Abstract
BackgroundEarly surgical repair to restore nerve integrity has become the most commonly practiced method for managing facial nerve injury. However, the evidence for the efficacy of surgical repair for restoring the function of facial nerves remains deficient. This study evaluated the outcomes of surgical repair for facial nerve lesions.MethodsThis retrospective observational study recruited 28 patients with the diagnosis of facial nerve injury who consecutively underwent surgical repairs from September 2012 to May 2019. All related clinical data were retrospectively analyzed according to age, sex, location of the facial nerve lesion, size of the facial nerve defect, method of repair, facial electromyogram, and blink reflex. Facial function was then stratified with the House-Brackmann grading system pre-operation and 3, 9, 15, and 21 months after surgical repair.ResultsThe 28 patients enrolled in this study included 17 male and 11 female patients with an average age of 34.3 ± 17.4 years. Three methods were applied for the repair of an injured facial nerve, including great auricular nerve transplantation in 15 patients, sural nerve grafting in 7 patients, and hypoglossal to facial nerve anastomosis in 6 patients. Facial nerve function was significantly improved at 21 months after surgery compared with pre-operative function (P = 0.008). Following surgical repair, a correlation was found between the amplitude of motor unit potential (MUP) and facial nerve function (r = -6.078, P = 0.02). Moreover, the extent of functional restoration of the facial nerve at 21 months after surgery depended on the location of the facial nerve lesion; lesions at either the horizontal or vertical segment showed significant improvement(P = 0.008 and 0.005), while no functional restoration was found for lesions at the labyrinthine segment (P = 0.26).ConclusionsFor surgical repair of facial nerve lesions, the sural nerve, great auricular nerve, and hypoglossal-facial nerve can be grafted effectively to store the function of a facial nerve, and MUP may provide an effective indicator for monitoring the recovery of the injured nerve.
Highlights
Surgical repair to restore nerve integrity has become the most commonly practiced method for managing facial nerve injury
All clinical data were collected from the medical records of the 28 patients, including the location of the facial nerve lesion, the defect of the facial nerve, the duration of facial paralysis before surgical intervention, the pathology of the lesion, the method of nerve repair, and the facial electromyogram
The surgical approaches applied for the patients who suffered from facial nerve resection included great auricular nerve transplantation in 15 cases, sural nerve graft in 7 cases, and hypoglossal to facial nerve anastomosis in 6 cases (Table 1)
Summary
Surgical repair to restore nerve integrity has become the most commonly practiced method for managing facial nerve injury. The primary paradigm for managing damaged facial nerve has been early microsurgical repair and restoration of nerve continuity [6, 7]. Any tumor in the course of the facial nerve from the brainstem to the periphery can cause facial palsy, or surgical treatment of the tumor might be the cause of facial palsy. In such circumstances, typically surgery of the primary disease is combined with surgical reconstruction of the facial nerve
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