gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Microneurovascular reconstruction in chronic facial nerve lesions: does anomalous innervation through the masseteric nerve work?

Meeting Abstract

  • K.G. Krishnan - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • V. Seifert - Neurochirurgische Klinik, Johann Wolfgang Goethe-Universität Frankfurt
  • J.K. Krauss - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • G. Schackert - Neurochirurgische Klinik, Carl Gustav Carus Universitätsklinikum Dresden

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.06.07

DOI: 10.3205/11dgnc140, URN: urn:nbn:de:0183-11dgnc1408

Published: April 28, 2011

© 2011 Krishnan et al.
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Outline

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Objective: Unilateral and bilateral facial palsies resulting from the invasion of the facial nuclei and/or nerves are well known in lesions of the brainstem, cerebellopontine angle and the petrous bone. The aim of the study was to retrospectively analyze the functional outcomes of microneurovascular facial reanimation using masseteric innervation.

Methods: Seventeen patients with irreparable facial paralyses resulting from benign lesions involving the facial nuclei (n=14) or Möbius Syndrome (n=3) were treated with microneurovascular muscle transplantation using ipsilateral masseteric innervation. Results were analyzed by a commissural excursion (CE) index, and a patient self-evaluation score. The presence of synkinesis was documented. Follow-up ranged from 8 to 48 months (mean - 26.4 months).

Results: Normalization of the CE-indices could be observed in 8/17 patients (47%), an improvement in 7/17 (41%) and failure in 2/17 (12%). A natural smiling response was observed in 10/17 (59%) patients. Patients' self-evaluation scores were a level higher than objective indices.

Conclusions: Innervation of free microneurovascular muscle flaps with the masseteric nerve plays an important role in patients with lesions bringing forth a compromise of the facial nuclei. Synkinesis persists for long periods after surgery. However, most of the patients had learned to express their emotions by overcoming this phenomenon. Despite hyper or inadequate correction, patients evaluate themselves favourably.