The Experience of a Facial Nerve Unit in the Treatment of Patients With Facial Paralysis Following Skull Base Surgery
| Autor: | José M. Roda, Javier Gavilán, Susana Moraleda, Teresa González-Otero, José M. Morales-Puebla, Luis Lassaletta |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Stylomastoid foramen medicine.medical_treatment Facial Paralysis Schwannoma Neurosurgical Procedures 03 medical and health sciences 0302 clinical medicine Humans Medicine 030223 otorhinolaryngology Facial Nerve Injuries Skull Base business.industry medicine.disease Facial nerve Sensory Systems Facial paralysis Surgery Facial Nerve medicine.anatomical_structure Otorhinolaryngology Skull base surgery Referral center Neurology (clinical) business 030217 neurology & neurosurgery Watchful waiting Reinnervation |
| Zdroj: | Otology & Neurotology. 41:e1340-e1349 |
| ISSN: | 1537-4505 1531-7129 |
| DOI: | 10.1097/mao.0000000000002902 |
| Popis: | The management of facial paralysis following skull base surgery is complex and requires multidisciplinary intervention. This review shows the experience of a facial nerve (FN) unit in a tertiary university referral center. A multidisciplinary approach has led to the breaking of some old treatment paradigms. An overview of five FN scenarios is presented. For each setting a contemporary approach is proposed in contrast to the established approach. 1) For patients with an anatomically preserved FN with no electrical response at the end of surgery for vestibular schwannoma, watchful waiting is usually advocated. In these cases, reinforcement with an interposed nerve graft is recommended. 2) In cases of epineural FN repair, with or without grafting, and a poor expected prognosis, an additional masseter-to-facial transfer is recommended. 3) FN transfer, mainly hypoglossal-to-facial and masseter-to facial, are usually chosen based on the surgeons' preference. The choice should be based on clinical factors. A combination of techniques improves the outcome in selected patients. 4) FN reconstruction following malignant tumors requires a combination of parotid and temporal bone surgery, involving different specialists. This collaboration is not always consistent. Exposure of the mastoid FN is recommended for lesions involving the stylomastoid foramen, as well as intraoperative FN reconstruction. 5) In patients with incomplete facial paralysis and a skull base tumor requiring additional surgery, consider an alternative reinnervation procedure, "take the FN out of the equation" before tumor resection. In summary, to achieve the best results in complex cases of facial paralysis, a multidisciplinary approach is recommended. |
| Databáze: | OpenAIRE |
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