Facial nerve reconstruction: outcome and failures.
OBJECTIVE
Our study was conducted to assess the outcome of reconstruction of the facial nerve after various resections for parotid neoplasms.


METHODS
A 10-year retrospective analysis of 350 primary parotid neoplasms (of which 70 were malignant) and 10 recurrent benign neoplasms involving facial nerve resection in 19 and 2 patients, respectively. Four patients had total resection of the facial nerve and reconstruction with a five-branch assemblage using standard microtechniques. Four patients had reconstruction of the orbital branch only. Twelve patients, of whom three also had a midface branch reconstructed, had reconstruction of the ramus mandibularis. One patient had a direct anastomosis of a partial resection of the main trunk of the nerve. Objective assessment of muscle activity was carried out in the distribution of the reconstructed nerve with a minimum of 18 months follow-up.


RESULTS
All four patients with total facial nerve reconstruction had excellent tone in repose. None had purposeful focused movement, and all had mass movement; however, all had good eye closure. None of the patients with mandibular branch grafting alone had useful return of function, but those who had concomitant midface grafting had good return of function of the reconstructed branches. All patients who had orbital grafting had appropriate eye closure.


CONCLUSIONS
Facial nerve grafting is effective to rehabilitate gaps in the pes anserinus, even if patients undergo postoperative radiotherapy. Total nerve grafting provides good tone in repose and eye closure, which justifies the procedure. Single-branch grafting is mandatory for the orbital branch, but one can question the use of a single-branch graft for the mandibular branch.
Department of Otolaryngology, Mt. Sinai Hospital, Toronto, Ontario.
J D
JD
Kerrebijn
J L
JL
Freeman
D000328:Adult; D005154:Facial Nerve / Q000502:physiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008866:Microsurgery; D010307:Parotid Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome