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[Analysis of the neurological status and functional outcome after facial nerve neuroplasctics using accessory nerve]
Iu A Shulev1, A V Trashin, V L Rychkov
1Kafedra neĭrokhirurgii, GBOU VPO "Severo-Zapadnyĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.I. Mechnikova" Minzdrava RF; Otdelenie neĭrokhirurgii Gorodskoĭ mnogoprofil'noĭ bol'nitsy #2, Sankt-Peterburg.
Aim:
to assess effectiveness of mimic muscles rehabilitation after cross neuroplastics using accessory nerve (AN) by neurological scales estimating functional outcome.
Material And Methods:
During 1998-2010 20 patients underwent cross neuroplastics of facial nerve (FN) by a main trunk of AN. The average follow-up was 4.65 years (1-10 years). At baseline all patients had total function loss of FN after excision of acoustic neuroma. The interval between function loss and surgery was 1-6 months (4.7 months in average). Patients were within age range 37-73 years (51.8 years in average). Each patient was accessed by clinical scales House-Brackmann Facial Grading Systems (HB) and Yanagihara system (YS) for estimation of the extent of mimic paresis. Sunnybrook Facial Grading scale (SFG) was used to assess facial symmetry and synkineses. Self-assessment questionnaire Facial Disability Index (FDI) was also used. Original questionnaire, Shoulder Disability Index (SDI), including 4 questions was used for self-assessment of a denervated shoulder segment (maximum 100 degrees).
Results:
4 patients (20%) recovered up to HB II, 11 (55%) - up to HB III and 5 (25%) - up to HB IV-V. Average degree by YS was 27.5±4.06, average SFG was 71.1±9.38. Average degree by self-assessment (FDI) was 143.75± 22,82, and average SDI was 69.06± 22.16. All acquired data was statistically analyzed and compared. Strong correlation (r= -0.72, p< 0.001) was found between magnitudes of HB, YS and SFG after surgery, and between total FDI and SDI (r=0.56, p<0.001).
Conclusion:
Results of cross neuroplastics of FN using AN are compatible with those in other neuroplastic techniques and improve patients' quality of life. This procedure is acceptable for rehabilitation of FN function after surgery of skull base. The main problem of assessment of mimic muscles is subjectivism, that is why clinical scales and self-assessment questionnaires have to be used. After cross neuroplastics denervated segment of shoulder should be assessed by the specialized scale.
