Free Vascularized Nerve Grafting for Immediate Facial Nerve Reconstruction
Article first published online: 3 JAN 2009
Copyright © 2005 The Triological Society
Volume 115, Issue 2, pages 331–336, February 2005
How to Cite
Kimata, Y., Sakuraba, M., Hishinuma, S., Ebihara, S., Hayashi, R. and Asakage, T. (2005), Free Vascularized Nerve Grafting for Immediate Facial Nerve Reconstruction. The Laryngoscope, 115: 331–336. doi: 10.1097/01.mlg.0000154753.32174.24
- Issue published online: 3 JAN 2009
- Article first published online: 3 JAN 2009
- Manuscript Accepted: 26 AUG 2004
- Vascularized nerve graft;
- facial nerve reconstruction;
- facial palsy;
- immediate reconstruction
Objectives/Hypothesis: To obtain better functional results after reconstruction to treat facial palsy in the patients with preoperative and intraoperative factors that might inhibit functional recovery, the authors have used free vascularized nerve grafts to immediately reconstruct severed facial nerves.
Study Design: The indications for vascularized nerve grafts were 1) scarred recipient bed attributable to previous operations, 2) a history of previous irradiation at the wound, 3) facial skin defects over the nerve graft after tumor ablation, 4) patient age greater than 60 years, and 5) preoperative facial palsy.
Methods: Four types of free vascularized nerves were used. Functional recovery after reconstruction could be assessed with two facial nerve grading systems.Ten patients who underwent immediate reconstruction of severed facial nerve after ablative surgery of malignant tumors of the parotid gland were reviewed.
Results: Functional recovery after reconstruction could be assessed with the House-Brackmann grading system and a 40-point grading system in 6 of the 10 patients after a mean follow-up period of 29.8 months (range, 10–60 mo). Results with the House-Brackmann system were grade II in 1 patient, grade III in 4 patients, and grade IV in 1 patient; scores on the 40-point grading system were 20 in 1 patient, 22 in 3 patients, 24 in 1 patient, and 28 in 1 patient.
Conclusion: The study results indicated that muscle movement recovers satisfactorily after free vascularized nerve grafting. Although a study comparing vascularized nerve grafts and conventional nerve grafts would be necessary to confirm the superiority of vascularized nerve grafts, free vascularized nerve grafts are effective for immediate reconstruction of the severed facial nerve in patients with preoperative and intraoperative factors that might inhibit functional recovery.