Facial nerve grafting – what’s the wait?
Reviewed by Bilal Gani Taib

An uninterrupted facial nerve after resection of cerebellopontine angle (CPA) tumour does not always translate into preserved facial animation. Fortunately there is a high probability spontaneous recovery may occur and hence patients are typically observed for 12 months postoperatively. However, this delay negatively impacts those who don’t have a spontaneous recovery. A previous study on vestibular schwannomas revealed that the rate of recovery after six months is 97% specific and sensitive as a predictor of ultimate facial nerve recovery. Of the 62 patients who developed House-Brackmann (HB) grade IV, V, or VI facial paralysis, 35 spontaneously recovered. Ten patients underwent nerve grafting within 12 months, nine after 12 months and eight had no intervention. Early facial reanimation surgery resulted in a shorter total duration of paralysis and masseteric nerve grafting resulted in earlier recovery compared with hypoglossal nerve grafting (p=0.005). Patients who showed no signs of recovery and declined facial reanimation surgery demonstrated at best HB grade V recovery after 18 months observation. This demonstrates that patients can be counselled as early as six months postoperatively for facial reanimation surgery if there is no sign of spontaneous recovery within the first six months. 

Early nerve grafting for facial paralysis after cerebellopontine angle tumor resection with preserved facial nerve continuity.
Albathi M, Oyer S, Ishii LE, et al.
JAMA FACIAL PLASTIC SURGERY
2016;18(1):54-60.