[Section of the facial nerve. Apropos of 40 cases]

From January, 1985 through December, 1992, 40 patients were referred to the Department of Otoneurology of the Lille University Hospital for traumatic facial nerve injury. The injury was located in the intracranial, intratemporal, or extracranial segments of the nerve in 19, 15 and 6 patients, respectively. The trauma was iatrogenic in 30 patients. It was the result of surgery for a tumor of the posterior fossa, of the temporal bone or of the parotid in 19, 2 and 3 patients, respectively. Nerve injury had occurred during surgery for chronic otitis or a parotid fistula in 5 and 1 patients, respectively. Finally, it was the result of temporal bone fracture in 7 patients. We used various techniques for repair of the nerve. Anastomosis, whether end to end or with an interposition graph and with or without rerouting, was accomplished in 17 patients, as often as possible during the first month following injury (12/17 patients). Hypoglossofacial crossovers were used in 23 patients. Evaluation of the results may vary according to the choice and interpretation of an international facial nerve grading system. We define 4 categories of results: satisfactory, moderate poor and no improvement. The results of anastomosis were best when the repair with or without rerouting was undertaken as soon after injury as possible (7 satisfactory results for 16 patients evaluated). Hypoglossofacial anastomosis gave 5 satisfactory results for 17 patients evaluated. Following this operation a spastic tendency is frequent and seems more important in patients operated during the two months following nerve injury.(ABSTRACT TRUNCATED AT 250 WORDS)