Reconstruction for facial nerve defects of zygomatic or marginal mandibular branches using upper buccal or cervical branches.

Abstract

Many reconstructive methods for facial nerve defects have been described previously, such as the greater auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. Herein, we want to instruct a new technique of repairing facial nerve defects of zygomatic or marginal mandibular branches using upper buccal or cervical branches when we have to face segment defects of facial nerve with wide gaps between facial nerve stumps. The distal part of the upper buccal or cervical branches with peripheral tissue was removed to repair the defects of zygomatic or marginal mandibular branches. Clinical and electromyographic examinations were employed to investigate the clinical efficacy of this method. Killed branches of facial nerve included 11 marginal mandibular branches and 16 zygomatic branches in 26 patients. The length of facial nerve defects ranged from 0.9 cm to 2.3 cm with a mean gap of 1.87 cm (SD, 0.89). Seventeen patients finally showed a superb facial function (grade I), 6 patients an excellent outcome (grade II), and 3 patients a good result (grade III). A fair or poor result (grade IV or V) was not observed. The essence of this method is equivalent to direct facial-facial nerve anastomosis which seems to be able to avoid synkinesis between the upper and lower face. We believe that this method is adaptable to the length of facial nerve defects less than 2 cm.