Grading Facial Nerve Function Following Combined Static and Mimetic Surgical Techniques

The most commonly used facial nerve grading systems were designed to assess progressive neural recovery with an anatomically in-tact facial nerve. Advanced lateral skull base tumors that require facial nerve and adjacent musculature resection and cases of longstanding facial paralysis may necessitate the use of free muscle transfer in conjunction with neural grafting, oculoplastic techniques, and static soft-tissue tightening to optimize the long-term functional and cosmetic results. Traditional facial recovery grading tools are not sufficient to describe and compare functional recovery results in this patient population.

We propose the following grading system for patients undergoing combined facial nerve reconstructive techniques. Case examples will be provided.