Introduction:
The facial nerve is the brain nerve which is most often affected by traumas. Regarded
more closely it's caused mainly by fractures of the petrosal bone and traumas in the
periphere nerval path including the paroid gland. Therapy depends on the degree and
time of the subsequent paralysis.
Case Report:
As a result of a stabing injury a 30-year-old patient presented an extensive cervical
wound which reached up to the paroid gland and a complete paralysis of the left facial
nerve (House-Brackmann V). This led to the decision for early facial nerve rehabilitation
by surgery. During surgery inspection showed a complete traumatic dissection of the
temporal and the zygomatic branch in the parotid region of the original stabbing wound.
Due to loss of nerval tissue it was not possible to reconnect the nerve as it was.
So an interponate of the cervical plexus was obtained and transplanted between the
nerval ends.
Additionally a platinium string was implanted in the upper eyelid to protect the cornea
(lidloading).
Results:
In the further course the facial paralysis showed a significant regress (House-Brackmann
Scale I-II). Via high solution sonography the nerval recovery could be monitored.
Two years after surgery the patient consulted us again with a Frey's syndrome. Here
local injection with botulin toxin showed to be a highly effective therapy.
Conclusion:
Surgical rehabilitation of the facial nerve can achieve good results after trauma
with nerval dissection. If anastomosis without tension is not possible due to a loss
of nerval tissue the application of a nerval interponat can be considered. Possible
complications include Frey's syndrome. An effective therapy therefor is local botulin
toxin injection.
