64864 Suture of facial nerve; extracranial

Name of the Procedure:

Suture of Facial Nerve; Extracranial
Common name(s): Facial nerve repair, Extracranial facial nerve suture
Medical term: Extracranial facial nerve anastomosis

Summary

The suture of the facial nerve (extracranial) is a surgical procedure to repair damage to the facial nerve outside the skull. This nerve controls the muscles of facial expression and can be damaged due to trauma, surgery, or disease.

Purpose

Addresses facial nerve injuries or damages such as those caused by trauma or surgical complications. Goals: Restore muscle function and facial symmetry, and prevent long-term facial paralysis.

Indications

• Trauma to the face causing nerve damage
• Post-surgical nerve injury
• Tumors impacting facial nerve function
• Congenital facial nerve abnormalities
• Chronic ear infections leading to nerve damage

Preparation

• Fasting as per anesthesia guidelines (usually 6-8 hours before the procedure)
• Medication adjustments as directed by the physician (e.g., blood thinners)
• Pre-operative imaging (such as MRI or CT scans) to assess the extent of nerve damage

Procedure Description

1. The procedure begins with the administration of general anesthesia to ensure the patient is unconscious and pain-free.
2. The surgeon makes an incision near the area of the nerve injury.
3. Using microsurgical techniques and instruments, the surgeon carefully isolates the damaged section of the facial nerve.
4. The severed or damaged ends of the nerve are realigned and sutured together using fine, specialized sutures.
5. The incision is then closed with stitches or surgical staples, and a sterile dressing is applied.

Duration

Typically takes between 3 to 6 hours, depending on the complexity of the injury.

Setting

Usually performed in a hospital setting, specifically in an operating room equipped for microsurgery.

Personnel

• Surgeon (often an otolaryngologist or plastic/reconstructive surgeon)
• Anesthesiologist
• Surgical nurses and assisting staff

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Failure to restore full nerve function
• Facial asymmetry
• Neuroma formation (nerve scar)
• Recurrence of facial weakness or paralysis

Benefits

• Restoration of facial movement and expression
• Improved facial symmetry
• Enhanced quality of life and self-esteem
• Potential to prevent long-term complications from nerve damage

Recovery

• Post-operative care includes keeping the surgical site clean and dry.
• Pain management typically involves prescribed pain relievers.
• Swelling and bruising are common and usually resolve within a few weeks.
• Follow-up appointments to monitor healing and assess nerve function.
• Physical therapy may be recommended to aid in muscle function recovery.
• Recovery time can vary but generally takes several weeks to months.

Alternatives

• Nerve grafting: Using a nerve from another part of the body to repair the damaged facial nerve.
• Medications: To manage symptoms if surgery is not an option.
• Physical therapy alone: For less severe cases or supplementary treatment post-surgery. Pros and Cons: Non-surgical options may offer less dramatic improvement but come with lower risk. Surgery offers the potential for more significant restoration of function but with higher risks.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. After the surgery, there may be discomfort, swelling, and a temporary decrease in facial movement which subsides as healing progresses. Pain management will be provided, and gradual improvement in nerve function is expected over time.