Assessment of the effect and predictability of cross-face-nerve-grafting in reconstruction of facial nerve paralysis

Veen, T. van (Tijn) (2016) Assessment of the effect and predictability of cross-face-nerve-grafting in reconstruction of facial nerve paralysis. thesis, Medicine.

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Abstract

Introduction: Facial nerve paralysis seriously affects a patient, both physically as psychosocially. A cross-face-nerve-graft (CFNG) is one of the most commonly used techniques for facial reanimation. Depending on the underlying condition, this CFNG can be combined with a muscle transplantation or a cranial to facial nerve anastomosis. This study is an evaluation of the facial nerve reconstructions with a CFNG performed at the UMCG and Isala Clinics. Aim of this study was to assess the effect of dynamic facial nerve reconstructions using a CFNG. Methods: All patients from the UMCG and Isala Clinics treated with a CFNG, possibly in combination with Gracilis muscle transplantation or hypoglossal-facial nerve anastomosis, or a hypoglossal-facial nerve anastomosis without a CFNG were invited to participate. The imagery was divided in three categories: preoperatively, postoperatively (0.5 to 2.5 years after the procedure) and long term (more than 2.5 years after the procedure). Patients were asked to fill in a quality-of-life and synkinesis questionnaire. The photographs were analyzed with the FACE-gram software and graded according to May. The videos were graded according to Terzis’ Grading system. Additionally, a relationship between the degree of facial disfigurement and quality-of-life, and the additional benefit of a CFNG to a hypoglossal-facial nerve anastomosis were tested. Results: Forty-one patients from the UMCG and Isala Clinics were included. Analysis of the photographs showed an increase in excursion and an improvement of symmetry of the mouth in repose and during smile. At the same time, an improvement of May classification scores from “poor” to “good” were seen. Analysis of the video material showed no significant improvement, although increasing median scores were seen. Divided by type of operation, the Gracilis muscle transplantation showed the best results. Furthermore, no association between the degree of facial disfigurement and quality-of-life was seen, and no difference between the either or not addition of a CFNG to a hypoglossal-facial nerve anastomosis was seen. Conclusion: This study shows that the reconstructive facial nerve procedures performed, cause better symmetry of the face. Additionally it shows that a CFNG, as proven in animal models before, has differing results, depending on the muscle it is attached to. No association between the degree of facial disfigurement and quality-of-life has, and no additional value of a CFNG to a hypoglossal-facial nerve anastomosis have been proven. This information can be used to reconsider the addition of a CFNG to a hypoglossal-facial nerve anastomosis in the future.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Werker, Prof. dr. P.M.N. Head of department and Department: Plastic and Reconstructive surgery, University M
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:43
Last Modified:	25 Jun 2020 10:43
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/502

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