Intratemporal Grafting of the Facial Nerve following Lateral Skull Base Tumor Resection

Abstract

Intratemporal skull base tumors may invade the facial nerve in the horizontal (tympanic) or descending (vertical) segments, while parotid malignancies typically infiltrate the facial nerve at the stylomastoid foramen. This article will describe our results following intratemporal facial nerve grafting in 44 patients. This was a retrospective analysis of 44 patients requiring intratemporal facial nerve repair following lateral skull base tumor resection at our tertiary care, academic medical center. Tumor histology included 17 parotid cancers, 13 temporal bone malignancies, 9 glomus tumors, 3 facial neuromas, and 2 endolymphatic sac tumors. The greater auricular nerve was used in 25 patients and the sural nerve was used in 19 cases. Forty patients were available for facial function assessment at 2 years. Using the House-Brackmann (H-B) recovery scale, the breakdown of patients by facial function was as follows: Grade I, 0 patients; Grade II, 4 patients; Grade III, 29 patients; Grade IV, 4 patients; Grade V, 3 patients; and Grade VI, 0 patients. Facial paralysis may occur from intrinsic or external lateral skull base invasion of the facial nerve. Intratemporal interposition grafting resulted in favorable facial function (H-B II or III) in 33 of the 40 (82.5%) patients at the 2-year assessment.