2025 Proffered Presentations
S173: FACIAL REANIMATION AFTER TEMPORAL BONE RESECTION WITH FACIAL NERVE SACRIFICE FOR SKULL BASE TUMORS: RESTORING FUNCTION AND SYMMETRY
Roberto M Soriano, MD; Alejandra Rodas, MD; David Chou, MD; Gustavo Pradilla, MD; C. Arturo Solares, MD, FACS; Michael Baddour, MD; Emory University
Objective: Temporal bone resections (TBR) are frequently performed as part of a composite resection for the management of malignant lateral skull base tumors and often requiring facial nerve (CN VII) sacrifice due to malignant nerve infiltration and intimate association to malignancy. Facial reanimation is performed to restore facial function when CN VII is sacrificed. In patients undergoing TBR, facial reanimation poses a challenging problem as CN VII is commonly transected in its proximal segments and direct nerve re-anastomosis cannot be performed. Two types of facial reanimation exist, dynamic and static. Dynamic facial nerve reanimation restores facial movement and static facial reanimation restores facial symmetry, but not movement. To the date, a paucity of literature exists regarding facial reanimation following TBR. In this study, we review our experience with both dynamic and static facial reanimation following TBR with CN VII sacrifice.
Methods: An IRB approved retrospective chart review was performed of all patients who underwent facial reanimation procedures following temporal bone resection with facial nerve sacrifice for lateral skull base tumors, from August 2016 to July 2024 at Emory University Hospitals.
Results: A total of 43 patients underwent facial reanimation following TBR and facial nerve sacrifice with a mean age of 65 years (range: 24-86) of which 35 (81%) were male. Fourty-one patients underwent a lateral TBR (LTBR) and two patients underwent a subtotal TBR (STBR), most commonly performed for cutaneous malignancies (n=26) and salivary malignancies (n=16). Twenty-six patients (60%) underwent dynamic facial reanimation to provide voluntary movement, most frequently using an interposition nerve cable graft (n=16, 62%) followed by use of masseteric nerve to midfacial branches of CN VII transfer (n=13, 50%) and temporalis tendon transfer (n=2, 7%). Twenty-nine patients (70%) underwent static facial reanimation, most frequently using a tensor fascia lata sling for targeted facial rehabilitation (n=26) and upper eyelid gold weights (n=6), tarsorrhaphy (n= 5), direct brow lift (n= 4) and lateral tarsal strip (n= 2) for eye rehabilitation. Twelve (28%) patients underwent both static and dynamic reanimation and 17 (40%) underwent only static and 14 (33%) only dynamic reanimation. All procedures were performed on the same day as the resection.
Conclusion: Facial nerve reanimation poses a complex problem following TBR with CN VII sacrifice. In one of the largest case series, we report our experience with facial reanimation in this patient population. On the day of surgery, static facial reanimation for targeted facial and eye rehabilitation was most frequently used followed by dynamic reanimation to provide facial movement. Although most patients underwent either static or dynamic reanimation on the day of surgery, both can be used in conjunction to maximize facial rehabilitation and optimize outcomes.