Management of the facial nerve in parotid cancer: preservation or resection and reconstruction

Guntinas‐Lichius, Orlando; Silver, Carl E.; Thielker, Jovanna; Bernal‐Sprekelsen, Manuel; Bradford, Carol R.; Bree, Remco de; Kowalski, Luiz Paulo; Olsen, Kerry D.; Quer, Miquel; Rinaldo, Alessandra; Rodrigo, Juan R; Sanábria, Álvaro; Shaha, Ashok R.; Takes, Robert P.; Poorten, Vincent Vander; Zbären, Peter; Ferlito, Alfio

doi:10.1007/s00405-018-5154-6

Cited by 65 publications

(53 citation statements)

References 51 publications

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“…The 5-year "overall survival," "recurrence-free survival" and "disease free survival" of our cohort were 89.6, 85.2, and 56.5%, respectively (►Fig. 7).…”

Section: Carcinologic Resultsmentioning

confidence: 84%

“…4,5 The histologic subtypes most frequently responsible for oncologic facial palsy (FP) are salivary gland cancers, FN schwannomas, and squamous cell carcinomas. 6,7 Their extension often goes beyond the parotid compartment and requires extensive local resection leading to complex multitissue type defects. The goals of reconstruction may be summarized in two parts that are restoration of the volumetric tissue defect and FN reconstruction.…”

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confidence: 99%

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Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Mangialardi

Honart

Qassemyar³

et al. 2020

J Reconstr Microsurg

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Background Cancer involving the parotid gland region may originates from parotid parenchyma itself or from locoregional organs and in rare cases, the facial nerve (FN) has to be sacrificed during tumor resection. In these cases, cancer extension often goes beyond the parotid compartment and requires extensive local resection responsible for complex multitissular defects. The goals of reconstruction may be summarized in the following two components: (1) restoration of the volumetric tissue defect and (2) FN reconstruction. The aim of this study is to describe our surgical technique and our cosmetic results using the chimeric scapulodorsal vascularized nerve (SDVN) flap to reconstruct extensive maxillofacial defects associated with FN sacrifice. Methods All patients undergone an extensive maxillofacial resection with FN sacrifice and primarily reconstructed with a SDVN flap were included. We classified the maxillofacial defects into six groups based on the type of resection. Intraoperative data including flap composition, topography of FN injury, length of nerve gap, and number of nervous anastomosis were recorded. Results Twenty-nine patients were included. Mean follow-up was 38.7 months. The harvested flaps included the SDVN combined with different components according to the defect group. A satisfactory volumetric restoration was obtained in 93% of cases. The mean number of distal nervous anastomosis was 4.5. The length of the vascularized grafted nerve ranged from 7 to 10 cm. Conclusion This is largest series presented in literature on primary FN reconstruction utilizing a vascularized nerve graft. We believe that the chimeric SDVN flap should be highly considered for these cases due to its versatility. The surgeon is able to use single donor site available soft and hard tissues components along with a vascular motor nerve graft, which offers a great length and number of distal branches, and easily matches with the extracranial FN trunk and its peripheral ramifications.

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“…The 5-year "overall survival," "recurrence-free survival" and "disease free survival" of our cohort were 89.6, 85.2, and 56.5%, respectively (►Fig. 7).…”

Section: Carcinologic Resultsmentioning

confidence: 84%

mentioning

confidence: 99%

Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Mangialardi

Honart

Qassemyar³

et al. 2020

J Reconstr Microsurg

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“…Preoperative FNM in adults was only performed by Park using the technique prior to plastic surgery . Preoperative FNM prior to parotid tumor surgery should be feasible too but has not yet been investigated …”

Section: Discussionmentioning

confidence: 99%

Altered facial muscle innervation pattern in patients with postparetic facial synkinesis

2019

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Objectives/Hypothesis: Using surface electrostimulation, we aimed to use facial nerve mapping (FNM) in healthy subjects and patients with postparetic facial synkinesis (PPFS) to define functional facial target regions that can be stimulated selectively.Study Design: Single-center prospective cohort study. Methods: FNM was performed bilaterally in 20 healthy subjects and 20 patients with PPFS. Single-pulse surface FNM started at the main trunk of the facial nerve and followed the peripheral branches in a distal direction. Stimulation started with 0.1 mA and increased in 0.1 mA increments. The procedure was simultaneously video recorded and evaluated offline.Results: A total of 1,873 spots were stimulated, and 1,875 facial movements were evaluated. The stimulation threshold was higher on the PPFS side (average = 9.8 AE 1.0 mA) compared to the contralateral side (4.1 AE 0.8 mA) for all stimulation sites or compared to healthy subjects (4.1 AE 0.5 mA; all P < .01). In healthy subjects, selective electrostimulation AE one unintended coactivation was possible at all sites in >80% of cases, with the exception of pulling up the corner of the mouth (65%-75%). On the PPFS side, stimulation was possible for puckering lips movements in 60%/75% (selective stimulation AE one coactivation, respectively), blinking in 55%/80%, pulling up the corner of the mouth in 50%/85%, brow raising in 5%/85, and raising the chin in 0%/35% of patients, respectively.Conclusions: FNM mapping for surgical planning and selective electrostimulation of functional facial regions is possible even in patients with PPFS. FNM may be a tool for patient-specific evaluation and placement of electrodes to stimulate the correct nerve branches in future bionic devices (e.g., for a bionic eye blink).

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“…EMG in the form of surface EMG (sEMG) is an important tool for facial muscle expression analysis. Intraoperative nerve monitoring was not part of this study: instead, we refer to other recently published recommendations [12,13]. Facial electrodiagnostics are also used for other diseases than facial nerve palsy i.e.…”

Section: Introductionmentioning

confidence: 99%

Facial nerve electrodiagnostics for patients with facial palsy: a clinical practice guideline

Guntinas‐Lichius

Volk

Olsen

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Facial nerve electrodiagnostics is a well-established and important tool for decision making in patients with facial nerve diseases. Nevertheless, many otorhinolaryngologist-head and neck surgeons do not routinely use facial nerve electrodiagnostics. This may be due to a current lack of agreement on methodology, interpretation, validity, and clinical application. Electrophysiological analyses of the facial nerve and the mimic muscles can assist in diagnosis, assess the lesion severity, and aid in decision making. With acute facial palsy, it is a valuable tool for predicting recovery. Methods This paper presents a guideline prepared by members of the International Head and Neck Scientific Group and of the Multidisciplinary Salivary Gland Society for use in cases of peripheral facial nerve disorders based on a systematic literature search. Results Required equipment, practical implementation, and interpretation of the results of facial nerve electrodiagnostics are presented. Conclusion The aim of this guideline is to inform all involved parties (i.e. otorhinolaryngologist-head and neck surgeons and other medical specialists, therapeutic professionals and the affected persons) and to provide practical recommendations for the diagnostic use of facial nerve electrodiagnostics.

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Management of the facial nerve in parotid cancer: preservation or resection and reconstruction

Cited by 65 publications

References 51 publications

Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Reconstruction of Extensive Composite Parotid Region Oncologic Defects with Immediate Facial Nerve Reconstruction Using a Chimeric Scapulodorsal Vascularized Nerve Free Flap

Altered facial muscle innervation pattern in patients with postparetic facial synkinesis

Facial nerve electrodiagnostics for patients with facial palsy: a clinical practice guideline

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