title: Global assessment of outcomes after varying reinnervation techniques for patients with facial paralysis subsequent to acoustic neuroma excision.
abstract: OBJECTIVE
  To determine whether there are objective and/or subjective differences in facial function, tongue function and quality of life in patients who have undergone 1) direct facial-to-facial (Primary, 4 patients), 2) direct facial-to-hypoglossal (End-to-End, 7 patients), 3) end-to-side facial-to-hypoglossal nerve anastomoses with sural nerve/greater auricular nerve interposition (End-to-Side with Interposition Graft, 7 patients), and 4) end-to-side facial-to-hypoglossal nerve anastomoses (End-to-Side, 7 patients) after acoustic neuroma excision.
  
  
  METHODS
  Tertiary university referral center.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Twenty-five patients with complete facial paralysis after acoustic neuroma surgery who have also undergone 1 of 4 types of facial musculature reinnervation volunteered for the study. The mean duration of follow-up was 11.5 years (range, 1-25 yr). Each patient was globally assessed using the Sunnybrook Facial Grading scale (objective), Facial Disability Index (subjective), Oral-Pharyngeal Disability Index (subjective), Tongue Movement/Muscle symmetry (objective), and short-form SF-36 quality-of-life index (subjective).
  
  
  RESULTS
  Patients who underwent direct facial-to-hypoglossal anastomosis had generally poorer outcomes some of which were statistically significant (p < 0.05) in some components of the Oral-Pharyngeal Disability Index. All of these patients had reduced lateral tongue movement as well as ipsilateral tongue atrophy. There was no significant difference in the Sunnybrook Facial Grading scale scores in those patients in whom end-to-side interposition reinnervation surgery was performed compared with those in whom direct end-to-side anastomosis surgery was performed.
  
  
  CONCLUSIONS
  Complete sacrifice of the ipsilateral hypoglossal nerve does present with clinically and statistically significant morbidity in patients. Facial function is statistically similar in patients who underwent an end-to-side anastomosis with or without an interposition graft. These findings suggest thatin the setting of the posttranslabryinthine approach, the technicallyeasier interposition graft procedure is not acompromise.
authors.affiliation: Department of Otolaryngology/Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada. vincent.lin@sunnybrook.ca
authors.forename: Vincent
authors.initials: V
authors.lastname: Lin
authors.forename: Marlene
authors.initials: M
authors.lastname: Jacobson
authors.forename: Joanne
authors.initials: J
authors.lastname: Dorion
authors.forename: Joseph
authors.initials: J
authors.lastname: Chen
authors.forename: Julian
authors.initials: J
authors.lastname: Nedzelski