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Published on: March 1, 2015
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Facial reanimation according to the postresection defect during lateral skull base surgery
John P Leonetti1, Sahar Nadimi, Sam J Marzo
1Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153. jleonet@lumc.edu.
Ear, Nose, & Throat Journal
|December 9, 2016
Summary
Facial nerve reconstruction after lateral skull base surgery uses various techniques based on nerve and muscle availability. These methods aim to restore facial animation, achieving good functional outcomes.
Area of Science:
- Neurosurgery
- Plastic Surgery
- Head and Neck Surgery
Background:
- Benign tumors of the cerebellopontine angle, temporal bone, and parotid gland are typically resected without facial nerve injury.
- Malignant or recurrent tumors may necessitate facial nerve (cranial nerve VII) sacrifice, particularly with preoperative facial paresis.
Observation:
- This article details case examples of facial animation reconstruction following lateral skull base resections requiring cranial nerve VII sacrifice.
- Facial mimetic outcomes were assessed using the House-Brackmann scale.
Findings:
- Primary neurorrhaphy or interposition grafting is suitable when proximal/distal facial nerve and viable musculature are present.
- A split hypoglossal-to-facial nerve anastomosis is used when only distal nerve and viable musculature remain.
- Microvascular free flaps (proximal facial nerve or cross-facial) are employed when distal nerve or musculature is unavailable.
- All presented methods achieved a postoperative House-Brackmann score of III/VI.
Implications:
- The choice of facial reanimation technique is dictated by the availability of viable proximal and distal facial nerve segments and functioning facial musculature.
- Successful facial reanimation is achievable even after extensive resections requiring nerve sacrifice.
- These reconstructive strategies are crucial for improving quality of life after complex head and neck tumor surgery.
