Functional Outcomes of Multiple Sural Nerve Grafts for Facial Nerve Defects after Tumor-Ablative Surgery

Abstract

BackgroundFunctional restoration of the facial expression is necessary after facial nerve resection to treat head and neck tumors. This study was conducted to evaluate the functional outcomes of patients who underwent facial nerve cable grafting immediately after tumor resection.MethodsPatients who underwent cable grafting from April 2007 to August 2011 were reviewed, in which a harvested branch of the sural nerve was grafted onto each facial nerve division. Twelve patients underwent facial nerve cable grafting after radical parotidectomy, total parotidectomy, or schwannoma resection, and the functional facial expression of each patient was evaluated using the Facial Nerve Grading Scale 2.0. The results were analyzed according to patient age, follow-up duration, and the use of postoperative radiation therapy.ResultsAmong the 12 patients who were evaluated, the mean follow-up duration was 21.8 months, the mean age at the time of surgery was 42.8 years, and the mean facial expression score was 14.6 points, indicating moderate dysfunction. Facial expression scores were not influenced by age at the time of surgery, follow-up duration, or the use of postoperative radiation therapy.ConclusionsThe results of this study indicate that facial nerve cable grafting using the sural nerve can restore facial expression. Although patients were provided with appropriate treatment, the survival rate for salivary gland cancer was poor. We conclude that immediate facial nerve reconstruction is a worthwhile procedure that improves quality of life by allowing the recovery of facial expression, even in patients who are older or may require radiation therapy.

Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases

“…2,17,47,50 However, the best possible postoperative outcome is HB Grade III, regardless of the graft material used or the technique employed, because the frontal muscle function rarely recovers and a certain degree of synkinesis is unavoidable after grafting. 2,30,39 The factors that could influence the results of FN reconstruction are discussed below.…”

“…Microscopically, the fascicle count of the FN in the mastoid segment is between 4 and 16. 8 Likewise, the SN consists of 6-12 fascicles 30,51 and hence can be considered to be a compatible graft. Remember, however, that while small-diameter grafts spontaneously revascularize, large-diameter grafts (for example, the SN or greater auricular nerves) do so incompletely due to central necrosis with subsequent endoneurial fibrosis, and this could be a reason for suboptimal results.…”

Variations in sural nerve formation pattern and distribution on the dorsum of the foot

“…It is a graft donor for many other nerves including the sciatic nerve (Shin et al, 2006), the femoral nerve (Tsuchihara et al, 2008), the oculomotor nerve (Mariniello et al, 1999), the inferior alveolar nerve (Chang et al, 2012), and the facial nerve (Lee et al, 2015). It is a graft donor for many other nerves including the sciatic nerve (Shin et al, 2006), the femoral nerve (Tsuchihara et al, 2008), the oculomotor nerve (Mariniello et al, 1999), the inferior alveolar nerve (Chang et al, 2012), and the facial nerve (Lee et al, 2015).…”

“…Although it is a skin sensory nerve, the sural nerve has several clinical uses. It is a graft donor for many other nerves including the sciatic nerve (Shin et al, 2006), the femoral nerve (Tsuchihara et al, 2008), the oculomotor nerve (Mariniello et al, 1999), the inferior alveolar nerve (Chang et al, 2012), and the facial nerve (Lee et al, 2015). Its utility stems from the fact that it is easy to find and harvest due to its usual location in the superficial fascia and just posterior to the lateral malleolus in close association with the small saphenous vein.…”

Editorial. Outcomes of facial nerve repair using nerve grafts applied immediately following nerve discontinuity in skull base surgery

“…Lee et al demonstrated low rates of synkinesis following sural nerve grafting in 12 patients for facial nerve injuries due to various reasons. 15 While Prasad et al should be congratulated on their large series and good results, their outcomes are only comparable and not superior to those of other smaller series. As a matter of fact, there has not been a substantial improvement in the outcome of facial nerve grafting over the past few decades.…”