Early Nerve Grafting for Facial Paralysis After Cerebellopontine Angle Tumor Resection With Preserved Facial Nerve Continuity

Albathi, Monirah; Oyer, Sam; Ishii, Lisa E.; Byrne, Patrick J.; Ishii, Masaru; Boahene, Kofi

doi:10.1001/jamafacial.2015.1558

Cited by 65 publications

(61 citation statements)

References 17 publications

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“…10,23,41 Whereas this review did not seek to compare masseteric transfer to other cranial nerve transfers, 2 of the included studies did. Masseteric nerve was shown to have a faster rate of recovery than hypoglossal nerve transfers in 2 studies, those of Albathi et al 19 (5.6 vs 10.8 months) and Hontanilla and colleagues 1 (62 vs 136 days). Time to nerve recovery was not only linked to facial nerve branch, but also age of the patient.…”

Section: Discussionmentioning

confidence: 92%

“…38 Therefore, the ability of procedures to reestablish symmetry be- tween the paretic and healthy sides of the face, both at rest and smiling, has long been one of the most important primary outcome measures in facial paralysis treatment. Three studies in our cohort used similarly graded qualitative scales to measure symmetry, Smile Recovery Score (Albathi 19 ) and Terzis Smile Function (Bianchi et al, 20 Wang et al 22 ) Score. Both are observer graded, 5-point scales focusing on smile function in regard to symmetry.…”

Section: Discussionmentioning

confidence: 99%

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Masseteric Nerve Transfer for Facial Nerve Paralysis

Murphey

Clinkscales

Oyer

2018

JAMA Facial Plast Surg

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IMPORTANCE A review of the role of masseteric nerve transfer is needed to guide its use in facial reanimation. OBJECTIVE To systematically review the available literature, and, when applicable, analyze the combined outcomes of masseteric nerve transfer to better define its role in reanimation and to guide further research. DATA SOURCES Two independent researchers conducted the review using PubMed-NCBI and Scopus literature databases for studies on masseteric nerve transfer for facial nerve paralysis. STUDY SELECTION Studies that examined masseter nerve transfer with additional cranial nerve transposition/coaptation or muscle flap were excluded. DATA EXTRACTION AND SYNTHESIS Literature review and data extraction followed established PRISMA guidelines. Two researchers extracted data independently. MAIN OUTCOMES AND MEASURES The main planned outcomes for the study were quantitative results of facial nerve movement after nerve transfer including oral commissure movement and time to nerve recovery. RESULTS A total of 13 articles met inclusion criteria with a total of 183 patients undergoing masseteric nerve transfer. From those studies, there were a total of 183 patients who underwent masseteric nerve transfer. There were 85 men and 98 women with a mean (SD) age of 43 (12.2) years and mean (SD) follow up examination after surgery of 22 (7.6) months. Mean (SD) duration of nerve paralysis was 14 (6) months. Most common cause of paralysis was cerebellopontine angle tumors (81%). Six studies coapted the masseteric nerve to the main facial nerve trunk, whereas 7 used distal branches (buccal or zygomatic). Four studies used interposition nerve grafts with great auricular nerve. Two measures, improvement in oral commissure excursion and length from reanimation to facial movement, were measured consistently across the studies. Pooled analysis showed time from surgery to first facial movement, described in 10 studies, to be 4.95 months (95% CI, 3.66 to 6.24). Distal branch coaptation improved time to recovery vs main branch coaptation, 3.76 vs 5.76 months (95% CI, −0.33 to 4.32), but mean difference was not significant. The use of interposition graft significantly delayed time of nerve recovery, 6.24 vs 4.06 months (95% CI, 0.20 to 4.16). When controlled for main trunk coaptation only, interposition nerve graft delayed recovery but difference was no longer statistically significant, 6.24 vs 4.75 months (95% CI, −0.94 to 3.92). Reported complications were minor and rare occurring in only 6.5% (12 of 183) of patients. CONCLUSIONS AND RELEVANCE The masseteric nerve was found to be a good option for nerve transfer in this patient population, and showed favorable results in both time to nerve recovery and improvement in oral commissure excursion. LEVEL OF EVIDENCE NA.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Masseteric Nerve Transfer for Facial Nerve Paralysis

Murphey

Clinkscales

Oyer

2018

JAMA Facial Plast Surg

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“…Facial asymmetry was assessed with the facial asymmetry index (FAI) that was generated using the Mirror medical imaging software. 16 First, the length from the medial canthus to the ip-silateral oral commissure was measured on the affected and nonaffected sides. The difference between these 2 values, which provides an objective quantitative measure of asymmetry, is termed the facial asymmetry index (mm).…”

Section: Restoration Of Facial Symmetrymentioning

confidence: 99%

“…Recovered smiles were rated from 1 to 5 (1, poor; 2, adequate; 3, good; 4, very good; 5, excellent). 16 The smile recovery was reproducibly and objectively scored based on dental show counting the number of exposed upper teeth on each side of midline.…”

Section: Smile Recovery Scorementioning

confidence: 99%

Transposition of the Intratemporal Facial to Hypoglossal Nerve for Reanimation of the Paralyzed Face

Kochhar

Albathi²,

Sharon³

et al. 2016

JAMA Facial Plast Surg

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The hypoglossal nerve has long been an axonal source for reinnervation of the paralyzed face. In this study, we report our experience with transposition of the intratemporal facial nerve to the hypoglossal nerve for facial reanimation. OBJECTIVES To determine the feasibility and outcomes of the transposition of the infratemeporal facial nerve for end-to-side coaptation to the hypoglossal nerve for facial reanimation. DESIGN, SETTINGS, AND PARTICIPANTS A case series of 20 patients with facial paralysis who underwent mobilization and transposition of the intratemporal segment of the facial nerve for an end-to-side coaptation to the hypoglossal nerve (the VII to XII technique). Participants were treated between January 2007 and December 2014 at a tertiary care center. MAIN OUTCOMES AND MEASURES Outcome measures include paralysis duration, facial tone, facial symmetry at rest, and with smile, oral commissure excursion, post-reanimation volitional smile, and synkinesis. METHODS Demographic data, the effects of this technique on facial tone, symmetry, oral commissure excursion and smile recovery were evaluated. Preoperative and postoperative photography and videography were reviewed. Facial symmetry was assessed with a facial asymmetry index. Smile outcomes were evaluated with a visual smile recovery scale, and lip excursion was assessed with the MEEI-SMILE system. RESULTS All 20 patients had adequate length of facial nerve mobilized for direct end-to-side coaptation to the hypoglossal nerve. The median duration of facial paralysis prior to treatment was 11.4 months. Median follow-up time was 29 months. Three patients were excluded from functional analysis due to lack of follow-up. Facial symmetry at rest and during animation improved in 16 of 17 patients. The median (range) time for return of facial muscle tone was 7.3 (2.0-12.0) months. A significant reduction in facial asymmetry index occurred at rest and with movement. The MEEI FACE-gram software detected a significant increase in horizontal, vertical, overall lip excursion and smile angle. No patient developed significant tongue atrophy, impaired tongue mobility, or speech or swallow dysfunction. CONCLUSIONS AND RELEVENCE Mobilization of the intratemporal segment of the facial nerve provides adequate length for direct end-to-end coaptation to the hypoglossal nerve and is effective in restoring facial tone and symmetry after facial paralysis. The resulting smile is symmetric or nearly symmetric in the majority of patients with varying degree of dental show. The additional length provided by utilizing the intratemporal segment of the facial nerve reduces the deficits associated with complete hypoglossal division/splitting, and avoids the need for interposition grafts and multiple coaptation sites. LEVEL OF EVIDENCE 4.

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“…In cases of planned facial nerve resection due to oncological reasons, early nerve grafting or facial reanimation procedures can be performed. If inadvertent intraoperative facial nerve injury occurs, direct coaptation of the facial nerve or interposition nerve grafting are possible, even in proximal injuries (Albathi et al, ; Arriaga & Brackmann, ; Humphrey & Kriet, ).…”

Section: Introductionmentioning

confidence: 99%

Functional results after facial reanimation in iatrogenic facial palsy

et al. 2019

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Background Iatrogenic facial nerve injury is a common cause of long‐standing facial palsy. This study aimed to assess functional results after facial reanimation in iatrogenic facial palsy and to determine correlating patient factors. Methods The data of 128 iatrogenic facial palsy patients were analyzed for this case series. Inclusion criteria for assessment of facial function by three‐dimensional video analysis were preoperative and postoperative (>18 months) video sets for facial marker tracking, which were available in 63 patients. Demographic factors and treatment concepts were analyzed and correlations to functional outcomes calculated. Results One hundred and twenty‐eight patients with iatrogenic facial palsy underwent facial reanimation procedures and were included in this study. The mean duration of facial palsy was 7.8 years. The most common procedures leading to iatrogenic facial palsy were acoustic neuroma resection (29.7%), parotidectomy (21.1%), and brainstem/cerebellopontine angle tumor resection (21.1%). Selected functional results were significantly improved after facial reanimation surgery. The mean lagophthalmos during eyelid closure reduced from 7.3 ± 4.1 mm to 5.4 ± 4 mm (p < .001). The function of the mouth was significantly improved, both statically (static asymmetry: 10.3 ± 7.6 mm preoperatively, 0.8 ± 9.5 mm postoperatively; p < .001), and during smile movement (“Dynamic Symmetry Index”: 0.16 preoperatively, 0.39 postoperatively; p < .001). The mean duration of facial palsy correlated with postoperative smiling function (r = .358, p = .011). Conclusion Facial reanimation significantly improves facial function in iatrogenic facial palsy. Early referral to a facial nerve center is crucial as duration of facial palsy influences functional outcomes.

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Early Nerve Grafting for Facial Paralysis After Cerebellopontine Angle Tumor Resection With Preserved Facial Nerve Continuity

Cited by 65 publications

References 17 publications

Masseteric Nerve Transfer for Facial Nerve Paralysis

Masseteric Nerve Transfer for Facial Nerve Paralysis

Transposition of the Intratemporal Facial to Hypoglossal Nerve for Reanimation of the Paralyzed Face

Functional results after facial reanimation in iatrogenic facial palsy

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