INDICATION, TECHNIQUE AND RESULTS OF FACIAL-NERVE RECONSTRUCTION

160 patients with various intra- or extracranial pathologies were trea ted by microsurgical facial nerve reconstruction at Nordstadt Neurosur gical Clinic between 1978 and 1993. Facial nerve reconstruction was ac complished along the anatomical course of the facial nerve from its or igin at the brainstem, within the mastoid, at the stylomastoid foramen and within the face. Mostly, reconstruction was indicated because of nerve discontinuity (n = 61), whereas facial nerve reanimation with a donor nerve such as the contralateral facial nerve or the ipsilateral hypoglossal nerve was indicated in 99 cases of loss of a proximal nerv e stump. Depending on the site of the lesion reinnervation started at 5 to 15 months postoperatively lasting for 2 to 3 years with overall s atisfactory results. 69% of all the patients regained good symmetry on rest, complete eye closure equivalent to House-Brackmann-Score III: P atients with complete failures either suffered of non-related diseases such as cancer leading to death before the estimated time of recovery or were exposed to radiation or received facial nerve reconstruction after long-standing facial deficit and marked muscular atrophy. The in dication of the adequate method depends on the clinical course with or without preexisting facial paresis, on considering the intraoperative state of the facial nerve, the identification and microsurgical prepa ration of adequate nerve stumps, as well as on the adaptation techniqu es and the postoperative guidance of the patient. We conclude that fac ial nerve reconstruction by transplantation at either site of the nerv e course or by reanimation with a donor nerve are effective and reliab le procedures of treatment leading to satisfactory functional and cosm etic results.