Outcomes of facial nerve grafting in 155 cases: Predictive value of history and preoperative function

Objective: To investigate the factors that were effectual on the recovery of the facial nerve functions after repair with grafting. Study Design: Retrospective case review. Setting: Private neuro-otologic and cranial base quaternary referral center. Patients: One hundred ninety-four patients underwent facial nerve grafting during lateral cranial base surgery between July 1989 and December 2009. The mean age of the patients was 44.1 +/- 15.8 years (range, 2-79 yr). There were 94 male and 100 female patients. Facial nerve functions were normal in 89 patients, whereas facial nerve paresis or paralysis was present for a mean duration of 25.4 months (range, 1-600 mo) in the rest of the patients. Main Outcome Measure: Final facial nerve motor function. Results: Best outcome, which was Grade III according to House-Brackmann scale, was achieved in 105 of 155 patients with a follow-up of 1 year or longer (67.7%). Final result was grade IV in 23 (14.8%), grade V in 8 (5.2%), and grade VI in 19 patients (12.3%). Preoperative deficit duration was found to be the only significant factor that affected the prognosis (p = 0.027). Receiver operating characteristic curve analysis revealed that the most critical time for recovery to grades III and IV function is 6 months (p < 0.001). Conclusion: A number of factors were implicated to affect the success rate of facial nerve grafting, but only the duration of preoperative facial nerve deficit was found to be significant. Thus, timely management of facial nerve problems is critical for achieving optimal results