Facial nerve function after petrosectomy

Objectives: Evaluation of facial nerve function after petrosectomy in a pat ient series with facial nerve denudation-decompression, forward or backward rerouting, and facial nerve suture and grafting. Study Design: Fifty-six p atients with petrosectomies performed for 24 benign and 9 malignant tumors of the petrous bone, 13 malignant tumors of the parotid gland or of the inf ratemporal spaces with infiltration of the petrous bone, 8 traumatic facial nerve disruptions, and 2 osteoradionecroses were retrospectively evaluated with respect to facial nerve function. Sixteen cases involved a partial, 2 5 a subtotal, and 15 an extended subtotal petrosectomy. Methods: The treatm ent of the facial nerve included 15 denudation-compressions, 23 denudation- compressions with rerouting, 4 primary sutures, and 14 nerve grafts. The Ho use-Brackmann grading system was used for facial nerve evaluation. Results: Normal or nearly normal facial nerve function was obtained in facial nerve denudation-decompression with and without rerouting (House-Brackmann Grade I or II) except in cases of malignant tumors and osteoradionecrosis, where preoperative impaired function remained. Satisfactory results were obtaine d with nerve suturing and nerve grafting after petrous bone fracture (Grade III or IV, in one case practically Grade II) except in a case of late repa ir 3 years after the trauma (Grade V). Variable results were obtained with nerve grafting in cases with tumor infiltration: Satisfactory results (5 of Grade III or IV) were obtained when the tumor was healed and also when pos toperative radiotherapy was applied; poor results were obtained in the case of tumor recurrence (6 of Grade V or VI). Conclusions: Our results show th at petrosectomy with denudation-decompression of the facial nerve with or w ithout rerouting usually results in a normal mimic of the face. When the fa cial nerve is disrupted by trauma or when the nerve is infiltrated by tumor , early reconstruction with nerve suture or grafting mostly leads to a part ial and quite acceptable reinnervation of the face.