Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (1): 15-19.doi: 10.6040/j.issn.1673-3770.1.2019.064

• Clinical Report • Previous Articles     Next Articles

Facial nerve reconstruction in the parotid area under a variety of circumstances

Zhili WANG,Zhe CHEN,Fangyu LIN,Yongchuan CHAI,Zhaoyan WANG*()   

  1. Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200011, China
  • Received:2019-12-25 Online:2020-01-20 Published:2020-03-06
  • Contact: Zhaoyan WANG E-mail:wzyent@163.com

Abstract: Objective

To discuss the efficacy of surgical facial nerve (FN) reconstruction in the parotid area under various circumstances.

Method

We considered 46 cases of surgical facial nerve reconstruction with nerve involvement in the parotid area. Among these cases, 3 required facial nerve relaxation (facial nerve intact), 7 required facial nerve suturing, 22 required sural nerve grafting (long distance nerve defects), and 14 required additional masseteric-facial nerve anastomosis due to sural nerve grafting.

Results

All patients in the study received postoperative follow-up at 6 to 12 months. Using the House-Brackmann grading system at follow-up, 2 of the 3 facial nerve relaxation cases received grade Ⅲ, while the third received grade Ⅱ; all 7 facial nerve suturing cases received grades Ⅲ-Ⅳ. The 22 sural nerve grafting cases received grades Ⅲ-Ⅳ, however in one of these cases severe synkinesis was observed; 3 cases presented obvious synkinesis, and tight synkinesis was observed in the other 7 cases. The 14 sural nerve grafting and masseteric-facial nerve anastomosis cases received grades Ⅲ-Ⅴ with no obvious synkinesis observed in any of these cases.

Conclusion

Immediate, individualized surgical facial nerve reconstruction could lead to satisfactory results for various circumstances of facial nerve damage. Nerve suturing was preferred for achieving tension-free anastomosis, and masseteric-facial nerve anastomosis was preferred as a means to avoid synkinesis.

Key words: Facial palsy, Facial nerve reconstruction, Nerve suturing, Nerve grafting, Masseteric-facial nerve anastomosis

CLC Number: 

  • R739

Table 1

Surgical methods in 46 patients (n)"

修复时机 手术方式 n
一期修复
  Ⅰ 腓肠神经桥接 9
  Ⅱ 腓肠神经桥接+咬肌-颊支吻合 4
二期修复
  Ⅰ 松解减压 3
  Ⅱ 面神经端-端吻合 7
  Ⅲ 腓肠神经桥接 13
  Ⅳ 腓肠神经桥接+咬肌-颊支吻合 10

Fig.1

Sural nerve grafting after parotidectomy. The two branches of sural nerve were separately sutured to the upper and lower branches of facial nerve, while the trunk of both nerves were sutured together"

Fig.2

Sural nerve grafting (A) and Masseteric-facial Nerve Anastomosis (B)"

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