Facial Reanimation Results by Spinal Accessory Nerve–Facial Nerve (FN) Anastomosis

Aim: To evaluate facial reanimation efficacy for patients with total loss of FN function.

Methods: Between 1998 and 2008, 73 patients underwent major division accessory nerve–facial nerve anastomosis. The study consisted of 41 men and 32 women whose mean age was 54 years (range, 30–78 years). Eight patients had traumatic injuries (group I), and 65 had undergone CPA tumor removal (group II). The interval between FN loss and anastomosis ranged from 2 weeks to 14 months. For all group I patients, palsy arose immediately after the injury and lasted for 3–6 months. Total loss of FN function was confirmed by EMG. For group II: If during the operation total anatomical FN injury was visualized, then anastomosis was performed in 2–4 weeks; if anatomical FN structure was preserved, the anastomosis was performed in 6 months, unless FN function recovered (confirmed by EMG). All the patients underwent extracranial major division accessory nerve–facial nerve anastomosis.

Results: Facial nerve function reanimation occurred in 4–6 months. The House-Brackmann (HB) grades were: 32 patients (44%) achieved HB II, 27 (37%) had HB III, 11 (15%) had HB IV, and 3 (4%) had HB V. Results were better for patients with anastomosis before 6 months. Forty-eight (65.7%) patients had no complaints or symptoms related to their shoulder or arm; the rest had some complaints, but none had significant shoulder and arm morbidity. Sixty-four (87.6%) patients appeared to benefit and improve quality of life after the procedure.

Conclusion: Analysis of spinal accessory nerve–facial nerve anastomosis results indicates that this procedure is useful and beneficial for patients with total loss of FN function.