Subdivision of the sural nerve: Step towards individual facial reanimation

Osinga, Rik; Buncke, Harry J.; Buncke, Gregory M.; Meuli‐Simmen, Claudia

doi:10.3109/2000656x.2011.554693

Cited by 8 publications

(7 citation statements)

References 12 publications

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“…Similarly, the sural nerve can be harvested with cutaneous branches or split into multiple fascicular bundles for reconstructing the facial nerve defects. 13 The distal facial nerve stumps may be pooled together to provide a bettercaliber match for coaptation with the cable graft. 8 Cable grafting comes with slow recovery of volitional movement and unavoidable synkinesis.…”

Section: Discussionmentioning

confidence: 99%

Facial Nerve Reconstruction With Concurrent Masseteric Nerve Transfer and Cable Grafting

Owusu

Truong

Kim

2016

JAMA Facial Plast Surg

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ost tumors of the parotid gland are benign and can be adequately treated with facial nerve-sparing parotidectomy. Malignant tumors constitute approximately 20% of all tumors of the parotid gland, and about 20% of these will have facial nerve involvement. 1,2 Total parotidectomy with resection of the involved portion of the facial nerve is recommended when the tumor infiltrates or is adherent to the facial nerve. Immediate reconstruction of the resected nerve should be performed when feasible to mitigate the devastating effects of facial paralysis. 3 Facial paralysis has functional and aesthetic effects, including an asymmetric smile, oral incompetence, nasal obstruction, and lagophthalmos with a potential for corneal injury. These physical effects can have a significant psychosocial impact and result in a decline in the patient's quality of life. 4 Three options exist for nerve reconstruction, which depend on the extent of the nerve resection. Primary tension-free coaptation of the nerve segments is the best option when feasible. Cable grafting between the proximal and distal nerve stump is performed when the length of the resected nerve segment prevents primary coaptation, and a mastoid dissection may be indicated to gain access to the proximal stump of the facial nerve in some cases. 5 Nerve substitution is indicated when the proximal segment of the facial nerve is not accessible. Donor nerve graft options frequently used in facial nerve reconstruction include the great auricular nerve, sural nerve, and medial antebrachial cutaneous nerve. The medial antebrachial cutaneous nerve can be harvested with multiple branches that make it suitable for reconstruction of multiple peripheral branches. Compared with primary nerve repair, cable grafting has a slower return of nerve function and an increased rate of synkinesis. 5-7 Synkinesis results from aberrant axonal regeneration, which causes simultaneous movement of multiple muscle groups when 1 group is activated. Using a separate neural input for innervation of the upper and lower facial muscle groups can prevent or decrease synkinesis. A 2011 report by IMPORTANCE Reconstruction of the facial nerve after radical parotidectomy is commonly performed with cable grafting, which is associated with slow recovery of nerve function and synkinesis. OBJECTIVE To describe facial nerve reconstruction after radical parotidectomy using concurrent masseteric nerve transfer and cable grafting. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review at a tertiary referral hospital included 9 patients who underwent concurrent masseteric nerve transfer and cable grafting for facial nerve reconstruction performed by a single surgeon from January 1, 2014, to October 31, 2015. Final follow-up was completed on March 14, 2016. MAIN OUTCOMES AND MEASURES Improvement in resting facial symmetry and oral commissure excursion and synkinesis. RESULTS Nine patients (6 women; mean age, 62.6 years; age range, 51-73 years) underwent immediate facial nerve reconstruction after radic...

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Section: Discussionmentioning

confidence: 99%

Facial Nerve Reconstruction With Concurrent Masseteric Nerve Transfer and Cable Grafting

Owusu

Truong

Kim

2016

JAMA Facial Plast Surg

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“…The sural nerve is sufficiently long and consists of multiple fascicles with interfascicular bridges. An anatomical study demonstrated the presence of 6.3 fascicles at the proximal end of the sural nerve and 6.7 fascicles at the distal end [ 10 ]. The facial nerve has a fascicular organization, with the perineurium and epineurium distal to the geniculate ganglion.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it is a long nerve consisting of multiple fascicles with inter-fascicular bridges. Its morphology and topography, which have been studied by many investigators, allow the creation of three independent nerve grafts from every sural nerve that is dissected [ 10 ]. Splitting the sural nerve meticulously into two or three divisions mimics the branching pattern of the original facial nerve [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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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.

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“…61 The most popular autologous graft is the sural nerve, because of its excellent size match, length, minimal donor-site morbidity characterized by lateral foot numbness, and two-team approach. 7 The length of the sural nerve allows for the creation of two or three independent cable grafts, 62 which can be used to recreate the branching pattern of the original facial nerve during reconstruction. 63 Motor nerves generally carry unacceptable donor morbidity compared with their sensory counterparts.…”

Section: Dynamic Methods For Smile Restorationmentioning

confidence: 99%

Evidence-Based Practices in Facial Reanimation Surgery

Aronson,

Applebaum,

Kelsey

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Learning Objectives: After studying this article, the participant should be able to: 1. Describe the causes and preoperative evaluation of facial paralysis. 2. Discuss techniques to restore corneal sensation and eyelid closure, elevation of the upper lip for smile, and depression of the lower lip for lip symmetry. 3. Outline treatment goals, surgical treatment options, timing of repair, and other patient-specific considerations in appropriate technique selection. Summary: Congenital facial paralysis affects 2.7 per 100,000 children; Bell palsy affects 23 per 100,000 people annually; and even more people are affected when considering all other causes. Conditions that impair facial mimetics impact patients’ social functioning and emotional well-being. Dynamic and static reconstructive methods may be used individually or in concert to achieve adequate blink restoration, smile strength and spontaneity, and lower lip depression. Timing of injury and repair, patient characteristics such as age, and cause of facial paralysis are all considered in selecting the most appropriate reconstructive approach. This article describes evidence-based management of facial paralysis.

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Subdivision of the sural nerve: Step towards individual facial reanimation

Cited by 8 publications

References 12 publications

Facial Nerve Reconstruction With Concurrent Masseteric Nerve Transfer and Cable Grafting

Facial Nerve Reconstruction With Concurrent Masseteric Nerve Transfer and Cable Grafting

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

Evidence-Based Practices in Facial Reanimation Surgery

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