María Sánchez-Ocando1, Javier Gavilán2, Julio Penarrocha2, Teresa González-Otero3, Susana Moraleda4, José María Roda5, Luis Lassaletta2,6. 1. Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain. mari_0290@hotmail.com. 2. Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain. 3. Department of Oral and Maxillofacial Surgery, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain. 4. Department of Physical Medicine and Rehabilitation, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain. 5. Department of Neurosurgery, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain. 6. Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain.
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.
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.
Authors: Rocío Sánchez-Burgos; Teresa Gonzalez Otero; Luis Lassaletta; Javier Arias Gallo; Ignacio Navarro Cuellar; Miguel Burgueño García Journal: Ann Maxillofac Surg Date: 2015 Jul-Dec