title: A comparison of surgical techniques used in dynamic reanimation of the paralyzed face.
abstract: OBJECTIVE
  To compare the outcomes of three surgical techniques used in the rehabilitation of the paralyzed face.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University-based tertiary referral center.
  
  
  METHODS
  Between 1976 and 2000, rehabilitative facial nerve surgery was performed on 70 adult patients with varying underlying diseases.
  
  
  METHODS
  Three methods of facial nerve rehabilitative surgery were performed: end-to-end anastomosis, cable nerve graft interposition, and classic faciohypoglossal transposition.
  
  
  METHODS
  The House-Brackmann grade was scored at 6, 12, 24, and 36 months by the two senior authors. A favorable outcome was defined as House-Brackmann Grade </= III. Other parameters recorded were repair technique, age, nerve rerouting, whether the repair was immediate or delayed, and the anatomic position of the nerve defect in relation to the geniculate ganglion.
  
  
  RESULTS
  Data were available on 66 patients (94%), of whom 13 had an end-to-end anastomosis, 25 a cable nerve graft interposition, and 28 a classic faciohypoglossal transposition. At 24 months, a House-Brackmann Grade </= III was achieved in 84.6% of those who underwent end-to-end anastomosis, 56.0% of those who underwent cable nerve graft interposition, and 25.0% of those who underwent classical faciohypoglossal transposition. End-to-end anastomosis and cable nerve graft interposition were superior to classic faciohypoglossal transposition (log-rank test, p = 0.0013). Twenty-five percent of all cases demonstrated improvement in House-Brackmann grade after 24 months. Increasing age at the time of repair was associated with a poorer outcome (p = 0.03 on logistic regression).
  
  
  CONCLUSIONS
  End-to-end anastomosis confers the best facial function, followed by cable nerve graft interposition and then classic faciohypoglossal transposition. Contrary to some previous opinions, improvement in facial function can still occur 2 years after surgical repair, particularly with classic faciohypoglossal transposition.
authors.affiliation: University Department of Otorhinolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, England, UK.
authors.forename: Tass H
authors.initials: TH
authors.lastname: Malik
authors.forename: Gerard
authors.initials: G
authors.lastname: Kelly
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmed
authors.forename: Shakeel R
authors.initials: SR
authors.lastname: Saeed
authors.forename: Richard T
authors.initials: RT
authors.lastname: Ramsden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005152:Facial Muscles / Q000294:innervation*; D005154:Facial Nerve / Q000601:surgery*; D020220:Facial Nerve Injuries / Q000601:surgery; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D007431:Intraoperative Complications / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010525:Peripheral Nerves / Q000637:transplantation*; D012189:Retrospective Studies