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Management of Facial Palsy

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Surgery of Cerebellopontine Lesions

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Abstract

Despite the major advancement in CP angle surgery, in certain cases, it is impossible to preserve normal facial nerve function. Even if the nerve is preserved anatomically, complete and lasting paralysis may ensue. Comprehensive management of patients with facial nerve paralysis aims at restoration of function and appearance, as well as prevention of negative sequelae. Restoration of facial nerve function can be performed by (1) nerve reconstruction, either directly or via an interposition graft, or (2) nerve reanimation with donor nerves. Direct end-to-end neurorrhaphy yields the best results, followed by reconstruction with interposition graft, and then reanimation with a donor nerve. Reanimation with donor nerve is indicated in case of complete facial nerve loss or loss of its proximal stump at the brain stem during tumor surgery, as well as in case the anatomically intact nerve shows no signs of recovery at follow-up. In case of nerve loss, the procedure is performed within 1 or 2 weeks after tumor removal. If a complete facial palsy persists for 10–12 months without signs of spontaneous functional or electromyographic recovery, even though the integrity of the nerve has been preserved, nerve reanimation procedure is also indicated.

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References

  1. Arai H, Sato K, Yanai A (1995) Hemihypoglossal-facial nerve anastomosis in treating unilateral facial palsy after acoustic neurinoma resection. J Neurosurg 82(1):51–54. doi:10.3171/jns.1995.82.1.0051

    Article  PubMed  CAS  Google Scholar 

  2. Arriaga MA, Brackmann DE (1992) Facial nerve repair techniques in cerebellopontine angle tumor surgery. Am J Otol 13(4):356–359

    PubMed  CAS  Google Scholar 

  3. Asaoka K, Sawamura Y (1999) Hypoglossal-facial nerve side-to-end anastomosis. J Neurosurg 91(1):163–164

    PubMed  CAS  Google Scholar 

  4. Campero A, Socolovsky M (2007) Facial reanimation by means of the hypoglossal nerve: anatomic comparison of different techniques. Neurosurgery 61(3 Suppl):41–49. doi:10.1227/01.neu.0000289710.95426.19; discussion 49–50

    Article  PubMed  Google Scholar 

  5. Cheney ML, McKenna MJ, Nath R, Healy C, Bartlett SP (1999) Facial nerve reconstruction and facial ­reanimation following oncologic surgery. Head Neck 21(3):276–284. doi:10.1002/(SICI)1097-0347(199905)21:3<276::AID-HED15>3.0.CO;2-K [pii]

    Article  PubMed  CAS  Google Scholar 

  6. Conley J, Baker DC (1979) Hypoglossal-facial nerve anastomosis for reinnervation of the paralyzed face. Plast Reconstr Surg 63(1):63–72

    Article  PubMed  CAS  Google Scholar 

  7. Cusimano MD, Sekhar L (1994) Partial hypoglossal to facial nerve anastomosis for reinnervation of the paralyzed face in patients with lower cranial nerve palsies: technical note. Neurosurgery 35(3):532–533; discussion 533–534

    Article  PubMed  CAS  Google Scholar 

  8. Darrouzet V, Guerin J, Bebear JP (1999) New technique of side-to-end hypoglossal-facial nerve attachment with translocation of the infratemporal facial nerve. J Neurosurg 90(1):27–34. doi:10.3171/jns.1999.90.1.0027

    Article  PubMed  CAS  Google Scholar 

  9. Dellon A (1992) Restoration of facial nerve function: an approach for the twenty-first century. Neurosurg Q 2:199–222

    Google Scholar 

  10. Dott NM (1958) Facial paralysis; restitution by extra-petrous nerve graft. Proc R Soc Med 51(11):900–902

    PubMed  CAS  Google Scholar 

  11. Draf W, Samii M (1980) Intracranial-intratemporal anastomosis of the facial nerve (author’s transl). Laryngol Rhinol Otol (Stuttg) 59(5):282–287

    Article  CAS  Google Scholar 

  12. Falcioni M, Taibah A, Russo A, Piccirillo E, Sanna M (2003) Facial nerve grafting. Otol Neurotol 24(3):486–489

    Article  PubMed  Google Scholar 

  13. Flores LP (2007) Surgical results of the Hypoglossal-Facial nerve Jump Graft technique. Acta Neurochir (Wien) 149(12):1205–1210. doi:10.1007/s00701-007-1412-x; discussion 1210

    Article  CAS  Google Scholar 

  14. Frey M, Giovanoli P, Michaelidou M (2006) Functional upgrading of partially recovered facial palsy by cross-face nerve grafting with distal end-to-side neurorrhaphy. Plast Reconstr Surg 117(2):597–608. doi:10.1097/01.prs.0000197136.56749.c6

    Article  PubMed  CAS  Google Scholar 

  15. Gidley PW, Gantz BJ, Rubinstein JT (1999) Facial nerve grafts: from cerebellopontine angle and beyond. Am J Otol 20(6):781–788

    PubMed  CAS  Google Scholar 

  16. Hammerschlag PE (1999) Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: evolution in management of facial paralysis. Laryngoscope 109(2 Pt 2 Suppl 90):1–23

    Article  PubMed  CAS  Google Scholar 

  17. Kessler LA, Moldaver J, Pool JL (1959) Hypoglossal-facial anastomosis for treatment of facial paralysis. Neurology 9(2):118–125

    Article  PubMed  CAS  Google Scholar 

  18. Magliulo G, D’Amico R, Forino M (2001) Results and complications of facial reanimation following cerebellopontine angle surgery. Eur Arch Otorhinolaryngol 258(1):45–48

    Article  PubMed  CAS  Google Scholar 

  19. Malik TH, Kelly G, Ahmed A, Saeed SR, Ramsden RT (2005) A comparison of surgical techniques used in dynamic reanimation of the paralyzed face. Otol Neurotol 26(2):284–291. doi:00129492-200503000-00028 [pii]

    Article  PubMed  Google Scholar 

  20. Manni JJ, Beurskens CH, van de Velde C, Stokroos RJ (2001) Reanimation of the paralyzed face by indirect hypoglossal-facial nerve anastomosis. Am J Surg 182(3):268–273. doi:S0002-9610(01)00715-2 [pii]

    Article  PubMed  CAS  Google Scholar 

  21. May M (1984) Muscle transposition for facial reanimation. Indications and results. Arch Otolaryngol 110(3):184–189

    Article  PubMed  CAS  Google Scholar 

  22. May M, Sobol SM, Mester SJ (1991) Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy. Otolaryngol Head Neck Surg 104(6):818–825

    PubMed  CAS  Google Scholar 

  23. Pitty LF, Tator CH (1992) Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors. J Neurosurg 77(5):724–731. doi:10.3171/jns.1992.77.5.0724

    Article  PubMed  CAS  Google Scholar 

  24. Sabin HI, Bordi LT, Symon L, Compton JS (1990) Facio-hypoglossal anastomosis for the treatment of facial palsy after acoustic neuroma resection. Br J Neurosurg 4(4):313–317

    Article  PubMed  CAS  Google Scholar 

  25. Samii M (1981) Preservation and reconstruction of the facial nerve in the cerebellopontine angle. In: Samii M, Janetta P (eds) The cranial nerves. Springer, Berlin, pp 438–450

    Chapter  Google Scholar 

  26. Samii M (1984) Facial nerve grafting in acoustic neurinoma. Clin Plast Surg 11(1):221–225

    PubMed  CAS  Google Scholar 

  27. Samii M (1986) Surgery of facial nerve paralysis. No Shinkei Geka 14(8):943–955

    PubMed  CAS  Google Scholar 

  28. Samii M, Draf W (1989) Surgery of the skull base. Springer, Heidelberg

    Book  Google Scholar 

  29. Samii M, Jannetta P (eds) (1981) The cranial nerves: anatomy, pathology, pathophysiology, diagnosis, treatment. Springer, New York

    Google Scholar 

  30. Samii M, Koerbel A, Safavi-Abbasi S, Di Rocco F, Samii A, Gharabaghi A (2006) Using an end-to-side interposed sural nerve graft for facial nerve reinforcement after vestibular schwannoma resection. Technical note. J Neurosurg 105(6):920–923. doi:10.3171/jns.2006.105.6.920

    Article  PubMed  Google Scholar 

  31. Samii M, Matthies C (1994) Indication, technique and results of facial nerve reconstruction. Acta Neurochir (Wien) 130(1–4):125–139

    Article  CAS  Google Scholar 

  32. Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve–preservation and restitution of function. Neurosurgery 40(4):684–694; discussion 694–685

    Article  PubMed  CAS  Google Scholar 

  33. Tate JR, Tollefson TT (2006) Advances in facial reanimation. Curr Opin Otolaryngol Head Neck Surg 14(4):242–248. doi:10.1097/01.moo.0000233594.84175.a0

    Article  PubMed  Google Scholar 

  34. Viterbo F, Trindade JC, Hoshino K, Mazzoni A (1994) Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats. Br J Plast Surg 47(2):75–80

    Article  PubMed  CAS  Google Scholar 

  35. Viterbo F, Trindade JC, Hoshino K, Mazzoni Neto A (1994) End-to-side neurorrhaphy with removal of the epineural sheath: an experimental study in rats. Plast Reconstr Surg 94(7):1038–1047

    Article  PubMed  CAS  Google Scholar 

  36. Ylikoski J, Brackmann DE, Savolainen S (1982) Facial nerve abnormalities after acoustic tumor removal. Morphological and clinical study of seven patients with postoperative facial paralysis. Arch Otolaryngol 108(12):795–800

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. International Neuroscience Institute INI, Hannover, Germany

    Madjid Samii

  2. Department of Neurosurgery, International Neuroscience Institute, Hannover, Germany

    Venelin Gerganov

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  1. Madjid Samii
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  2. Venelin Gerganov
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Samii, M., Gerganov, V. (2013). Management of Facial Palsy. In: Surgery of Cerebellopontine Lesions. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35422-9_12

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  • DOI: https://doi.org/10.1007/978-3-642-35422-9_12

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-35421-2

  • Online ISBN: 978-3-642-35422-9

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