Back to Search Start Over

Facial Nerve Revascularization Strategies in Facial Restoration

Authors :
Ankur Khajuria, MRCS, PhD
Brian Bisase, FRCS
Paul Norris, FRCS
Jag Dhanda, FRCS, PhD
Isao Koshima, MD, PhD
Charles Nduka, MD, FRCS
Ruben Y. Kannan, FRCS, PhD
Source :
Plastic and Reconstructive Surgery, Global Open, Vol 10, Iss 1, p e4038 (2022)
Publication Year :
2022
Publisher :
Wolters Kluwer, 2022.

Abstract

Background:. Facial transplants represent the current exemplar in the reconstruction of severely damaged faces, whereas conventional free flap reconstruction has its limitations in restoring both function and surface cover. Methods:. In a retrospective study over 6 years (2014–2020), 5 cases (n = 5) of vascularized nerve flaps (VNFs) were performed by our team. These involved three acute and two late reconstructions. The mean age was 41 years with a maximum of 6-year follow-up. To objectify the different permutations and combinations, we categorized composite, chimeric, and hybrid VNFs into types I, IIa-c, and III, each with a unique characteristic. Postoperative function was evaluated using the validated Sunnybrook and Terzis scores for facial nerve palsy; masticatory function was assessed using dental impression studies. Results:. There was a 100% flap survival rate, with no instances of flap necrosis and only one complication: hematoma at 24 hours postoperative. Sunnybrook and Terzis scores showed a statistically significant improvement postoperatively, indicating both improved repose and facial expressions (paired student t test, P < 0.05). Given that each VNF was specifically customized for a particular patient, each type of VNF in this cohort was unique, thereby illustrating each type succinctly. Conclusions:. VNFs are separate entities from standard free flaps, as they require extensive preoperative planning to allow the deconstructing of composite blocks of tissue into separate vascularized entities and amalgamating them into a new conglomerate. This allows VNFs to fill a niche area in facial reconstructive surgery between face transplants and conventional free tissue transfers, with enormous potential.

Subjects

Subjects :
Surgery
RD1-811

Details

Language :
English
ISSN :
21697574 and 00000000
Volume :
10
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Plastic and Reconstructive Surgery, Global Open
Publication Type :
Academic Journal
Accession number :
edsdoj.410c33d08ade462b9d8797808a87daa6
Document Type :
article
Full Text :
https://doi.org/10.1097/GOX.0000000000004038