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Abstract

AOI KSCON 2010

Title : Facial nerve re routing and anostomosis in a case of facial nerve injury

Author : Dr. C.B. Nadyal

Abstract:

An 18 years old girl presented with history of left facial paralysis for 2 months she had a past history of
left MRM done with Type IV tympnoplasty and aural polypectomy 2 months backs she had developed
left gradual facial paralysis within first 24 hours of post operative period for which she was given medical
treatment for 6 weeks. Facial nerve decompression was planed her.

A post aural incision was tkane and all the epithelium from mastoid cavity was removed. Tympnometal
flap was elevated the cartilage graft which put on foot plate of stapes was removed. granulation tissue
and soft tissue mass were seen just above the oval window. Facial ridge was reduced and the vertical
limb of facial nerve was exposed from stylomastoid foramen to second genu of facial nerve. Than
the horizontal part of facial nerve deskeletonised with a pik which showed soft mass encriling near the
second genu. Granulation tissue and mass was excited vertical limb of facial nerves was rerouted after
cutting the nerve the stapedius and brought on to the promontory for anastomosis with the horizontal
part.

The anastomaotic ends of facial nerve were supported by 5-0 vicril as a sling and covered with
temporalis fascia graft. Then tempnometal flap was replaced and matoid cavity and external auditory
cannal was filled with gel foam and wound sutured in layers.

The patient was on methyl cobalamine 1500 mcg for 3 months. Post operatively patient noticed
tingling sensation over facial nerve branches in 2 nd month. Eye closure and angle of mouth showed
movement after 8 months but wringling of forehead was absent.

Conclusion

Facial nerve rerouting and anastamosis can be easily done following iatrogenic injury during mastoid
surgery which gives good results. In this patient had full recovery of all the branches facial nerve expect
the temporal division.

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