Head and Neck

Outcomes of static and dynamic facial nerve repair in head and neck cancer

  1. Tim A. Iseli MBBS1,
  2. Gregory Harris BS2,
  3. Nichole R. Dean DO2,
  4. Claire E. Iseli MBBS, MS1,
  5. Eben L. Rosenthal MD2,*

Article first published online: 3 FEB 2010

DOI: 10.1002/lary.20789

Issue

The Laryngoscope

The Laryngoscope

Volume 120, Issue 3, pages 478–483, March 2010

Additional Information

How to Cite

Iseli, T. A., Harris, G., Dean, N. R., Iseli, C. E. and Rosenthal, E. L. (2010), Outcomes of static and dynamic facial nerve repair in head and neck cancer. The Laryngoscope, 120: 478–483. doi: 10.1002/lary.20789

Author Information

  1. 1

    Department of Otolaryngology, Head & Neck Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia

  2. 2

    Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.

*University of Alabama at Birmingham, BDB 563, 1530 3rd Avenue South, Birmingham AL 35294-0012

Publication History

  1. Issue published online: 16 FEB 2010
  2. Article first published online: 3 FEB 2010
  3. Manuscript Accepted: 27 OCT 2009

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Keywords:

  • Facial nerve;
  • squamous cell carcinoma;
  • graft;
  • static or dynamic procedures;
  • House-Brackmann score

Abstract

Objectives/Hypothesis:

Determine outcomes associated with nerve grafting versus static repair following facial nerve resection.

Study Design:

Retrospective chart review.

Methods:

Charts from 105 patients who underwent facial nerve reconstruction between January 1999 and January 2009 were reviewed. The majority had parotid malignancy (78.1%), most commonly squamous cell carcinoma (50.5%). Patients underwent static (n = 72) or dynamic (n = 33) reconstruction with nerve grafting. Facial nerve function was measured using the House-Brackmann (H-B) scale.

Results:

Patients receiving static reconstruction were on average 10.3 years older (P = .002). Mean overall survival for tumor cases was 61.9 months; parotid squamous cell carcinoma was associated with worse prognosis (P = .10). Median follow-up was 16.1 months (range, 4–96.1 months). Most (97%) patients receiving a nerve graft had some return of function at a median of 6.2 months postoperatively (range, 4–9 months) and the majority (63.6%) had good function (H-B score ≤4). Patients having static reconstruction (29.2%) were more likely to have symptomatic facial palsy than those having a nerve graft (15.2%, P = .12).

Conclusions:

Where possible, nerve grafting is the preferred method of facial nerve reconstruction. Although elderly patients with parotid malignancy have traditionally been considered poor candidates for nerve grafting, we demonstrate good results within 9 months of facial nerve repair even with radiotherapy, the use of long grafts (>6 cm), and prolonged preoperative dysfunction. Laryngoscope, 2010

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