Selective role of partial XI-VII anastomosis in facial reanimation

Objectives: Review techniques available for transposition of an alternative motor neuron if end-to-end anastomosis or interposition nerve grafting cannot be accomplished when there has been a complete facial nerve loss. Describe the selective use of a partial spinal accessory-facial nerve anastomosis and high-light cases when this may be a useful alternative. Describe the modifications of decompression of the facial nerve for tension-free anastomosis and the use of the muscle pedicle for repair of cerebrospinal fluid leakage. Study Design: Report of three cases and a review of the literature. Methods: Charts were reviewed and indications for the procedure were analyzed. The degree of facial movement was recorded as well as the resolution of any cerebrospinal fluid leak. Results: The results varied between Class III and Class IV on the House-Brackmann scale following initial complete paralysis. In the two cases in which spinal fluid leakage had occurred before surgery the leakage was resolved. No donor site morbidity was noted. Conclusions: The potential of low morbidity associated with the use of the sternocleidomastoid branch, along with the potential for delivering a vascularized muscle pedicle to the temporal bone region, makes selective use of this procedure a valuable addition to the multiple reconstruction options for the paralyzed face.