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Modern concepts in facial nerve reconstruction.

Volk GF, Pantel M, Guntinas-Lichius O - Head Face Med (2010)

Bottom Line: Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons.The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques.A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otorhinolarnygology, University Jena, Lessingstrasse 2, Jena, Germany.

ABSTRACT

Background: Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons. The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques. On this background it is worthwhile to develop a standardized approach for diagnosis and treatment of patients asking for facial rehabilitation.

Conclusion: A standardized approach is feasible: Patients with chronic facial palsy first need an exact classification of the palsy's aetiology. A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy, an individual surgical concept is applicable using three main approaches: a) early extratemporal reconstruction, b) early reconstruction of proximal lesions if extratemporal reconstruction is not possible, c) late reconstruction or in cases of congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardized evaluation of the therapeutic results is recommended to evaluate the necessity for adjuvant surgical procedures or other adjuvant procedures, e.g. botulinum toxin application. Up to now controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies.

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Hypoglossal-facial jump nerve anastomosis. a: Harvest of the greater auricular nerve as interpositional graft; b: End-to-end nerve suture of the graft (g) to the peripheral facial nerve (f); p = parotid gland; c: incision (arrow) of the hypoglossal nerve (h); d: end-to-side nerve suture between hypoglossal nerve (h) and the graft (g).
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Figure 2: Hypoglossal-facial jump nerve anastomosis. a: Harvest of the greater auricular nerve as interpositional graft; b: End-to-end nerve suture of the graft (g) to the peripheral facial nerve (f); p = parotid gland; c: incision (arrow) of the hypoglossal nerve (h); d: end-to-side nerve suture between hypoglossal nerve (h) and the graft (g).

Mentions: First choice for cross-nerve suture is the hypoglossal-facial jump nerve anastomosis (Figure 2 and 3). The classical type of hypoglossal-facial nerve anastomosis using the entire proximal hypoglossal nerve should be avoided nowadays. Classical hypoglossal-facial nerve anastomosis leads to unpleasant long-term sequelae, because the unilateral tongue atrophy produces permanent speech and swallowing problems. The hypoglossal-facial jump nerve anastomosis using only part of the hypoglossal nerve avoids tongue atrophy and the success rate is comparable to the classical type. Hyperkinesia, often seen after the classical technique, is avoided by the jump technique, because less nerve fibres regenerate to the periphery.


Modern concepts in facial nerve reconstruction.

Volk GF, Pantel M, Guntinas-Lichius O - Head Face Med (2010)

Hypoglossal-facial jump nerve anastomosis. a: Harvest of the greater auricular nerve as interpositional graft; b: End-to-end nerve suture of the graft (g) to the peripheral facial nerve (f); p = parotid gland; c: incision (arrow) of the hypoglossal nerve (h); d: end-to-side nerve suture between hypoglossal nerve (h) and the graft (g).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2984557&req=5

Figure 2: Hypoglossal-facial jump nerve anastomosis. a: Harvest of the greater auricular nerve as interpositional graft; b: End-to-end nerve suture of the graft (g) to the peripheral facial nerve (f); p = parotid gland; c: incision (arrow) of the hypoglossal nerve (h); d: end-to-side nerve suture between hypoglossal nerve (h) and the graft (g).
Mentions: First choice for cross-nerve suture is the hypoglossal-facial jump nerve anastomosis (Figure 2 and 3). The classical type of hypoglossal-facial nerve anastomosis using the entire proximal hypoglossal nerve should be avoided nowadays. Classical hypoglossal-facial nerve anastomosis leads to unpleasant long-term sequelae, because the unilateral tongue atrophy produces permanent speech and swallowing problems. The hypoglossal-facial jump nerve anastomosis using only part of the hypoglossal nerve avoids tongue atrophy and the success rate is comparable to the classical type. Hyperkinesia, often seen after the classical technique, is avoided by the jump technique, because less nerve fibres regenerate to the periphery.

Bottom Line: Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons.The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques.A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otorhinolarnygology, University Jena, Lessingstrasse 2, Jena, Germany.

ABSTRACT

Background: Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons. The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques. On this background it is worthwhile to develop a standardized approach for diagnosis and treatment of patients asking for facial rehabilitation.

Conclusion: A standardized approach is feasible: Patients with chronic facial palsy first need an exact classification of the palsy's aetiology. A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy, an individual surgical concept is applicable using three main approaches: a) early extratemporal reconstruction, b) early reconstruction of proximal lesions if extratemporal reconstruction is not possible, c) late reconstruction or in cases of congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardized evaluation of the therapeutic results is recommended to evaluate the necessity for adjuvant surgical procedures or other adjuvant procedures, e.g. botulinum toxin application. Up to now controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies.

Show MeSH
Related in: MedlinePlus