A comparison of surgical techniques used in dynamic reanimation of the paralyzed face. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. [Otol Neurotol] Journal article | | Title | A comparison of surgical techniques used in dynamic reanimation of the paralyzed face. | | Author(s) | Malik TH, Kelly G, Ahmed A, Saeed SR, Ramsden RT | | Institution | University Department of Otorhinolaryngology-Head and Neck Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, England, UK. | | Source | Otol Neurotol 2005 Mar; 26(2):284-91. | | MeSH | Adolescent
Adult
Aged
Anastomosis, Surgical
Comparative Study
Facial Muscles
Facial Nerve
Facial Nerve Injuries
Facial Paralysis
Female
Humans
Hypoglossal Nerve
Intraoperative Complications
Male
Microsurgery
Middle Aged
Outcome and Process Assessment (Health Care)
Peripheral Nerves
Retrospective Studies
| | Abstract | OBJECTIVES: To compare the outcomes of three surgical techniques used in the rehabilitation of the paralyzed face.
STUDY DESIGN: Retrospective study.
SETTING: University-based tertiary referral center.
PATIENTS: Between 1976 and 2000, rehabilitative facial nerve surgery was performed on 70 adult patients with varying underlying diseases.
INTERVENTION: Three methods of facial nerve rehabilitative surgery were performed: end-to-end anastomosis, cable nerve graft interposition, and classic faciohypoglossal transposition.
MAIN OUTCOME MEASURES: The House-Brackmann grade was scored at 6, 12, 24, and 36 months by the two senior authors. A favorable outcome was defined as House-Brackmann Grade </= III. Other parameters recorded were repair technique, age, nerve rerouting, whether the repair was immediate or delayed, and the anatomic position of the nerve defect in relation to the geniculate ganglion.
RESULTS: Data were available on 66 patients (94%), of whom 13 had an end-to-end anastomosis, 25 a cable nerve graft interposition, and 28 a classic faciohypoglossal transposition. At 24 months, a House-Brackmann Grade </= III was achieved in 84.6% of those who underwent end-to-end anastomosis, 56.0% of those who underwent cable nerve graft interposition, and 25.0% of those who underwent classical faciohypoglossal transposition. End-to-end anastomosis and cable nerve graft interposition were superior to classic faciohypoglossal transposition (log-rank test, p = 0.0013). Twenty-five percent of all cases demonstrated improvement in House-Brackmann grade after 24 months. Increasing age at the time of repair was associated with a poorer outcome (p = 0.03 on logistic regression).
CONCLUSION: End-to-end anastomosis confers the best facial function, followed by cable nerve graft interposition and then classic faciohypoglossal transposition. Contrary to some previous opinions, improvement in facial function can still occur 2 years after surgical repair, particularly with classic faciohypoglossal transposition. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 15793421 |
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