
- Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, Università La Sapienza, Rome, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentino Valentini
- Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, Università La Sapienza, Rome, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Sánchez-Ocando M, Gavilán J, Penarrocha J, González-Otero T, Moraleda S, Roda JM, Lassaletta L. Facial nerve repair: the impact of technical variations on the final outcome. Eur Arch Otorhinolaryngol 2019; 276:3301-3308. [PMID: 31538238 DOI: 10.1007/s00405-019-05638-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the outcome of facial nerve (FN) reconstruction, the impact of technical variations in different conditions and locations, and the importance of additional techniques in case of suboptimal results. STUDY DESIGN Retrospective study. SETTING University-based tertiary referral center. PATIENTS Between 2001 and 2017, reconstruction of the FN was performed on 36 patients with varying underlying diseases. INTERVENTIONS FN repair was performed by direct coaptation (n = 3) or graft interposition (n = 33). Microsurgical sutures were used in 17 patients (47%) and fibrin glue was used in all cases. Additional reinnervation techniques (hypoglossal-facial or masseter-facial transfers) were performed in five patients with poor results after initial reconstruction. MAIN OUTCOME MEASURES FN function was evaluated using the House-Brackmann (HB) and the electronic clinician-graded facial function (eFACE) grading systems. Minimum follow-up was 12 months. RESULTS FN reconstruction yielded improvement in 83% of patients, 21 patients (58.3%) achieving a HB grade III. The eFACE median composite, static, dynamic and synkinesis scores were 69.1, 78, 53.2, and 88.2 respectively. A tendency towards better outcome with the use of sutures was found, the difference not being significant. All patients undergoing an additional reinnervation procedure achieved a HB grade III, eFACE score being 74.8. CONCLUSIONS FN reconstruction offers acceptable functional results in most cases. No significant differences are expected with technical variations, different locations or conditions. In patients with poor initial results, additional reinnervation techniques should be always considered. The eFACE adds substantial information to the most used HB scale.
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Affiliation(s)
- María Sánchez-Ocando
- Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain.
| | - Javier Gavilán
- Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain
| | - Julio Penarrocha
- Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain
| | - Teresa González-Otero
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Susana Moraleda
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - José María Roda
- Department of Neurosurgery, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain.,Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
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Prasad SC, Laus M, Dandinarasaiah M, Piccirillo E, Russo A, Taibah A, Sanna M. Surgical Management of Intrinsic Tumors of the Facial Nerve. Neurosurgery 2017; 83:740-752. [DOI: 10.1093/neuros/nyx489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/04/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
Intrinsic tumors of the facial nerve are a rare entity. Dealing with this subset of tumors is challenging both in terms of decision making and surgical intervention.
OBJECTIVE
To review the outcomes of surgical management of facial nerve tumors and cable nerve graft interpositioning.
METHODS
A retrospective analysis was performed at a referral center for skull base pathology. One hundred fifteen patients who were surgically treated for facial nerve tumors were included. In case of nerve interruption during surgery, the cable nerve interpositioning technique was employed wherein the facial nerve palsy lasted for less than 1-yr duration. In cases of facial nerve palsy lasting for greater than 1 yr, the nerve was restituted by a hypoglossal facial coaptation.
RESULTS
Various degrees of progressive paralysis were seen in 84 (73%) cases. Sixty nine (60%) of the tumors involved multiple segments of the facial nerve. Sixty-two (53.9%) tumors involved the geniculate ganglion. Seventy four (64.3%) of the cases were schwannomas. Hearing preservation surgeries were performed in 60 (52.1%). Ninety one (79.1%) of the nerves that were sectioned in association with tumor removal were restituted primarily by interposition cable grafting. The mean preoperative House-Brackmann grading of the facial nerve was 3.6. The mean immediate postoperative grading was 5.4, which recovered to a mean of 3.4 at the end of 1 yr.
CONCLUSION
In patients with good facial nerve function (House-Brackmann grade I-II), a wait-and-scan approach is recommended. In cases where the facial nerve has been interrupted during surgery, the cable nerve interpositioning technique is a convenient and well-accepted procedure for immediate restitution of the nerve.
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Affiliation(s)
| | - Melissa Laus
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
- Department of ENT-Head & Neck Surgery, University of Chieti, Chieti, Italy
| | - Manjunath Dandinarasaiah
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
- Department of ENT-Head & Neck Surgery, Karnataka Institute of Medical Sciences, Hubli, India
| | - Enrico Piccirillo
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Alessandra Russo
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Abdelkader Taibah
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mario Sanna
- Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
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Prasad SC, Balasubramanian K, Piccirillo E, Taibah A, Russo A, He J, Sanna M. Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases. J Neurosurg 2017; 128:631-638. [PMID: 28387625 DOI: 10.3171/2016.9.jns16997] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries. METHODS The authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system. RESULTS Two hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002). CONCLUSIONS Cable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue-aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.
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Affiliation(s)
- Sampath Chandra Prasad
- 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and
| | | | - Enrico Piccirillo
- 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and
| | - Abdelkader Taibah
- 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and
| | - Alessandra Russo
- 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and
| | - Jingchun He
- 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and.,2Department of Otorhinolaryngology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic ofChina
| | - Mario Sanna
- 1Department of Otology & Skull Base Surgery, Gruppo Otologico, Piacenza and Rome,Italy; and
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Ramachandran S, Midha R. Editorial. Outcomes of facial nerve repair using nerve grafts applied immediately following nerve discontinuity in skull base surgery. J Neurosurg 2017; 128:627-630. [PMID: 28387622 DOI: 10.3171/2016.10.jns162354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Zhang L, Li D, Wan H, Hao S, Wang S, Wu Z, Zhang J, Qiao H, Li P, Wang M, Su D, Schumacher M, Liu S. Hypoglossal-facial nerve 'side'-to-side neurorrhaphy using a predegenerated nerve autograft for facial palsy after removal of acoustic tumours at the cerebellopontine angle. J Neurol Neurosurg Psychiatry 2015; 86:865-72. [PMID: 25228445 DOI: 10.1136/jnnp-2014-308465] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/28/2014] [Indexed: 01/10/2023]
Abstract
TRIAL DESIGN Hypoglossal-facial nerve (HN-FN) neurorrhaphy is a method commonly used to treat facial palsy when the proximal stump of the injured FN is unavailable. Since the classic HN-FN neurorrhaphy method that needs to section the injured FN is not suitable for incomplete facial palsy, we investigated a modified method that consists of HN-FN 'side'-to-side neurorrhaphy, retaining the remaining or spontaneously regenerated FN axons while preserving hemihypoglossal function. METHODS To improve axonal regeneration, we used for the first time a predegenerated sural autograft for performing HN-FN 'side'-to-side neurorrhaphy followed by postoperative facial exercise. We treated 12 patients who had experienced FN injury for 1-18 months as a result of acoustic tumour removal. All patients experienced facial grade V-VI paralysis according to the House-Brackmann scale, but their FN was anatomically preserved. No spontaneous facial reinnervation was detected before repair. RESULTS Although we did not perform fresh nerve grafts and HN-FN 'side'-to-end neurorrhaphy as controls for ethical reasons, the reparative outcomes after nerve reconstruction were remarkable: functional improvements were detected as soon as 3 months after repair, House-Brackmann grade II or III FN functions were achieved in five and four patients, respectively, and there were no apparent signs of synkinesis. The three patients who experienced less satisfactory outcomes had exhibited facial palsy for more than 1 year accompanied by muscle atrophy, consistent with a need for rapid surgical intervention. CONCLUSIONS Based on fundamental concepts and our experimental results, this new surgical method represents a major advance in the rehabilitation of FN injury. TRIAL REGISTRATION NUMBER JS2013-001-02.
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Affiliation(s)
- Liwei Zhang
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dezhi Li
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Wan
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Shuyu Hao
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiwei Wang
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Zhen Wu
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junting Zhang
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui Qiao
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Ping Li
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Mingran Wang
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Diya Su
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | | | - Song Liu
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China UMR 788, INSERM and Université Paris-Sud, Le Kremlin-Bicêtre, France
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Abstract
BACKGROUND Functional restoration of the facial expression is necessary after facial nerve resection to treat head and neck tumors. This study was conducted to evaluate the functional outcomes of patients who underwent facial nerve cable grafting immediately after tumor resection. METHODS Patients who underwent cable grafting from April 2007 to August 2011 were reviewed, in which a harvested branch of the sural nerve was grafted onto each facial nerve division. Twelve patients underwent facial nerve cable grafting after radical parotidectomy, total parotidectomy, or schwannoma resection, and the functional facial expression of each patient was evaluated using the Facial Nerve Grading Scale 2.0. The results were analyzed according to patient age, follow-up duration, and the use of postoperative radiation therapy. RESULTS Among the 12 patients who were evaluated, the mean follow-up duration was 21.8 months, the mean age at the time of surgery was 42.8 years, and the mean facial expression score was 14.6 points, indicating moderate dysfunction. Facial expression scores were not influenced by age at the time of surgery, follow-up duration, or the use of postoperative radiation therapy. CONCLUSIONS The results of this study indicate that facial nerve cable grafting using the sural nerve can restore facial expression. Although patients were provided with appropriate treatment, the survival rate for salivary gland cancer was poor. We conclude that immediate facial nerve reconstruction is a worthwhile procedure that improves quality of life by allowing the recovery of facial expression, even in patients who are older or may require radiation therapy.
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Toffola ED, Pavese C, Cecini M, Petrucci L, Ricotti S, Bejor M, Salimbeni G, Biglioli F, Klersy C. Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years. FUNCTIONAL NEUROLOGY 2014; 29:183-187. [PMID: 25473738 PMCID: PMC4264785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis (House-Brackmann grade VI) treated with hypoglossal-facial nerve (XII-VII) anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback. Reinnervation after XII-VII anastomosis occurred in 29 patients, on average 5.4 months after surgery. Three years after the anastomosis, 23.3% of patients had grade II, 53.3% grade III, 20% grade IV and 3.3% grade VI ratings on the House-Brackmann scale. Time to reinnervation was associated with the final House-Brackmann grade. Our study demonstrates that patients undergoing XIIVII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The recovery continues for at Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable.
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Affiliation(s)
- Elena Dalla Toffola
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Rehabilitation Unit - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Pavese
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Miriam Cecini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lucia Petrucci
- Rehabilitation Unit - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Susanna Ricotti
- Rehabilitation Unit - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Bejor
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Rehabilitation Unit, Fondazione Don Carlo Gnocchi ONLUS, “Santa Maria alle Fonti” Medical Center, Salice Terme, Pavia, Italy
| | | | - Federico Biglioli
- Unit of Maxillo-Facial Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Catherine Klersy
- Department of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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