RESULTS OF IMMEDIATE FACIAL NERVE RECONSTRUCTION IN PATIENTS UNDERGOING PAROTID TUMOUR RESECTION
Abstract
Background: Facial nerve is usually sacrificed in total parotidectomy. The objective of this study is to present results of immediate reconstruction of facial nerve in total parotidectomy cases where facial nerve is sacrificed. Methods: This is a prospective study done in patients who had total parotidectomy including facial nerve and immediate reconstruction was done with inter-positional nerve grafts (sural n=12 and greater auricular n=10) from December 2017 till February 2018 by single surgeon (MR). Wounds were closed primarily (n=15), local flap (n=2) and free flap (n=5). Clinical evaluation was done at four months minimum follow up (those operated in January to February 2018) and eight months maximum follow up (those operated in December 2017), for facial nerve functional recovery using House and Brackmann grading system by single author (MR). Results: Total of 22 (male n=7, female n=15) patients included in study from December 2017 till February 2018. Sural nerve grafts were used in 54% (n=12) and greater auricular nerve grafts in 45% (n=10) patients for reconstruction of facial nerve. On clinical evaluation using House and Brackmann grading system, showed grade V (n=4), grade IV (n=7), grade III (n=8) and grade II (n=3) repairs. Conclusion: Although primary end to end facial nerve repair is ideal but in situation where a significant segment of nerve is lost or where the repair is under tension, inter-positional nerve grafting is a simple and reliable reconstructive technique with good outcomes.Keywords: Facial nerve immediate reconstruction; total parotidectomy; sural nerve grafts; Facial nerve palsy; House and Brackmann grading; facial reanimationReferences
House JW, Brackman DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93(2):146–7.
Berger A, Bargmann HJ. Functional reconstruction after facial paralysis: a survey. World J Surg1990;14(6):748–56.
Millesi H. Nerve suture and grafting to restore the extratemporal facial nerve. Clin Plast Surg 1979;6(3):333–41.
Sobol SM, May M, Mester S. Early facial reanimation following radical parotid and temporal bone tumour resections. Am J Surg 1990;160(4):382–6.
Chuang DC, Wei FC, Noordhoff MS. "Smile" reconstruction in facial paralysis. Ann Plast Surg 1989;23(1):56–65.
Jääskeläinen J, Pyykkö I, blomstedt G, Porras M, Palva T, Troupp H. Functional results of facial nerve suture after removal of acoustic neurinoma: Analysis of 25 cases. Neurosurgery 1990;27(3):408–11.
Barrs DM. Facial nerve trauma: optimal timing for repair. Laryngoscope 1991;101(8):835–48.
Draf W. Surgical rehabilitation of facial nerve. Acta Neurochir (Wien) 1988;92(1–4):67–75.
May M, Sobol SM, Mester SJ. Managing segmental facial nerve injuries by surgical repair. Laryngoscope 1990;100(10 Pt 1):1062–7.
Iseli TA, Harris G, Dean NR, Iseli CE, Rosenthal EL. Outcomes of static and dynamic facial nerve repair in head and neck cancer. Laryngoscope 2010;120(3):478–83.
Allan J, Cha J, Kwei J, Vandervord JG. Sequelae following radical parotidectomy: the role of the reconstructive surgeon. Eplasty 2014;14:ic9.
Guntinas-Lichius O, Streppel M, Stennert E. Postoperative functional evaluation of different reanimation techniques for facial nerve repair. Am J Surg 2006;191(1):61–7.
Terzis JK, Kalantarian B. Microsurgical strategies in 74 patients for restoration of dynamic depressor muscle mechanism: a neglected target in facial reanimation. Plast Reconstr Surg 2000;105(6):1917–31.
Körte W, Bernhardt M. Ein Fall von Nervenpfropfung: des Nervus facialis auf den Nervus hypoglossus. Dtsch Med Wochenschr 1903;29(17):293–5.
Conley J, Baker DC. Hypoglossal-facial nerve anastomosis for reinnervation of the paralyzed face. Plast Reconstr Surg 1979;63(1):63–72.
de Oliveira FA, Duarte EC, Taveira CT, Máximo AA, de Aquino EC, Alencar Rde C, et al. Salivary gland tumour: a review of 599 cases in a Brazilian population. Head Neck Pathol 2009;3(4):271–5.
Kane WJ, McCaffrey TV, Olsen KD, Lewis JE. Primary parotid malignancies: a clinical and pathologic review. Arch Otolaryngol Head Neck Surg 1991;117(3):307–15.
Bell RB, Dierks EJ, Homer L, Potter BE. Management and outcome of patients with malignant salivary gland tumours. J Oral Maxillofac Surg 2005;63(7):917–28.
Horowitz SW, Leonetti JP, Azar-Kia B, Fine M, Izquierdo R. CT and MR of temporal bone malignancies primary and secondary to parotid carcinoma. AJNR Am J Neuroradiol 1994;15(4):755–62.
Agrogiannis N, Rozen S, Reddy G, Audolfsson T, Rodriguez‐Lorenzo A. Vastus lateralis vascularized nerve graft in facial nerve reconstruction: An anatomical cadaveric study and clinical implications. Microsurgery 2015;35(2):135–9.
Motomura H, Yamanaka K, Maruyama Y, Sakamoto M, Harada T. Facial nerve reconstruction using a muscle flap following resection of parotid gland tumours with thorough recipient bed preparation. J Plast Reconstr Aesthet Surg 2011;64(5):595–601.
Reddy PG, Arden RL, Mathog RH. Facial nerve rehabilitation after radical parotidectomy. Laryngoscope 1999;109(6):894–9.
Boahene K. Reanimating the paralyzed face. F1000Prime Rep 2013;5:49.
Iida T, Nakagawa M, Asano T, Fukushima C, Tachi K. Free vascularized lateral femoral cutaneous nerve graft with anterolateral thigh flap for reconstruction of facial nerve defects. J Reconstr Microsurg 2006;22(05):343–8.
Neiss WF, Guntinas Lichius O, Angelov DN, Gunkel A, Stennert E. The hypoglossal-facial anastomosis as model of neuronal plasticity in the rat. Ann Anat 1992;174(5):419–33.
Satoh Y, Kanzaki J, Yoshihara S. A comparison and conversion table of ‘the House–Brackmann facial nerve grading system’and ‘the Yanagihara grading system’. Auris Nasus Larynx 2000;27(3):207–12.
Tomov TL, Guntinas-Lichius O, Grosheva M, Streppel M, Schraermeyer U, Neiss WF, et al. An example of neural plasticity evoked by putative behavioral demand and early use of vibrissal hairs after facial nerve transection. Exp Neurol 2002;178(2):207–18.
Kimata Y, Sakuraba M, Hishinuma S, Ebihara S, Hayashi R, Asakage T. Free vascularized nerve grafting for immediate facial nerve reconstruction. Laryngoscope 2005;115(2):331–6.
Doi K, Tamaru K, Sakai K, Kuwata N, Kurafuji Y, Kawai S. A comparison of vascularized and conventional sural nerve grafts. J Hand Surg Am 1992;17(4):670–6.
Hontanilla B, Qiu SS, Marré D. Effect of postoperative brachytherapy and external beam radiotherapy on functional outcomes of immediate facial nerve repair after radical parotidectomy. Head Neck 2014;36(1):113–9.
Brown PD, Eshleman JS, Foote RL, Strome SE. An analysis of facial nerve function in irradiated and unirradiated facial nerve grafts. Int J Radiat Oncol Biol Phys 2000;48(3):737–43.
Gidley PW, Herrera SJ, Hanasono MM, Yu P, Skoracki R, Roberts DB, et al. The impact of radiotherapy on facial nerve repair. Laryngoscope 2010;120(10):1985–9.
Ch'ng S, Ashford BG, Gao K, McGuinness J, Clark JR. Reconstruction of post–radical parotidectomy defects. Plast Reconstr Surg 2012;129(2):e275–87.
Fisch U, Lanser MJ. Facial nerve grafting. Otolaryngol Clin North Am 1991;24(3):691–708.
Vaughan ED, Richardson D. Facial nerve reconstruction following ablative parotid surgery. Br J Oral Maxillofac Surg 1993;31(5):274–80.
Mohamed A, Omi E, Honda K, Suzuki S, Ishikawa K. Outcome of different facial nerve reconstruction techniques. Braz J Otorhinolaryngol 2016;82(6):702–9.
Renkonen S, Sayed F, Keski-Säntti H, Ylä-Kotola T, Bäck L, Suominen S, et al. Reconstruction of facial nerve after radical parotidectomy. Acta Otolaryngol 2015;135(10):1065–9.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
