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

Authors

  • Tim A. Iseli MBBS,

    1. Department of Otolaryngology, Head & Neck Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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  • Gregory Harris BS,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Nichole R. Dean DO,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
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  • Claire E. Iseli MBBS, MS,

    1. Department of Otolaryngology, Head & Neck Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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  • Eben L. Rosenthal MD

    Corresponding author
    1. 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
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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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