Microsurgical repair of the facial nerve.

OBJECTIVE: To report a series of 18 patients who underwent microsurgical repair of the facial nerve using different techniques and to discuss the indications and results of facial reinnervation procedures. METHODS: Eighteen patients with post-surgical facial palsy underwent facial reinnervation using different techniques.'These included classic hypoglossal-facial anastomosis in 13 cases, one-stage hemihypoglossal-intratemporal facial nerve anastomosis and translabyrinthine removal of residual intra-canalar acoustic schwannoma in 3, hemihypoglossal-facial nerve anastomosis in one, and neurotization of facial muscles through a nerve graft in one. RESULTS: The facial muscle function improved in all patients, up to grade III in 7 cases (39 %), grade IV in 9 (50 %) and grade V in 2 (11 %). The tongue atrophy was minimal in 70.5 %, moderate in 17.5 % and severe in 12 %. The outcome was better in younger patients (less than 40 years of age) and in those with a lesser grade of preoperative facial impairment. CONCLUSIONS: The classic hypoglossal-facial anastomosis is the technique of choice in most cases. The use of the intratemporal facial nerve is indicated when removal of an intra-canalar residual schwannoma must also be performed. The neurotization of the facial muscles through a nerve graft may be used when there is no distal trunk of the facial nerve available for the anastomosis.