Neurotization of the facial nerve as an effective way to treat paralysis of mimic muscles

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Pathologies of the facial nerve are one of the most common types of pathology of the peripheral nervous system. In the structure of lesions of the cranial nerves, this pathology occupies the first place. The clinical picture of facial nerve damage of various genesis is rather monotonous and manifests itself as persistent paresis or paralysis of the facial muscles. The literature describes a large number of different highly effective techniques aimed at restoring the function of the facial nerve and mimic muscles, examples of which are numerous conservative and surgical methods for the treatment of facial nerve neuropathy. The review presents the most common method of mimic muscles paralysis surgical treatment — facial nerve neurotization. The essence of this surgical intervention is in suturing to the affected facial nerve the trunk or a portion of individual fibers of the intact nerve-neurotic, which can be the hypoglossal, masticatory, phrenic, accessory, glossopharyngeal nerves, as well as the descending branch of the hypoglossal nerve and the anterior branches of the C2–C3 cervical nerves. Currently, options for the combined use of various donor nerves and autoextensions are gaining popularity among neurosurgeons, due to more favorable results in restoring the function of the facial nerve, as well as with an individual approach to each patient. The main stages of neurotization of the facial nerve include the isolation and intersection of the facial nerve, the isolation and intersection of the trunk or individual fibers of the neurotizer, the execution of the suture of the nerve in the “end to end” or “end to side” method. Particular attention should be paid to the most innovative method of facial nerve neurotization — facial nerve cross-plasty, during which an anastomosis between the damaged and intact facial nerves using autotransplants from the gastrocnemius nerve or a free muscle graft, including the tender muscle and the anterior branch of the obturator nerve is performed. The process of restoring facial nerve function and regressing characteristic symptoms takes a long period of time and requires specialized restorative treatment.

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Bogdan V. Skaliitchouk

Military Medical Academy named after S.M. Kirov

Author for correspondence.
ORCID iD: 0000-0002-6024-8142


Russian Federation, St. Petersburg, Russia

Alexey I. Gaivoronsky

Military Medical Academy named after S.M. Kirov; St. Petersburg State University

ORCID iD: 0000-0003-1886-5486

M.D., D. Sci. (Med.), Prof., Depart. of Neurosurgery

Russian Federation, St. Petersburg, Russia; St. Petersburg, Russia

Vyacheslav V. Vinogradov

Military Medical Academy named after S.M. Kirov

ORCID iD: 0000-0001-5930-3805


Russian Federation, St. Petersburg, Russia

Dmitriy V. Svistov

Military Medical Academy named after S.M. Kirov

ORCID iD: 0000-0002-3922-9887

M.D., Cand. Sci. (Med.), Assoc. Prof., Head of Depart., Depart. of Neurosurgery

Russian Federation, St. Petersburg, Russia


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Supplementary files

Supplementary Files
1. Рис. 1. Схема доступа к лицевому и добавочному нервам: 1 — лицевой нерв; 2 — добавочный нерв; 3 — околоушная слюнная железа; 4 — внутренняя яремная вена; 5 — грудино-ключично-сосцевидная мышца

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2. Рис. 2. Способ продольного ретроградного расщепления волокон подъязычного нерва с последующей невротизацией лицевого нерва по M.D. Cusimano: 1 — лицевой нерв; 2 — подъязычный нерв; 3 — шов нерва по типу «конец в конец»

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3. Рис. 3. Способ невротизации лицевого нерва жевательным по M. Spira: 1 — лицевой нерв; 2 — жевательный нерв; 3 — шов нерва по типу «конец в конец»; 4 — околоушная слюнная железа

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