Rethinking Oncologic Facial Nerve Reconstruction in the Acute Phase Through Classification of the Level of Injury

Area of Science:

• Reconstructive surgery
• Neurosurgery
• Head and neck oncology

Background:

• Facial nerve palsy significantly impacts function and psychosocial well-being.
• Oncologic resection is a leading cause of acute facial nerve injury.
• Timely and adequate reconstruction is essential for patient recovery.

Purpose of the Study:

• To present a systematic framework for facial nerve reconstruction after oncologic resection.
• To propose a three-level classification system for facial nerve injuries.
• To guide the selection of reconstruction methods based on injury level.

Main Methods:

• Classification of oncologic facial nerve injuries into three levels: Level I (intracranial to intratemporal), Level II (intratemporal to extratemporal/intraparotid), and Level III (extratemporal/extraparotid).
• Analysis of clinical features, donor nerves, recipient nerves, and reconstruction priorities for each level.
• Case examples illustrating the application of the injury level framework.

Main Results:

• The proposed three-level classification provides a systematic approach to facial nerve reconstruction.
• Selection of appropriate donor nerves, often a hybrid approach, is critical for reinnervation.
• The framework aids in prioritizing reconstruction methods based on injury extent.

Conclusions:

• Early facial nerve reconstruction is recommended for all patients undergoing oncologic resection of the facial nerve.
• The three-level injury classification system serves as a valuable guide for selecting reconstruction strategies.
• Prioritizing functional outcomes through tailored reconstruction based on injury level is paramount.