Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes

Purpose: Reanimation of facial paralysis is a complex problem with multiple treatment options. One option is hypoglossal-facial nerve grafting, which can be performed in the immediate postoperative period after nerve transection, or in a delayed setting after skull base surgery when the nerve is anatomically intact but function is poor. The purpose of this study is to investigate the effect of timing of hypoglossal-facial grafting on functional outcome. Materials and methods: A retrospective case series from a single tertiary otologic referral center was performed identifying 60 patients with facial nerve injury following cerebellopontine angle tumor extirpation. Patients underwent hypoglossal-facial nerve anastomosis following facial nerve injury. Facial nerve function was measured using the House-Brackmann facial nerve grading system at a median follow-up interval of 18 months. Multivariate logistic regression analysis was used determine how time to hypoglossal-facial nerve grafting affected odds of achieving House-Brackmann grade of <= 3. Results: Patients who underwent acute hypoglossal-facial anastomotic repair (0-14 days from injury) were more likely to achieve House-Brackmann grade <= 3 compared to those that had delayed repair (OR 4.97, 95% CI 1.5-16.9, p = 0.01). Conclusions: Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm. (C) 2016 Elsevier Inc. All rights reserved.