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Facial nerve reconstruction: outcome and failures
1Department of Otolaryngology, Mt. Sinai Hospital, Toronto, Ontario.
The Journal of Otolaryngology
|August 26, 1998
Summary
Facial nerve reconstruction after parotid tumor surgery is effective. Total nerve grafting provides good tone and eye closure, while orbital branch grafting ensures proper eye closure. Mandibular branch grafting shows better results with midface grafting.
Area of Science:
- Neurosurgery
- Head and Neck Surgery
- Plastic Surgery
Background:
- Parotid neoplasms often necessitate facial nerve resection, impacting facial function.
- Reconstruction of the facial nerve is crucial for restoring facial symmetry and function post-resection.
Purpose of the Study:
- To evaluate the outcomes of facial nerve reconstruction following various resections for parotid neoplasms.
- To assess the efficacy of different facial nerve grafting techniques.
Main Methods:
- Retrospective analysis of 350 parotid neoplasms requiring facial nerve resection.
- Detailed description of reconstruction techniques including total nerve grafting, single-branch grafting (orbital, mandibular), and direct anastomosis.
- Objective assessment of muscle activity and a minimum 18-month follow-up.
Main Results:
- Total facial nerve reconstruction yielded excellent tone and good eye closure, with mass movement but no purposeful focused movement.
- Orbital branch grafting consistently resulted in appropriate eye closure.
- Mandibular branch grafting alone showed limited functional return, whereas concomitant midface grafting improved function of reconstructed branches.
Conclusions:
- Facial nerve grafting effectively rehabilitates nerve gaps, even after radiotherapy.
- Total nerve grafting is justified by good resting tone and eye closure.
- Single-branch grafting is essential for the orbital branch; its utility for the mandibular branch may be limited without additional grafting.