Topographic Facial Nerve Transplantation

Benedikt M Schwaiger,Thomas Rath,Ines Tinhofer,Guenther Meissl,Chieh-Han John Tzou,Johannes Steinbacher

doi:10.24983/scitemed.imj.2021.00139

Abstract

This case report describes authors successfully attempt to perform a topographically correct sural nerve transplantation in the extracranial facial nerve stem using the intraneural facial nerve stem topography proposed by Meissl in 1979. This is the first reported case of successful fascicular nerve grafting of the facial nerve stem following extensive laceration.

Highlights

This is a clinical report describing the case of performing a topographically correct sural nerve transplantation in the extracranial facial nerve stem using the intraneural facial nerve stem topography
He had found three areas within the horizontal cross-section of the proximal facial nerve stem: (i) the ventro-medial portion innervating the muscles of the forehead and upper eyelid, (ii) the lateral portion innervating the lower eyelid and cheek, and upper lip, and (iii) the dorsal fascicles supplying the muscles of the neck and lower lip (Figure 1)
We performed a fascicular repair of the proximal facial nerve stump at the stylomastoid foramen using five autologous grafts from the sural nerve of approximately 6 cm length (Figure 2)

Summary

CLINICAL REPORT

This is a clinical report describing the case of performing a topographically correct sural nerve transplantation in the extracranial facial nerve stem using the intraneural facial nerve stem topography. Proposed by Meissl in 1979, this is the first case of successful fascicular nerve grafting of the facial nerve stem following extensive laceration It was performed on a young male patient who had suffered a deep traumatic soft tissue laceration to the left preauricular area because of a high velocity car accident. In the surgery performed immediately upon presentation, the facial nerve stump could not be identified at the stylomastoid foramen and was not reconstructed. Meissl had paired the electrophysiological examination of the facial nerve stem of cats in vivo with sequential microscopic analyses of human cadaveric nerves He had found three areas within the horizontal cross-section of the proximal facial nerve stem: (i) the ventro-medial portion innervating the muscles of the forehead and upper eyelid, (ii) the lateral portion innervating the lower eyelid and cheek, and upper lip, and (iii) the dorsal fascicles supplying the muscles of the neck and lower lip (Figure 1).

Composite score

DISCUSSION