title: Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes.
abstract: OBJECTIVE
  Reanimation of facial paralysis is a complex problem with multiple treatment options. One option is hypoglossal-facial nerve grafting, which can be performed in the immediate postoperative period after nerve transection, or in a delayed setting after skull base surgery when the nerve is anatomically intact but function is poor. The purpose of this study is to investigate the effect of timing of hypoglossal-facial grafting on functional outcome.
  
  
  METHODS
  A retrospective case series from a single tertiary otologic referral center was performed identifying 60 patients with facial nerve injury following cerebellopontine angle tumor extirpation. Patients underwent hypoglossal-facial nerve anastomosis following facial nerve injury. Facial nerve function was measured using the House-Brackmann facial nerve grading system at a median follow-up interval of 18months. Multivariate logistic regression analysis was used determine how time to hypoglossal-facial nerve grafting affected odds of achieving House-Brackmann grade of ≤3.
  
  
  RESULTS
  Patients who underwent acute hypoglossal-facial anastomotic repair (0-14days from injury) were more likely to achieve House-Brackmann grade ≤3 compared to those that had delayed repair (OR 4.97, 95% CI 1.5-16.9, p=0.01).
  
  
  CONCLUSIONS
  Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Yawn
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: Harry V
authors.initials: HV
authors.lastname: Wright
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Stephan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN, USA. Electronic address: marc.bennett@vanderbilt.edu.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Bennett
mesh_terms: D000328:Adult; D020220:Facial Nerve Injuries / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000637:transplantation*; D007431:Intraoperative Complications / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome