title: Intracranial Facial Nerve Grafting in the Setting of Skull Base Tumors: Global and Regional Facial Function Analysis and Possible Implications for Facial Reanimation Surgery.
abstract: BACKGROUND
  Reconstructive surgeons may encounter patients presenting after intracranial facial nerve resection and grafting in the setting of skull base tumors, who inquire regarding progression, final facial function, and need for future operations. Study goals were to analyze global and regional facial function using established grading systems and videography, while examine variables possibly affecting outcomes.
  
  
  METHODS
  Between 1997 and 2012, 28 patients underwent intracranial nerve grafting. Fifteen were prospectively evaluated by three facial nerve physical therapists with the Facial Nerve Grading System 2.0 and the Sunnybrook Facial Grading Score for function and the Facial Disability Index for quality of life. Still photographs and videography were used to assess quality of motion and tone, while demographic and medical variables were analyzed regarding their effect on end results.
  
  
  RESULTS
  Average patient age was 41.9 years (range, 22 to 66 years), and there were 10 women and five men. Average time interval between nerve grafting and evaluations was 42.9 months (range, 12 to 146 months). Both grading scores demonstrated best outcomes in the periorbita and worst outcomes in the brow. Buccinator muscle tone also improved. The average total Facial Disability Index was 67.5 percent. Although not statistically significant, the data suggest that nerve gap length affected total resting symmetry and voluntary movement, whereas preoperative palsy and age may affect total resting symmetry. Perioperative radiation therapy, tumor type, donor nerve, and coaptation technique were not found to affect outcomes.
  
  
  CONCLUSIONS
  Intracranial facial nerve grafting largely provides better resting tone and facial symmetry, potentially improving end results of future intervention; however, overall voluntary facial motion is poor.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Dallas, Texas From the Departments of Plastic Surgery, Otolaryngology, Physical Therapy, and Neurosurgery, University of Texas Southwestern.
authors.forename: Shai M
authors.initials: SM
authors.lastname: Rozen
authors.forename: Bridget L
authors.initials: BL
authors.lastname: Harrison
authors.forename: Brandon
authors.initials: B
authors.lastname: Isaacson
authors.forename: J Walter
authors.initials: JW
authors.lastname: Kutz
authors.forename: Peter S
authors.initials: PS
authors.lastname: Roland
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Blau
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Barnett
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Mickey
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005149:Facial Expression; D020220:Facial Nerve Injuries / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult