Neuroplastic Surgery of Facial Palsy

Abstract

Objective: The facial nerve is the most susceptible to injury of all the cranial nerves because of its complex course through the temporal bone confined within a prolonged bony canal. Facial nerve palsy produces important changes in facial aspect with devastating social consequences for the patient. Method: A retrospective study of 10 years of material (2000-2009) was done on 21 patients. After a thorough evaluation, surgical treatment was decided which comprised nerve decompression, or anastomosis between the end of intratympanic segment and the distal segment of facial nerve by interposing sural or auricularis magnus nerve graft. Results: The interposition of the graft in facial nerve was carried out in the mastoid, in 11 cases in the 72 hours after trauma, in 5 cases 3 months later and in 1 case twelve months later. Nerve decompression was performed in 4 cases. The nerve graft and the nervous ends were prepared beforehand by cutting a few millimeters of the epineural sheet. Then the graft was positioned in the bone canal, the ends were put together and the anastomosis was made with autologous fibrin adhesive. Conclusion: Surgical therapy in peripheral traumatic facial palsy gives good functional results. Nerve decompression has statistically better results compared to anastomosis and nerve transplant. The choice of surgical technique and results directly depend on location and intensity of the lesion and the treatment time.