Facial nerve grafts: from cerebellopontine angle and beyond.

OBJECTIVES To review the outcomes from facial nerve cable grafting in a variety of pathologic conditions and to determine the possible causes of poor facial function after facial nerve grafting. STUDY DESIGN A retrospective review of patients undergoing facial nerve grafts through a neurotologic procedure. SETTING This study was performed at a university-based tertiary referral center. PATIENTS All 27 patients undergoing a neurotologic procedure that required a facial nerve graft from 1982 to 1997 were reviewed. Fourteen patients had grafts from the facial nerve stump at the brainstem. INTERVENTIONS All patients had facial nerve function determined by the senior neurotologist and through use of historical data and photographs. MAIN OUTCOME MEASURE A facial nerve repair recovery score was developed for facial nerve transection and repair. The House-Brackmann scale was found to be inappropriate for transected and repaired nerves. RESULTS Facial function was found in 23/25 (92%) patients with at least 8 months follow-up. Statistical analysis revealed no significant correlation between graft length and recovery score. Patients who had the nerve grafted to a site distal to the meatal foramen had a mean outcome that was nearly one grade level better than those with an anastomosis proximal to the meatal foramen (i.e., at the brainstem), but this did not reach statistical significance. CONCLUSIONS Facial nerve grafting is an effective way of restoring facial motor function. A new facial recovery grading scale is proposed for repaired or grafted facial nerves.

目的 回顾在多种病理状况下面神经电缆式移植的结果，并确定面神经移植后面部功能不佳的可能原因。 研究设计 对通过耳神经外科手术进行面神经移植的患者进行回顾性研究。 研究地点 本研究在一所大学附属的三级转诊中心进行。 患者 对1982年至1997年间所有27例因耳神经外科手术需要进行面神经移植的患者进行了回顾。14例患者在脑干处的面神经残端进行了移植。 干预措施 所有患者的面神经功能由资深耳神经科医生通过使用历史数据和照片来确定。 主要结果测量指标 针对面神经横断和修复制定了面神经修复恢复评分。发现豪斯 - 布拉肯曼（House - Brackmann）量表不适用于横断和修复的神经。 结果 在随访至少8个月的25例患者中，23例（92%）发现有面部功能。统计分析显示移植长度与恢复评分之间无显著相关性。将神经移植到耳道孔远端部位的患者，其平均结果比在耳道孔近端（即在脑干处）进行吻合的患者几乎好一个等级，但这未达到统计学意义。 结论 面神经移植是恢复面部运动功能的一种有效方法。针对修复或移植的面神经，提出了一种新的面部恢复分级量表。