Impact of Patient and Surgical Factors on Outcomes of Facial Re-innervation Procedures.
TL;DR
End-to-end anastomosis appears to give the greatest improvement in facial nerve function, and where this is not viable, both grafting and nerve transfer should be given equal weighting when considered in a patient specific context.
Abstract
Background
Patients in whom the facial nerve has been resected or divided during surgical treatment may have it repaired by direct anastomosis, interposition graft, or may either primarily or up to 2 years later undergo reinnervation of the facial musculature, in most cases using the masseteric or hypoglossal nerve. The aim of this study is to compare outcomes of facial reanimation procedures for those who have undergone either direct anastomosis, nerve grafting, or masseteric nerve transfer.
Methods
Retrospective case note review of patients attending the Facial Palsy Clinics. Patients in whom surgery was not part of the treatment provided, revision cases, patients with recurrence of pathology, or incomplete datasets were excluded. Patient factors, etiology, operative findings, and pre- and post-operative Sunnybrook Facial Grading were recorded. In order to allow for differences in recovery time, the post-operative score was considered as the score recorded when improvement had plateaued.
Results
Thirty (16 female, 14 male) patients underwent primary surgery for facial palsy. Median age was 44 years. Sixteen patients underwent "Nerve Transfer," 10 "Nerve Grafting," and 4 "End-to-End." Pre-operative Sunnybrook Facial Grading Scale did not differ between the three subgroups. Nerve transfer patients had a mean post-operative score of 58.1, nerve graft 51.4, and end-to-end 68.8 (Chi2=2.196, P=.33).
Conclusion
End-to-end anastomosis, where viable, appears to give the greatest improvement in facial nerve function. Where this is not viable, both grafting and nerve transfer should be given equal weighting when considered in a patient specific context.