Evaluation of facial nerve function following surgical approaches for maxillofacial trauma

Abstract

Purpose:The aim of this study was to report facial nerve injury following extraoral surgical approaches for the treatment of maxillofacial trauma, using the House–Brackmann facial nerve grading system (HBFNGS) as a means of classifying and measuring the degree and type of injury.Materials and Methods:The sample comprised 100 consecutive cases of various maxillofacial trauma in which extraoral surgical approaches were used. Variety of surgical approaches such as coronal, preauricular, endaural, retromandibular, and submandibular approach and its modifications were used based on the anatomic location of the fracture and the accessibility required for its reduction and fixation. Facial nerve function of all patients was evaluated preoperatively and 24 hours after surgery. Patients who presented postoperative facial nerve injury were likewise examined using the HBFNGS at 24 hours, 1 week, 1 month, 3 months, and 6 months.Results:Of the 100 patients, temporofacial branch involvement was seen in 11 cases, whereas cervicofacial branch involvement was seen in 6 cases. Complete recovery of the temporofacial branches was seen in a period of 3–4 months; whereas cervicofacial branches recovered in 5–6 months postoperatively.Conclusion:The frequency of facial nerve injury was related to various surgical approaches in maxillofacial trauma. Facial nerve impairment was found to be temporary in all cases, although the recovery of cervicofacial branches took a longer time. Moreover, there is a need to standardize the reporting of facial nerve recovery.

Retrospective Study of Facial Nerve Injury in Temporomandibular Joint Surgeries Following Preauricular Approach

“…Despite the wide acceptance of HBFNGS and its clinical implications, we have experienced its limitations, as 85% of our patients had involvement of more than one branch with varying degrees of severity. When both temporal and zygomatic branches were involved, grading was given based on the ability to close the eye, as previously described by other authors [1,2].…”

“…Anatomic variations and multiple innervation patterns of the peripheral branches render facial nerve to an increased risk during various surgical procedures to temporomandibular joint using preauricular approach [1]. Facial nerve injury following various surgical procedures to the maxillofacial region ranges from 0-48% [1].…”

Outcome of Comminuted Mandibular Fracture Repair Using an Intraoral Approach for Osteosynthesis

“…Because an incision at the lateral neck is made to access the mandibular bone, several important structures are endangered: the marginal mandibular branch of the facial nerve, the lingual and the hypoglossal nerve, the facial vessels, and the submandibular and parotid glands. [8][9][10][11][12] Damage to any of these structures may result in severe and permanent functional or aesthetic consequences.…”

“…Although the extraoral approach inherits significant advantages regarding overview, simplifying fracture reduction, plate positioning, and fixation, it bears considerable risks of damaging important neurovascular and glandular structures, or even visible facial scarring, respectively. [8][9][10][11][12] This retrospective study was designed to objectively analyze the outcome of comminuted mandibular fracture treatment by an intraoral approach. We hypothesized that this treatment protocol is a comparable alternative to the extraoral approach but inheriting a reduced complication rate while still allowing proper reduction and osteosynthesis.…”

Evaluation of clinically relevant landmarks of the marginal mandibular branch of the facial nerve: A three‐dimensional study with application to avoiding facial nerve palsy

“…Injury to the MMN has been described following fixation of mandibular fractures, parotidectomy, submandibular gland excision, rhytidectomy, and oncologic neck dissection. The incidence of injury to the MMN varies depending on the surgical procedure: (1) Up to 7.3% following submandibular gland excision (Ichimura et al, 1997;Milton et al, 1986); (2) 2.56-16.66% following mandibular fracture fixation (Cabrini et al, 2003;Prabhu et al, 2012); (3) 5.6-16.3% postparotidectomy (Bron and O'Brien, 1997;Owusu et al, 2013); (4) 18-23% postcervical lymph node dissection in the submandibular triangle (level 1b; Nason et al, 2007;Batstone et al, 2009).…”