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

Tim A Iseli, Gregory Harris, Nichole R Dean, Claire E Iseli, Eben L Rosenthal
Laryngoscope 2010, 120 (3): 478-83

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 <or=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.

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