Neurofibromatosis Type II and Facial Paralysis: Clinical Evaluation and Management

Area of Science:

• Neurosurgery
• Plastic Surgery
• Oncology

Background:

• Neurofibromatosis type 2 (NF2) causes unique facial paralysis challenges, including bilateral acoustic neuromas and multiple cranial nerve involvement.
• Existing literature on facial reanimation for NF2 patients is limited.
• Management requires addressing neoplastic agents and complex surgical considerations.

Approach:

• A comprehensive literature review was conducted.
• Retrospective analysis of 12 NF2 patients with facial paralysis over 13 years.
• Data collected included paralysis type, NF2 sequelae, cranial nerve involvement, and interventions.

Key Points:

• Twelve NF2 patients with facial paralysis were identified, all post-vestibular schwannoma resection.
• Most patients had multiple cranial nerve involvement and had received antineoplastic agents.
• Surgical interventions included free functional muscle transfer, masseteric-to-facial nerve transfer, and myectomy.

Conclusions:

• Effective management of NF2-related facial paralysis requires understanding the disease's systemic nature and nerve involvement.
• Outcomes were not negatively impacted by antineoplastic agents (e.g., bevacizumab, temsirolimus) if managed perioperatively.
• Trigeminal schwannomas did not affect reconstructive outcomes when trigeminal nerve motor function was normal.