Outcomes of immediate facial nerve reanimation with nerve transfer for facial nerve neoplasm‐induced paralysis: a retrospective review

Abstract

Background: The purpose of this study was to evaluate the outcomes of our polyneural, zone-based reanimation approach for patients with neoplasm-induced facial paralysis. Methods: A retrospective review of consecutive patients who underwent facial reanimation surgery using multiple donor nerve transfers was undertaken. In each case, the selection of donor nerves was based on the availability of donor nerve and the viability of the motor endplate on the affected side. Sources of the neural inputs utilized included the remnant facial nerve stump, masseteric nerve, partial hypoglossal nerve, and branches of the contralateral facial nerve. Clinical outcomes were scored by expert raters. Ratings were undertaken using the modified House-Brackmann, eFACE and MEEI FACEgram scoring systems. Results: Between 2017 and 2020, 12 patients were included in the study (mean age 60 years; range 26-81 years). Eight patients (67%) achieved a grade III outcome on the modified House-Brackmann grading scale. Mean eFACE static and dynamic scores were 76 and 57 respectively, reflecting a high degree of symmetry at rest and moderate restoration of dynamic movement. Mean time to movement was 5.4 months (SD 1.9). Objective FACE-gram measurements confirmed restoration of midface movement with an average improvement in smile excursion and mouth angle excursion of 3.19 mm (SD 3.18) and 4.81 (SD 2.90) respectively. Conclusion: Facial reanimation using multiple nerve transfers is effective in achieving improvements in facial function and symmetry.

Analysis of risk factors related to the progression rate of hemifacial spasm

“…The facial nerve angle was defined as the angle between the inner margin of the facial acoustic nerve and the anterior surface of the brainstem at the point of nerve exit ( 8 ). Shein et al found that patients with smaller facial nerve angles had a higher incidence of hemifacial spasm ( 8 ).…”

“…The facial nerve angle was defined as the angle between the inner margin of the facial acoustic nerve and the anterior surface of the brainstem at the point of nerve exit ( 8 ). Shein et al found that patients with smaller facial nerve angles had a higher incidence of hemifacial spasm ( 8 ). Based on this, we speculated whether there was a critical value for the facial nerve angle that correlated with the progression rate of HFS patients.…”