Outcome of different facial nerve reconstruction techniques

Abstract Introduction: There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. Objective: To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Methods: Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. Results: For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Conclusion: Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.

引言：目前尚无能够确保面神经功能恢复至House-Brackmann（HB）Ⅲ级的面神经重建技术。
研究目的：评估不同面神经重建技术的有效性与安全性。
研究方法：本研究纳入22例面神经功能为House-Brackmann（HB）Ⅵ级的患者，其中11例行面神经间置移植术，另11例行舌下神经-面神经吻合术。患者病因包括外伤或肿瘤切除术后，除7例患者于初次手术后2周至4个月行晚期重建外，其余患者均接受一期神经重建手术。所有患者的随访周期均不少于2年。
研究结果：对于面神经间置移植术组，8例患者术后面神经功能恢复至HB Ⅲ级，3例恢复至Ⅳ级；其中8例出现联动运动，2例合并联动运动与面部挛缩。对于采用不同改良术式的舌下神经-面神经吻合术组，9例患者术后面神经功能恢复至HB Ⅲ级，2例恢复至Ⅳ级；其中3例出现面部挛缩、联动运动及舌萎缩，5例出现联动运动。值得注意的是，接受一期直接面神经-舌下神经端侧吻合术的患者预后最佳，未出现任何神经功能缺损。
研究结论：在各类面神经功能重建技术中，若适应证适配，通过神经外膜缝合实施的直接端侧面神经-舌下神经吻合术是最为有效的术式，其可实现优异的面神经功能重建效果并保留舌部运动功能，尤其作为一期手术开展时效果尤为突出。