Facial nerve grafts: from cerebellopontine angle and beyond
Objectives:
To review the outcomes from facial nerve cable grafting in a variety of pathologic conditions and to determine the possible causes of poor facial function after facial nerve grafting.
Study Design:
A retrospective review of patients undergoing facial nerve grafts through a neurotologic procedure.
Setting:
This study was performed at a university-based tertiary referral center.
Patients:
All 27 patients undergoing a neurotologic procedure that required a facial nerve graft from 1982 to 1997 were reviewed. Fourteen patients had grafts from the facial nerve stump at the brainstem.
Interventions:
All patients had facial nerve function determined by the senior neurotologist and through use of historical data and photographs.
Main Outcome Measure:
A facial nerve repair recovery score was developed for facial nerve transection and repair. The House-Brackmann scale was found to be inappropriate for transected and repaired nerves.
Results:
Facial function was found in 23/25 (92%) patients with at least 8 months follow-up. Statistical analysis revealed no significant correlation between graft length and recovery score. Patients who had the nerve grafted to a site distal to the meatal foramen had a mean outcome that was nearly one grade level better than those with an anastomosis proximal to the meatal foramen (i.e., at the brainstem), but this did not reach statistical significance.
Conclusions:
Facial nerve grafting is an effective way of restoring facial motor function. A new facial recovery grading scale is proposed for repaired or grafted facial nerves.
