How are facial nerves repaired?

Updated: Nov 28, 2018
  • Author: Tang Ho, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Currently, no medical treatment exists for facial nerve repair. Systemic corticosteroids and/or anti-virals are advocated by some to minimize swelling of the nerve in certain cases. In animal models, the use of electrical stimulation therapy appears to be beneficial for initiating and accelerating facial nerve recovery. [9] A number of metabolic factors (eg, neurotrophic factors, growth factors, and stem cells) have shown some promise for facilitating nerve repair in the laboratory, although these remain in the investigational phase and results to date have been mixed.

In animal experiments, glial cell line–derived neurotrophic factors promoted facial nerve regeneration in delayed grafting but inhibited immediate nerve grafting. [10] In similar experiments, stem cell therapy (eg, bone marrow–derived mesenchymal stem cells in collagen) promoted excessive growth support for axon regeneration and excessive collateral nerve branching of facial motor endplates (which was not improved by manual stimulation). Current stem cell therapy requires additional study before it can be clinically useful for facial nerve repair. [11]

Accordingly, surgical repair is the mainstay of treatment. At present, there are 3 surgical options for repair of the facial nerve: direct repair, cable nerve grafting, and nerve substitution techniques (see below). Primary end-to-end nerve anastomosis and cable graft interposition have shown to produce better functional outcomes than nerve substitution techniques. [8]

Additional techniques that have been proposed as possible alternatives to suture repair include laser neurorrhaphy and tissue adhesive repair. Synthetic and biologic tubules have been created to provide a path for the regenerating axons, even spanning small gaps in the nerve. These have not yet shown any clear superiority to standard nerve grafting techniques, but they remain under investigation.

Controversies persist regarding the type (epineural versus perineural) and the timing of repair. The cross-facial nerve graft has very good results in certain reports but has not been as effective in other hands.


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