Universität zu Köln

Beutner, Dirk and Grosheva, Maria (2019). Reconstruction of complex defects of the extracranial facial nerve: technique of the trifurcation approach. Eur. Arch. Oto-Rhino-Laryn., 276 (6). S. 1793 - 1799. NEW YORK: SPRINGER. ISSN 1434-4726

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Abstract

PurposeReconstruction of complex defects of facial nerve (FN) after extensive cancer surgery requires individualized solutions. We describe the trifurcation technique as a modification of the combined approach on example of two patients with locally advanced parotid cancer.MethodsDue to perineural invasion, extensive resection of the FN from the mastoid segment to the peripheral branches was required. For reanimation of the upper face, a complex cervical plexus graft was sutured end-to-end to the mastoid segment of the FN trunk. The branches of the graft enabled reanimation of three peripheral temporal and zygomatic branches. The mandibular branch was sutured end-to-side to the hypoglossal nerve (hypoglossal-facial nerve transfer, HFNT). Additionally, the buccal branch was independently reanimated with ansa cervicalis.ResultsFacial reanimation was successful in both patients. Good resting tone and voluntary movement were achieved with a mild degree of synkinesis after 13months. Patient 1 showed the Sunnybrook (SB) composite score 69 [76 (voluntary movement score)-0 (resting symmetry score)-7 (synkinesis score)]. In patient 2, the SB composite score was 76 (80-0-4, respectively).ConclusionsIn this trifurcation approach, cervical cutaneous plexus provides a long complex nerve graft, which allows bridging the gap between proximal FN stump and several peripheral branches without great expenditure. In combination with the HFNT and ansa cervicalis transfer, this procedure enables the facial reanimation with low grade of synkinesis.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Beutner, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Grosheva, Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-147066
DOI:	10.1007/s00405-019-05418-4
Journal or Publication Title:	Eur. Arch. Oto-Rhino-Laryn.
Volume:	276
Number:	6
Page Range:	S. 1793 - 1799
Date:	2019
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1434-4726
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ANASTOMOSIS; REANIMATION; SURGERY; GRAFT Multiple languages Otorhinolaryngology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14706