ANA Discussion Forum
Post-Treatment => Facial Issues => Topic started by: saralynn143 on September 08, 2008, 09:50:47 am
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I found a very informative article titled Management of Facial Paralysis after Intracranial Surgery last night at http://neurosurgery.mgh.harvard.edu/CranialBaseCenter/b95.htm
The section most fascinating to me pertains to predicting facial nerve recovery. Here is what is says:
Facial nerve is transected at surgery and grafted. These are among the least predictable group of patients. Results in this group vary from no recovery to recovery of all movement in all divisions with synkinesis. The endpoint for recovery may require 12 to 18 months. Electrical testing is of no use in predicitng recovery. Based on experience, the surgeon who has performed the repair can give the best prediction for recovery.
Facial nerve is anatommically intact but does not stimulate at the brainstem and there is no facial movement in the immediate postoperative period. Recovery in this group of patients is generally poor. If recovery does occur, the endpoint may requir 18 months. The best recovery to be reasonably hoped for is reinstutuion of resting tone and weak movement with synkinesis. Electroneurography (ENoG) in the early postoperative period generally demonstrates an absent compound action potential suggestive of sever neural degeneration.
Facial nerve is anatomically intact, stimulates at low voltage, but no movement immediately after surgery. In this group of patients, ENoG may be particularly useful in the postoperative period. If the compound action potential of the paralyzed side remains greater that 10% of that of the normal side after one week, then a good recovery usually occurs, although it may require several months.
Facial nerve is anatomically intact, there is some movement in the immediate postoperative period, but complete paralysis ensues within hours. This group generally has a satisfactory recovery. It is important that real significant movement is appreciated
ENoG is only of limited value in predicting the degree of overall recovery. It is most helpful during the first two postoperative weeks. It may be useful in distinguishing severe injuries with neural degeneration from neuropraxic irjury. Intramuscular electromyography may be useful in detecting reinnervation after injury and prolonged paralysis, before detectable motion is present. It is of no value in the late postoperative period.
I fall into either the second or third group since I had paralysis immediately after surgery, but I don't know which since I did not have an ENoG. I think my surgeon must have thought I was in the second group since he had a "bad feeling" about my nerve, but I am hopeful that I am in the third group.
The article also addresses eye care and reanimation surgery options.
Sara
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Interesting article. I was among the grafted ones and my results are what is mentioned as best in the 2nd paragraph which is talking about other post op results. I am not perfect but glad to have what improvement that I have had. Mine even seem to vary from day to day. Cheryl R
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Sara -
very interesting article - sure to help many - thanks for sharing :)
Jan