Surgical technique of nerve grafts for facial reanimation of a paralyzed face following parotid tumor surgery

Abstract

In choosing a corrective procedure for patients with facial palsy following parotid tumor resection, nerve grafts are mainstays. They are used for defects in which a tensionless closure is not possible with primaty anastomosis. Two or three grafts are usually placed from the main trunk to peripheral nerve branches to the eye, cheek and lip, excluding the forehead and cervical branches. Epineural nerve repair is commonly employed for extratemporal grafting. After the nerve edges have been freshened with microscissors an epineural suture is performed under an operating microscope with 8-0 or 9-0 monofilament nylon. A green square of silicone sheeting is used beneath the nerve ends to improve visibility during suturing. For the first merhod, two sutures 180 degrees apart are used as traction sutures to rotate and expose in inferior border to the nerve. Usually, six sutures are used for the main trunk and fewer sutures for smaller peripheral nerve branches. The most critical factor affecting the final result is the degree of tension on the suture line. An increased tension contributes to wound separation, leading to both axon escape with neuroma formation and to fibrous ingrowth of scar tissue.