Selective role of partial XI-VII anastomosis in facial reanimation.
OBJECTIVE
Review techniques available for transposition of an alternative motor neuron if end-to-end anastomosis or interposition nerve grafting cannot be accomplished when there has been a complete facial nerve loss. Describe the selective use of a partial spinal accessory-facial nerve anastomosis and highlight cases when this may be a useful alternative. Describe the modifications of decompression of the facial nerve for tension-free anastomosis and the use of the muscle pedicle for repair of cerebrospinal fluid leakage.


METHODS
Report of three cases and a review of the literature.


METHODS
Charts were reviewed and indications for the procedure were analyzed. The degree of facial movement was recorded as well as the resolution of any cerebrospinal fluid leak.


RESULTS
The results varied between Class III and Class IV on the House-Brackmann scale following initial complete paralysis. In the two cases in which spinal fluid leakage had occurred before surgery the leakage was resolved. No donor site morbidity was noted.


CONCLUSIONS
The potential of low morbidity associated with the use of the sternocleidomastoid branch, along with the potential for delivering a vascularized muscle pedicle to the temporal bone region, makes selective use of this procedure a valuable addition to the multiple reconstruction options for the paralyzed face.
Griebie
M S
MS
ENT Professional Associates, Ltd., Minneapolis, Minnesota 55402, USA.
Huff
J S
JS
D000055:Accessory Nerve / Q000601:surgery*; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002528:Cerebellar Neoplasms / Q000601:surgery; D002530:Cerebellopontine Angle / Q000601:surgery; D002558:Cerebrospinal Fluid Otorrhea / Q000601:surgery; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000601:surgery; D004428:Ear Neoplasms / Q000601:surgery; D005152:Facial Muscles / Q000503:physiopathology / Q000601:surgery; D005154:Facial Nerve / Q000503:physiopathology / Q000601:surgery*; D005158:Facial Paralysis / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D009119:Muscle Contraction / Q000502:physiology; D009334:Neck Muscles / Q000637:transplantation; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000601:surgery; D009442:Neurilemmoma / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D013701:Temporal Bone / Q000601:surgery; D015837:Vestibular Diseases / Q000601:surgery