National Utilization of Dynamic Facial Nerve Reconstruction Procedures in Pediatric Patients

Dynamic facial nerve reconstruction procedures are advanced surgical options for managing facial nerve disorders (FND), particularly in cases involving long-standing paralysis. While these procedures are increasingly utilized, there is limited national data comparing their use between pediatric and adult patients.

The authors conducted a retrospective cohort study using the Merative MarketScan Research Databases from 2007 to 2023 to evaluate surgical trends in patients with FND. Patients were stratified by age group (17 y or younger versus 18 y or older) and by surgical approach (static versus dynamic facial nerve reconstruction). χ 2 and multivariable logistic regression analyses were performed.

Among 4422 patients who underwent facial reconstruction, 251 (5.7%) were pediatric. Pediatric patients were significantly more likely to receive dynamic procedures (82.9% versus 33.6%) compared with adults ( P <0.001). In adjusted models, pediatric patients had over 9-fold greater odds of receiving dynamic reconstruction. Subgroup analysis of pediatric patients revealed that younger age (aOR: 4.84; 95% CI: 1.60-18.50) and more recent surgery year (aOR: 2.99; 95% CI: 1.21-7.97) were both associated with increased dynamic reconstruction utilization. Both adult and pediatric patients demonstrated positive temporal trends in dynamic facial nerve reconstruction utilization rates over the study period with adult utilization rates increasing from 28.4% in 2007 to 2011 to 44.1% in 2017 to 2023 and pediatric utilization rates increasing from 77.8% in 2007 to 2011 to 87.2% in 2017 to 2023.

Pediatric patients with FND are more likely to undergo dynamic facial reconstruction than adults, with consistently high utilization across the study period. These findings highlight age-related differences in the procedural management of facial paralysis.