Facial nerve-greater auricular nerve transplantation

The auricular nerve is a sensory nerve from the 2nd and 3rd cervical nerves. As an autograft material, it has the advantages of convenient material, a certain length and more nerve bundles. It does not leave serious dysfunction after cutting, and it is in the oral and maxillofacial region. It is an ideal and preferred material for nerve defect repair. Treatment of diseases: facial nerve injury Indication Trauma, resection of the tumor and other causes of facial nerve defects, from the vertical part of the facial nerve canal to the surrounding branches within 5cm of the defect, can be used for auricular nerve transplantation, provided that the facial nerve center side of the broken end must be healthy. Contraindications 1. Old facial paralysis, including Bell facial paralysis and central facial paralysis, it is estimated that the facial expression muscle has been severely atrophied. 2. The facial nerve side of the facial nerve is unhealthy. 3. Facial nerve defect > 5cm. Preoperative preparation 1. Electromyography and electroencephalogram examination of the lateral nerve function, for the future evaluation of the surgical results for comparison data. 2. The skin of the parotid gland in the affected area was routinely prepared for skin. Surgical procedure Incision Parotidectomy incision. 2. Flap and reveal the ear nerve Cut the skin, subcutaneous tissue and platysma, and fold the flap in front of the parotid fascia. When the sternocleidomastoid surface is turned back, it is easy to see that the auricular nerves are slightly above the midpoint of the posterior margin of the muscle and follow the muscle surface to the parotid lobes. It is often accompanied by a jugular vein along the way, with the nerve behind and the vein in front. 3. Free auricular nerve When the auricular nerve is separated from the midpoint of the posterior margin of the sternocleidomastoid muscle, the flap can be retracted backward with a hook, and generally no extension is needed. The nerves are separated upwards to the parotid lobes, and their branches are dissected one by one. Try not to damage the external jugular vein, but you can ligature and cut it if necessary. 4. Anatomical facial nerve The antegrade and retrograde anatomy can be used to reveal the central and peripheral lateral fractures of the facial nerve, respectively. If the central end of the facial nerve is in the vertical part of the facial nerve canal, the incision can be extended to the surface of the mastoid, the periosteum can be turned up, and the papillary cortical bone and the air chamber can be chiseled or removed to reveal the vertical part of the facial nerve canal. Grind the facial nerve canal in the second abdominal muscle spasm of the stem and fissure, and scrape the lateral wall of the facial nerve tube with the 4th curette along the total surface of the facial nerve, and free the length of the facial nerve from the central end of the facial nerve for nerve anastomosis. . 5. Cut the ear nerve The length of the large ear nerve should be more than 0.5cm longer than the actual facial nerve defect. If there are more than 2 branches around the facial nerve, the branch of the large ear should be dissected with sufficient number of bundles and length before the pedicle is broken. If the number of bundles is insufficient, the auricular nerves of the contralateral side can also be cut, or the repair of the facial nerve branches, buccal branches and mandibular branches should be given priority according to the principle of repairing important branches first. 6. Anastomotic nerve The excised auricular nerve is placed antegradely between the facial nerve defects, and there should be no tension in the alignment. Under the operating microscope, they were respectively anastomosed to the central and peripheral side of the facial nerve. 7. Close the wound Rinse the wound, completely stop bleeding, and sew the cut parotid tissue. In cases of open facial nerve canal, in order to eliminate the mastoid cavity and provide soft tissue protection for the transplanted nerve, the sternocleidomastoid muscle flap on the mastoid side can be cut and turned up 180° to cover the exposed mastoid Inside the cavity, the periphery is sutured with the periosteum. Finally, the subcutaneous tissue and skin were sutured in layers, a semi-tube drainage strip was placed, and the bandage was pressure-wrapped.