Neurorrhaphy for Facial Reanimation with Interpositional Graft: Outcome in 23 Patients and the Impact of Timing on the Outcome

• Published in: World neurosurgery Vol. 126; pp. e688 - e693
• Main Authors: Gao, Zhen, Jia, Xian-hao, Xu, Jian, Yu, Jing, Wang, Jing, Zhao, Wei-dong, Chi, Fang-lu, Dai, Chun-fu, Li, Hua-wei, Zhong, Ping, Chen, Bing, Yuan, Ya-sheng
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019
• Subjects: Adult; End-to-end anastomosis; End-to-side hypoglossal-facial anastomosis; Facial Nerve - surgery; Facial Nerve Injuries - complications; Facial Nerve Injuries - surgery; Facial paralysis; Facial Paralysis - etiology; Facial Paralysis - surgery; Female; Humans; Hypoglossal Nerve - transplantation; Interpositional graft; Male; Middle Aged; Nerve Transfer - methods; Neurorrhaphy; Neurosurgical Procedures - methods; Reconstructive Surgical Procedures - methods; Retrospective Studies; Time-to-Treatment; Treatment Outcome; Young Adult; Neurorrhaphy; Interpositional graft; End-to-side hypoglossal-facial anastomosis; HB; End-to-end anastomosis; Facial paralysis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.02.124

Neurorrhaphy with interpositional graft is a practical technique to achieve facial reanimation when the continuity of the facial nerve is interrupted and a large gap between the proximal and distal stump exists. The aim of this study was to report long-term outcomes of neurorrhaphy for facial reanimation with interpositional graft. The roles of some variable factors in the outcome of neurorrhaphy with interpositional graft were also evaluated and compared.
A retrospective case series from a single tertiary referral center comprised 23 patients with facial nerve interruptions who underwent neurorrhaphy with interpositional graft using either end-to-end anastomosis or end-to-side hypoglossal-facial technique. Preoperative data (age, sex, primary lesion, interval from paralysis to surgery, facial nerve function), intraoperative data (surgical approach, graft and type of neurorrhaphy), and postoperative data (facial nerve function) were collected and analyzed.
Mean follow-up time was 26.6 ± 11.9 months. Patients who underwent neurorrhaphy for facial reanimation within 1 year after onset of facial paralysis were more likely to achieve House-Brackmann grade ≤3 compared with patients who underwent neurorrhaphy >1 year after onset of facial paralysis (odds ratio = 23.85, P = 0.04). No other factors were associated with improved outcomes.
Early neurorrhaphy with interpositional graft (≤1 year) for facial reanimation resulted in better final facial nerve function outcomes compared with a delayed procedure.