Patient: Description of the condition (onset time, main symptoms, hospital visited, etc.): I underwent a total surgery for right-sided auditory neuroma at Peking Union Medical College Hospital in November 2010, and everything recovered normally, but my facial paralysis was more serious. I was discharged from the hospital in mid-December 2010 and have been undergoing acupuncture treatment with no significant effect. Is there any better treatment to recover from facial palsy Liang Jiantao, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University
Jiantao Liang, Department of Neurosurgery, Xuanwu Hospital, Beijing, China: Hello: I don’t know if your facial nerve was preserved during surgery. However, even if the facial nerve is preserved, if the facial palsy is severe and does not improve within six months, a nerve anastomosis should be considered, and we routinely perform a “partial hypoglossal nerve-facial nerve anastomosis” to improve the function of the facial nerve while preserving the function of the hypoglossal nerve. Here is my article on facial palsy after auditory neuroma, if you are interested in reading it.
Postoperative facial palsy is the most common complication of surgery for auditory neuroma, especially for giant auditory neuroma (up to 4 cm in diameter). Facial palsy not only affects the patient’s aesthetics, but the facial expressions are bizarre and often followed by psychological changes: the patient does not want to go out, does not want to meet people, closes himself off from society. In addition, because the eyelids cannot be closed in severe facial palsy, coupled with abnormal tear secretion, it often leads to exposure keratitis, which can lead to vision loss in the affected eye and even blindness, so the correct management of post-operative facial palsy after auditory neuroma is very important.
Postoperative facial palsy after auditory neuroma is divided into two cases.
(i) Intraoperative facial palsy in which the facial nerve anatomy is preserved.
That is, facial palsy in which the structure of the facial nerve remains intact and the continuity is not interrupted due to mechanical stimulation of the facial nerve during surgery. At present, for giant auditory neuroma, the highest international record of nerve anatomy preservation rate is 92% by Professor Samii, a German master neurosurgeon; about 80% in China; for these patients, the recovery of facial palsy should be promoted by active facial muscle exercises (insisting on forehead wrinkles, frowning, eye closing, teeth baring, cheek puffing, etc. in the morning, midday and evening), passive massage, rubbing, physiotherapy and acupuncture, etc. In most patients, facial palsy will recover to varying degrees within six months after surgery. However, if the facial palsy has not recovered in more than six months, facial nerve anastomosis (facial-sublingual nerve anastomosis or facial-paraneoplastic nerve anastomosis) should be considered because the effect of nerve anastomosis is inversely proportional to the duration of facial palsy, that is, the earlier the anastomosis, the better the effect; conversely, the later the anastomosis, the worse the effect.
(ii) Intraoperative facial nerve is not anatomically preserved.
In other words, if the facial nerve is broken during surgery, or even if the facial nerve is removed together with the tumor, then the possibility of recovery of facial palsy on its own is slim, and the nerve anastomosis should be performed as soon as possible without hesitation. At present, in the neurosurgery department of Xuanwu Hospital, if the facial nerve is severed during the removal of a giant auditory neuroma, direct anastomosis of the severed end of the nerve is preferred, and if the nerve defect is large, a facial-sublingual nerve anastomosis is performed immediately. (In view of protecting the patient’s privacy, we cannot upload the facial photos before and after the nerve anastomosis).
Therefore, for post-operative facial palsy after auditory neuroma, it is important to ask your surgeon if the facial nerve was preserved during surgery. so that you can decide the next step of treatment.
Liang Jiantao, Department of Neurosurgery, Xuanwu Hospital Consultation number: 13439661708
Patient: The main surgeon said that the facial nerve is protected and not broken, and the tumor is 3cm*3cm, I asked the main surgeon when I reviewed in January that I wanted to do surgery to restore facial palsy, but the main surgeon said no, let him recover slowly first, no big problem, and did not say what better way to help restore facial palsy after six months. I don’t know what to do and would like your help. What are the risks of having surgery to restore facial palsy? Won’t there be problems on the east side if the west side is repaired? What are the chances of recovery? Thank you
Liang Jiantao, Department of Neurosurgery, Beijing Xuanwu Hospital.
1, the facial nerve anatomical preservation and functional preservation are two concepts, anatomical preservation is the basis of functional preservation, but if the facial nerve is subjected to too much mechanical stimulation or blood supply interruption during surgery, even if the anatomical preservation of its function may be lost, because the facial nerve is too fragile; in this case should be observed, supplemented by acupuncture, physiotherapy, facial muscle functional exercise, the observation period is 6-9 months, more than 9 months the facial muscle may Atrophy, or even fibrosis, even the effect of nerve anastomosis will be poor, because the nerve is good, and the muscle is bad for nothing.
2, the classic facial-sublingual nerve anastomosis cut off the sublingual nerve to save the facial nerve, belongs to the demolition of the east wall to repair the west wall, but now we use a branch of the sublingual nerve, so it can not only repair the west wall, but also maintain the east wall, the specific performance is the tongue is not crooked, chewing, swallowing, vocalization is basically not affected after surgery.
3, facial-sublingual nerve anastomosis cannot cure facial palsy, but it can improve the function of facial nerve, about 6 months to 9 months after surgery, the static facial tension can be normalized, no facial palsy can be seen in a quiet state, the eyelids can be closed, and the level of facial palsy classification 3 can be reached, the probability of reaching this state is about 80%.
4.There are three factors affecting the effect of facial-sublingual nerve anastomosis, 1) the interval between facial palsy and nerve anastomosis, the shorter the time, the better the effect; 2) age, the younger the better; 3) facial muscle function exercise
5. At present, the most profound international attainment in auditory neuroma is Professor Samii from Hannove, Germany, who is also the honorary director of the Institute of Neuroscience of Xuanwu Hospital, and our current management of post-operative facial palsy in auditory neuroma is based on their standards. If you have a chance, you can ask our Professor Ling Feng to consult with you. She is very knowledgeable and has a good personal relationship with Professor Samii, so you can get her opinion. Her secretary’s contact number: 010-83198836; if you can’t reach her, I can help.