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Outcomes of static and dynamic facial nerve repair in head and neck cancer
Author(s) -
Iseli Tim A.,
Harris Gregory,
Dean Nichole R.,
Iseli Claire E.,
Rosenthal Eben L.
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20789
Subject(s) - medicine , facial nerve , surgery , palsy , malignancy , parotid gland , facial paralysis , head and neck cancer , radiation therapy , alternative medicine , dentistry , pathology
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