5. EVALUATION OF THE RESULTS OF NERVE TRANSFER SURGERY IN RESTORING MOTOR FUNCTION FOR PATIENTS WITH EARLY-STAGE FACIAL NERVE PALSY

Nguyen Cao Vien1, Nguyen Huu Tam1, Chu Van Dung1, Tran Ha Y Van1
1 115 People's Hospital

Main Article Content

Abstract

Objective: Facial nerve palsy (facial paralysis) is a common condition that significantly affects facial motor function and aesthetics, negatively impacting the quality of life and psychology of patients. Early detection of paralysis and its causes allows for early surgical intervention using neighboring nerves (such as the masseteric nerve V3, hypoglossal nerve XII, and accessory nerve XI) for the facial nerve VII, resulting in better and more natural recovery compared to muscle transfer surgery. This study aims to evaluate the effectiveness of nerve transfer in restoring motor function in patients with early-stage facial nerve palsy.


Subjects and Methods: The study was conducted on 32 patients with facial nerve palsy (25 females, 7 males) with an average age of 28, treated with nerve transfer surgery at 115 People's Hospital from 2012 to August 2023. All patients were assessed with electromyography before surgery and selected based on the criteria of facial nerve palsy grade V, VI according to the House-Brackmann scale.


Nerves were transferred from neighboring nerves, including: Masseteric nerve V3: 20 cases, Hypoglossal nerve XII: 5 cases, Accessory nerve XI: 7 cases. The time from paralysis onset to surgery ranged from 2 to 19 months. The facial nerve function of all patients was assessed before and after surgery using the Modified House-Brackmann scale. This scale is widely used to assess the degree of facial paralysis, ranging from normal (I) to complete paralysis (VI).


Results: The age of patients participating in the study ranged from 18 to 62 (average 28.3 ±12,5  years old). After surgery, signs of facial nerve function recovery appeared within 2-7 months (average 5,23 months), and patients achieved complete recovery with facial symmetry at rest within 4-14 months (average 6.7 months). The success rate of nerve transfer for facial nerve repair reached an impressive 94.7%. According to the Modified House-Brackmann scale, the distribution of functional recovery results was as follows: Grade I (normal): 6.1%. Grade II (mild paralysis): 59.3%. Grade III (moderate paralysis): 25.7%. Grade IV (moderately severe paralysis): 3.6%. Grade V (severe paralysis): 2.1%. Grade VI (total paralysis): 3.2%.


Regarding complications, some cases experienced: Hypoglossal nerve XII: 1/5 cases of hemi-tongue atrophy on the side of nerve harvesting. Accessory nerve XI: 3/7 cases of partial trapezius muscle atrophy, 1/7 case of sternocleidomastoid muscle and trapezius muscle atrophy. Masseteric nerve V3: No significant complications were noted. Complications related to the sural nerve graft included loss of sensation in the lateral dorsum of the foot, but sensation recovered after 9 months.


Conclusion: The study has demonstrated that early-stage nerve transfer surgery for facial nerve VII is an effective and safe method, providing good functional recovery for patients with a low complication rate at the nerve harvesting site.

Article Details

References

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