Microsurgical repair of the facial nerve.
OBJECTIVE
To report a series of 18 patients who underwent microsurgical repair of the facial nerve using different techniques and to discuss the indications and results of facial reinnervation procedures.


METHODS
Eighteen patients with post-surgical facial palsy underwent facial reinnervation using different techniques.'These included classic hypoglossal-facial anastomosis in 13 cases, one-stage hemihypoglossal-intratemporal facial nerve anastomosis and translabyrinthine removal of residual intra-canalar acoustic schwannoma in 3, hemihypoglossal-facial nerve anastomosis in one, and neurotization of facial muscles through a nerve graft in one.


RESULTS
The facial muscle function improved in all patients, up to grade III in 7 cases (39 %), grade IV in 9 (50 %) and grade V in 2 (11 %). The tongue atrophy was minimal in 70.5 %, moderate in 17.5 % and severe in 12 %. The outcome was better in younger patients (less than 40 years of age) and in those with a lesser grade of preoperative facial impairment.


CONCLUSIONS
The classic hypoglossal-facial anastomosis is the technique of choice in most cases. The use of the intratemporal facial nerve is indicated when removal of an intra-canalar residual schwannoma must also be performed. The neurotization of the facial muscles through a nerve graft may be used when there is no distal trunk of the facial nerve available for the anastomosis.
Donzelli
R
R
Department of Neurological Sciences, Section of Neurosurgery, "Federico II" University, Naples, Italy. jafca2@hotmail.com
Maiuri
F
F
Peca
C
C
Cavallo
L M
LM
Motta
G
G
de Divitiis
E
E
D000328:Adult; D000714:Anastomosis, Surgical; D001284:Atrophy; D007758:Ear, Inner / Q000601:surgery; D005152:Facial Muscles / Q000294:innervation / Q000601:surgery; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009417:Nerve Tissue / Q000637:transplantation; D009464:Neuroma, Acoustic / Q000601:surgery; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000601:surgery; D014059:Tongue / Q000473:pathology; D014060:Tongue Diseases / Q000209:etiology; D016896:Treatment Outcome