"Take the Facial Nerve Out of the Picture": A Novel Approach for Skull Base Recurrences and Facial Nerve Tumors.

INTRODUCTION

Facial paralysis secondary to skull base recurrences or facial nerve tumors presents a significant challenge, as tumor resection usually worsens facial function.

OBJECTIVE

The aim of this study is to show an alternative approach, ensuring facial reanimation irrespective of the evolution of the tumor, the so-called "take the facial nerve out of the picture."

METHODS

Retrospective study of patients with a skull base recurrence or a facial nerve tumor who underwent facial reanimation prior to tumor management. Facial function was assessed using the House-Brackmann and Sunnybrook Facial Grading Scale.

RESULTS

Four patients with skull base recurrences and eight with facial nerve tumors underwent facial reanimation with nerve transfers (n = 11) and a microvascular flap (n = 1) before tumor treatment. In all cases, facial function improved to House-Brackmann grades III or IV, with improvement of average Sunnybrook Facial Grading Scale scores from 25.25 (standard deviation [SD] 20.45) to 57.67 (SD 10.3) (p = 0.004). Three patients with skull base recurrence underwent tumor resection uneventfully, while the eight patients with facial nerve tumor remain observed.

CONCLUSIONS

Early facial reanimation can preserve long-term facial function, facilitate tumor resection, and provide flexibility in managing complex skull base recurrences and facial nerve tumors.