Facial reanimation after facial nerve injury

Facial Paralysis, Modification to Labbé Technique

Background

Facial paralysis is one of the conditions that affect functionally, emotionally and aesthetically to patients greatly. Multiple techniques have been described for its treatment, and we consider that Labbé's technique is the one that most surprises with its results.

Materials and Methods

In the Specialty Hospital "Dr. Bernardo Sepúlveda" National Medical Center Century XXI (CMN SXXI), Mexican Institute of Social Security (IMSS), three cases are presented: patients with facial paralysis due to trauma, surgical damage on the VII cranial nerve and conditions due to otological and idiopathic infections. Four modifications to the original Labbé technique are proposed to execute it more easily: trans-zygomatic oblique osteotomy, to reach directly the coronoid process; osteotomy of the descending coronoid; radiated suture fixation at 180° for temporary muscle replacement with positional replacement of the sutures trans-operatively; and the next day of the intervention with the patient awake, fixation of the orbicularis muscle of the lips, to the temporal tendon previously referenced. The modifications and results obtained are shown.

Results

The modifications offer a better surgical technique and very favorable results.

Conclusions

The modification to Labbé technique gives excellent results in the treatment of permanent facial paralysis, improving facial symmetry, salivary incontinence, facial tone, improving speech, giving the patient movement on the affected side and the ability to smile again.

Hypoglossal Facial Nerve Anastomosis for Post-Operative and Post-Traumatic Complete Facial Nerve Paralysis

AIM:

This study aims to evaluate the outcome of patients with complete facial paralysis following surgery to cerebellopontine angle tumours or following traumatic petrous bone fractures after reanimation by hypoglossal-facial anastomosis as regards clinical improvement of facial asymmetry and facial muscle contractility as well as complications associated with hypoglossal-facial reanimation procedure.

METHODS:

This thesis included a prospective study to be carried out on 15 patients with unilateral complete lower motor neuron facial paralysis (11 patients after cerebellopontine angle tumour resection and 4 patients after traumatic transverse petrous bone fracture) operated upon by end to end hypoglossal-facial nerve anastomosis in Cairo university hospitals in the period between June 2015 and January 2017.

RESULTS:

At one year follow up the improvement of facial nerve functions were as follows: Three cases (20%) had improved to House Hrackmann grade II, eleven cases (73.33%) had improved to grade III, and one patient (6.66%) had improved to House Brackmann grade IV.

CONCLUSION:

Despite the various techniques in facial reanimation following facial nerve paralysis, the end to end hypoglossal-facial nerve anastomosis remains the gold standard procedure with satisfying results in cases of the viable distal facial stump and non-atrophic muscles. Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.

Approaches to Peripheral Nerve Repair: Generations of Biomaterial Conduits Yielding to Replacing Autologous Nerve Grafts in Craniomaxillofacial Surgery

Peripheral nerve injury is a common clinical entity, which may arise due to traumatic, tumorous, or even iatrogenic injury in craniomaxillofacial surgery. Despite advances in biomaterials and techniques over the past several decades, reconstruction of nerve gaps remains a challenge. Autografts are the gold standard for nerve reconstruction. Using autografts, there is donor site morbidity, subsequent sensory deficit, and potential for neuroma development and infection. Moreover, the need for a second surgical site and limited availability of donor nerves remain a challenge. Thus, increasing efforts have been directed to develop artificial nerve guidance conduits (ANCs) as new methods to replace autografts in the future. Various synthetic conduit materials have been tested in vitro and in vivo, and several first- and second-generation conduits are FDA approved and available for purchase, while third-generation conduits still remain in experimental stages. This paper reviews the current treatment options, summarizes the published literature, and assesses future prospects for the repair of peripheral nerve injury in craniomaxillofacial surgery with a particular focus on facial nerve regeneration.

Effect of FK506 on apoptosis of facial motor neurons in rats and its possible mechanism

To investigate the effect of FK506 on apoptosis of facial motor neurons in rats and its possible mechanism. A total of 48 Wistar rats were randomly divided into experimental group and control group. Facial nerve injury model was established by transection of facial nerve at stylomastoid foramen. Rats in experimental group and control group were provided with FK506 and normal saline by intraperitoneal injection, respectively. The morphology of facial neurons was observed under light microscope at different time points after injury. Apoptotic facial motor neurons were detected by TdT-mediated dUTP-biotin nick and labeling (TUNEL) staining, and expression of bcl-2 and bax was evaluated by immunohistochemistry. After facial nerve transection, the apoptotic cells in experimental group significantly decreased compared to control group (P < 0.05), with higher expression of bcl-2 and lower expression of bax in experimental group. FK506 could inhibit apoptosis of facial motor neurons after facial nerve transection, possibly via up-regulation of bcl-2 expression and down-regulation of bax expression.

Complications of microsurgery of vestibular schwannoma

BACKGROUND

The aim of this study was to analyze complications of vestibular schwannoma (VS) microsurgery.

MATERIAL AND METHODS

A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup.

RESULTS

In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225) removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB III-VI) was observed in 124 cases (45%) immediately after surgery and in 104 cases (33%) on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IX-XI) deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%), headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis.

CONCLUSIONS

Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery.

Facial reanimation after facial nerve injury using hypoglossal to facial nerve anastomosis: the gruppo otologico experience

To evaluate the results of facial nerve reanimation after facial nerve injury by means of hypoglossal to facial nerve anastomosis. Retrospective case review. Private neuro-otologic and cranial base quaternary referral center. Sixty patients underwent hypoglossal to facial nerve anastomosis for facial nerve reanimation between April 1987 and December 2010. Only forty patients completed a minimal follow up of 24 months at the time of evaluation and were included in the study population. Facial nerve paralysis was present for a mean duration of 11.3 months (range 2-42 months) and all the patients had a HB grade VI prior their surgery. Final facial nerve motor function. The most common cause of facial paralysis was vestibular Schwannoma surgery. All the patients achieved a postoperative HB grade III or IV after a mean follow-up time of 20 months. The facial movements were detected after a period that ranged from ranged from 5 to 9 months. Only 4 patients suffered from difficulties during eating and drinking and three of them had associated lower cranial nerve deficit. Despite the various techniques in facial reanimation following total facial nerve paralysis, the end to end of hypoglossal to facial nerve anastomosis remains one of the best treatments in cases of viable distal facial stump and nonatrophic musculature.

[Reconstructive surgery of facial nerve injuries]

The facial nerve is main motor nerve of the face and its injury leads to total ipsilateral paralysis. There are several surgical procedures in reconstruction of the facial nerve, and the most frequent one is hypoglosso-facial anastomosis. In this study were analysed a series of 69 patients operated on Institute of neurosurgery from 1981 to 2000 year. The most frequent cause of injury was the operation of cerebellopontine angle tumors, as well as the skull base fractures. Hypoglosso-facial anastomosis was done in 57 patients, in 5 cases we performed nerve grafting in the cerebellopontine angle, and in 7 patients the facial nerve was operated peripherally. Results were analyzed in 27 of 57 patients with hipoglosso-facial nerve anastomosis. Functional recovery was achived in 22 (81.4%) patients.