Implications Of Intracranial Facial Nerve Grafting In The Setting Of Facial Reanimation
Shai M. Rozen, M.D., Bridget Harrison, M.D., Brandon Isaacson, M.D., Walter Kutz, M.D., Peter Roland, M.D., Patti Blau, Ph.D., Sam Barnett, M.D., Bruce Mickey, M.D..
University of Texas Southwestern Medical Center, DALLAS, TX, USA.
Purpose: Evaluate varying degrees of facial reanimation by facial region after intracranial nerve grafting and identify implications for future facial reanimation.
Methods: Between 1997-2012, twenty-seven patients underwent intracranial nerve grafting after tumor extirpation. Fourteen were prospectively evaluated by three facial nerve physical therapists using Facial Disability Index (FDI), and two regional grading systems - Facial Nerve Grading System 2.0 (FNGS 2.0), and SunnyBrook Facial Grading Score (SFGS). Additionally, all patients underwent photos and videography to assess quality of motion and tonicity in repose. Demographic and surgical variables were analyzed for their effect on end results.
Results: Average age was 43 (22-66), average time interval between nerve grafting to evaluations was 44 months (12-146), Average total FDI was 67.5% (Physical Function and Social/Well-Being - 62.8% and 72.6% respectively). FNGS 2.0 demonstrates best outcomes in Eye and Oral Commissure portions and worse in Brow and Nasolabial fold. Final FNGS 2.0 grade averaged 4.3 (1-5) i.e. moderately severe dysfunction. The SFGS reveals 64.3% have oral resting symmetry, but only 28.6% resting symmetry in eye and nasolabial fold. Symmetry in voluntary movement revealed gentle eye closure and lip pucker as best - 3.6 and 3.0 respectively, while brow lift as worst - 1.0 and open mouth smile at 2.0 (5-25). Total synkinesis score averaged low at 3.6 (0-15).
Conclusion: Intracranial nerve grafting doesn’t provide consistently good facial animation. It may provide periocular protection, afford good midface symmetry in repose, potentially improving results of midface reanimation surgery by providing improved baseline tonicity with minimal synkinesis.
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