Vestibular Schwannoma Complicated by Facial Paralysis: Considerations of Techniques and Timing for Facial Reanimation

Abstract

To understand the risk factors for facial paralysis following vestibular schwannoma removal and determine the appropriate conditions for and timing of surgical intervention. Intraoperative facial nerve response to stimulation helps identify patients likely to have good facial function ( 0.1 mA). Patients with severe postoperative paralysis (HB V–VI) who fail to improve in the first 7–10 months are unlikely to develop good long-term facial function and surgical intervention may be considered as early as 6–7 months. Hypoglossal nerve transfer improves facial tone and motion; techniques preserving part of the hypoglossal nerve are preferred. Masseter nerve transfer is supplanting the hypoglossal nerve at many centers due to quicker reinnervation, easier activation, and lower morbidity. Facial reanimation with early nerve transfer should be considered for patients with severe paralysis failing to improve over the first 6 months following vestibular schwannoma removal.