64742 Transection or avulsion of; facial nerve, differential or complete

Name of the Procedure:

Transection or Avulsion of the Facial Nerve, Differential or Complete (Facial Nerve Section)

Summary

The procedure involves surgically cutting (transection) or removing (avulsion) part or all of the facial nerve. This nerve controls the muscles of facial expression and its damage or removal can be partial (differential) or complete.

Purpose

This procedure is typically performed to address severe facial pain, involuntary muscle twitching, or certain types of facial spasm disorders. The goal is to alleviate symptoms by disrupting the problematic nerve signals.

Indications

• Severe, chronic facial pain that has not responded to other treatments.
• Hemifacial spasm that is not controlled with medication or other interventions.
• Failed previous surgical attempts to relieve symptoms.
• Specific criteria may include patient’s age, overall health status, and severity of symptoms.

Preparation

• Patients may need to fast for several hours before the procedure.
• Pre-operative tests such as imaging studies (MRI or CT scans) and nerve conduction studies might be required.
• Reviewing and possibly adjusting current medications, especially blood thinners and pain medications.
• Consultation with the surgical team to understand the risks and benefits.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A small incision is made near the area where the facial nerve is accessed.
3. Exposure: The surgeon carefully exposes the facial nerve, utilizing microsurgical tools and a microscope for precision.
4. Transection or Avulsion: Depending on the goal, the nerve is either carefully cut (transection) or a section is completely removed (avulsion).
5. Closure: The incision is closed with sutures, and a sterile dressing is applied.
6. Monitoring and Care: The patient is monitored in recovery for any immediate complications.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the case.

Setting

Generally performed in a hospital setting, specifically in a surgical suite.

Personnel

• Surgeon: A neurosurgeon or specialized ENT (ear, nose, and throat) surgeon.
• Anesthesiologist: Administers and monitors anesthesia.
• Nurses and Surgical Technicians: Assist with the procedure and provide care.

Risks and Complications

• Infection and bleeding at the surgical site.
• Facial weakness or paralysis.
• Loss of facial sensation or altered facial contour.
• Recurrence of symptoms.
• General risks associated with anesthesia.

Benefits

• Alleviation of chronic facial pain or muscle spasms.
• Improved quality of life.
• Benefits may be noticeable within a few days to weeks post-surgery.

Recovery

• Hospital stay for 1 to 3 days for monitoring and pain management.
• Instructions on incision care and signs of infection.
• Follow-up appointments to monitor healing.
• Temporary restrictions on physical activity and driving.
• Full recovery may take several weeks to months.

Alternatives

• Medications such as anticonvulsants or muscle relaxants.
• Botulinum toxin (Botox) injections to relieve spasms.
• Other surgical interventions such as microvascular decompression.
• Pros and cons vary based on individual patient condition and response to non-surgical treatments.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not experience pain or discomfort.
• After the procedure: Some pain and discomfort around the incision site, manageable with prescribed pain medications.
• Swelling and bruising around the surgical area, typically subsiding within a few weeks.
• Emotional support and counseling may be beneficial due to changes in facial function and appearance.