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19.09.2019 | Otology

Facial nerve repair: the impact of technical variations on the final outcome

Zeitschrift:
European Archives of Oto-Rhino-Laryngology
Autoren:
María Sánchez-Ocando, Javier Gavilán, Julio Penarrocha, Teresa González-Otero, Susana Moraleda, José María Roda, Luis Lassaletta
Wichtige Hinweise

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Abstract

Objectives

To analyze the outcome of facial nerve (FN) reconstruction, the impact of technical variations in different conditions and locations, and the importance of additional techniques in case of suboptimal results.

Study design

Retrospective study.

Setting

University-based tertiary referral center.

Patients

Between 2001 and 2017, reconstruction of the FN was performed on 36 patients with varying underlying diseases.

Interventions

FN repair was performed by direct coaptation (n = 3) or graft interposition (n = 33). Microsurgical sutures were used in 17 patients (47%) and fibrin glue was used in all cases. Additional reinnervation techniques (hypoglossal–facial or masseter–facial transfers) were performed in five patients with poor results after initial reconstruction.

Main outcome measures

FN function was evaluated using the House–Brackmann (HB) and the electronic clinician-graded facial function (eFACE) grading systems. Minimum follow-up was 12 months.

Results

FN reconstruction yielded improvement in 83% of patients, 21 patients (58.3%) achieving a HB grade III. The eFACE median composite, static, dynamic and synkinesis scores were 69.1, 78, 53.2, and 88.2 respectively. A tendency towards better outcome with the use of sutures was found, the difference not being significant. All patients undergoing an additional reinnervation procedure achieved a HB grade III, eFACE score being 74.8.

Conclusions

FN reconstruction offers acceptable functional results in most cases. No significant differences are expected with technical variations, different locations or conditions. In patients with poor initial results, additional reinnervation techniques should be always considered. The eFACE adds substantial information to the most used HB scale.

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