Results and complications of facial reanimation following cerebellopontineangle surgery

The present study was undertaken to evaluate the results of a group of pati ents following treatment for cerebellopontine angle lesions who developed p ostoperative facial palsy and underwent facial nerve repair in order to rea nimate the muscles of facial expression. A retrospective study was performe d on 23 patients treated between 1988 and 1997 at the 2nd and 4th ENT chair s of University "La Sapienza" of Pome for facial palsy following cerebellop ontine angle surgery. Tumors included acoustic neuromas (n = 3). Seventeen patients underwent hypoglossal-facial anastomoses [10 with end-to-end anast omoses, 4 with May's interposition "jump-nerve" grafts and 3 with partial ( 30%) use of the hypoglossal nerve plus a facial cross-over]. The remaining patients were operated on using a cable graft with the sural nerve (n = 2) and the great auricular nerve (n = 4). Postoperative facial function was de termined by the House-Brackmann 6-scale classification The hypoglossal-faci al anastomoses resulted in long-term grade III or IV findings. Cable grafts improved facial function from grade VI to grade III. None of the patients operated on with the modified VII-XII anastomosis developed swallowing dist urbances. The ten patients having traditional hypoglossal-facial anastomose s showed different degrees of tongue disability and retention of residue in the oral cavity. Surgical recovery of postoperative facial palsy can be ob tained with various techniques according to the availability of the proxima l facial nerve stump at the brain stem. Since a traditional hypoglossal-fac ial anastomosis procedure can be a source of a separate disability for the patient: techniques are preferred that leave the hypoglossal nerve mostly i ntact and uncompromised.