Direct Intratemporal Facial Nerve Reconstruction

Purpose: The complete loss of facial nerve function is a very severe handicap for every patient. There are a lot of techniques for the reconstruction of the damaged facial nerve. Authors present a case report of a 67-year-old woman with an iatrogenic disconnection (ENT operation for cholesteatoma) of the tympanic segment of the facial nerve.

Method: Due to the age of the patient, the time from the surgery (12 months after the injury) and a relatively a short damaged segment, the facial nerve was reconstructed by a rarely used direct end-to-end intratemporal anastomosis after transposition of the mastoid and the labyrinthine segments.

Results: The functional result 2 years after the facial nerve reconstruction was a House-Brackmann scale grade II, with movement of the forehead, successful closure of the eye, recovery of spontaneous mimic motion, symmetry at rest, and slight asymmetry during movement.

Conclusion: The intratemporal end-to-end anastomosis of the facial nerve after intratemporal transposition of undamaged segments is very a rare method of reconstruction, but with the possibility of surprisingly very good results.