Facial Nerve Graft

[jilljpower]

Hi, my name is Jill and I am now 11 months post-operation of an 4 centimeter AN.  Even though my facial nerve is still connected, my nerves have not recovered much at all.  Next month I am going to surgery for the platinum gold weight to help me close my eye.  Soon after that I will be scheduling the nerve graft.  With all of the research I have done, I am not sure which option is the best.  I have a couple questions, which I will ask the nerve specialist at my next appt, but I thought this discussion forum would help direct me considering most of you have or know of someone who may have  had this experience.

1st question?  My nerve specialist says he has the best results with what he calls a "facial hypoglossal anastamosis."  Is the 7/12 jump graft the same operation?

2nd question?  Can you give me your opinion on which nerve graft operation has best affects, or is the common surgery at this time? 

3rd question?  Does the graft really bring back your smile and animation?  I miss being able to communicate via smile with "everyday people."

Thank you so much for your information.  I was really hoping to recover on my own, but now that the time has come, I need to research and pick the right decision.  Thank you, Jill

[moe]

Hi Jill,
Welcome to the forum!
 In answer to your questions:

1st question?  My nerve specialist says he has the best results with what he calls a "facial hypoglossal anastamosis."  Is the 7/12 jump graft the same operation?

Yep it's the same. I had the 7/12 operation 18 months post AN surgery.(too long a time period, but military geographic situation......)
 My face nerve was cut then reconnected during original AN surgery. I had partial results with 7/12. I would imagine you would have better results since your face nerve is still connected, and the sooner the 7/12 is done, the better results. Are you going to a face nerve clinic by  chance?

2nd question?  Can you give me your opinion on which nerve graft operation has best affects, or is the common surgery at this time? 

I think this is the main  nerve graft operation, though I am scheduled for  a "gracilis free flap surgery" next week, which takes the masseter nerve (jaw) and connects to transplanted muscle from my thigh (gracilis muscle) to the cheek. Since my 12/7 had partial results, this was the next step. I will be able to obtain movement and smiling ability with this surgery. It is another option, but not as common. I just happened to be at the right place (University of WA in Seattle) at the right time. Ask your doc if he does this or knows someone who does.

3rd question?  Does the graft really bring back your smile and animation?  I miss being able to communicate via smile with "everyday people."


Lori on the forum has had good results , so she may chime in. I'm not sure about the animation and full smile.
The gracilis free flap surgery will 90% guarantee animation and full smile. We'll see.....


Hope that helps!

Feel free to PM me with any other concerns!
Maureen

[chelsmom]

Hi Jill,

I'm glad you posted these questions.  My daughter has right side facial paralysis and she is also 11 months out from her last AN surgery.  Your stories sound alike.  Her surgeon has suggested that she have the 7/12 nerve graft sooner than later for the best results.  She really would like to wait as long a possible as she is not convinced that doing the surgery will make that much difference in her smile which is her biggest concern.  I would like to ask another question to those in the know about this surgery.
Is the facial nerve completely cut or is it grafted and still left intact?  Her concern is that if the facial nerve is severed and the 7/12 jump doesn't innervate the nerve then is all hope lost for the nerve to come back on it's own?  We will see her surgeons again in June to discuss the next steps and if we have as much information about the outcome of the surgery as possible then I think she will be able to decide what steps she will take in the future. 

Jill, i hope you don't mind that I added this question to your list of questions.  I just feel that the more information...the better.

Keeping my fingers crossed for the return of all your smiles,
Michelle

 

[lori67]

Hi Jill.

I had the 7/12 done at about 18 months post-op.  I was being optimistic that my facial nerve would come back on it's own, but that just wasn't happening.
It seems that the 7/12 would be the first choice of surgery, as it's a much easier one to do and usually has good results.  It's when things don't quite work out that they seem to move on to bigger things, such as the surgery Moe mentioned.

I had, and am still having, good results from my graft.  I do not have my big smile back, but I am having some issues with very tight muscles in my chin and lower lower lip area that are hindering the movement.  That will be addressed at a doctor's appointment next month and I expect we'll come up with a plan to make that better.  I don't expect to have more than a decent closed-mouth smile, but that will be okay with me.  I can almost blink now and can close my eye almost all the way.  I would suggest you find out what the doctor would grade your facial paralysis right now.  They usually use the House-Brackmann scale (1-6, with 6 being no movement).  I was a 5 prior to surgery and was told that I should be able to get back to at least a 3 after the graft, so I didn't have much to lose.  That might help you decide if the surgery is right for you.

I miss being able to smile big at the general public too, but I've found that even with only half of a good smile, I can still get my point across and people know when I'm smiling (or not smiling  ).  Michelle, I don't think the facial nerve is severed for the graft, but I wouldn't swear to it.  Good question for the doc though!

Good luck Jill!
Lori

[saralynn143]

Michelle, I went to my favorite site about post-surgical facial paralysis (http://neurosurgery.mgh.harvard.edu/CranialBaseCenter/b95.htm) and scrolled down to "Partial hypoglossal-facial nerve anastomosis" where it indicates that the facial nerve is indeed dissected during the procedure. I think it would have to be, since the nerve impulses from the hypoglossal nerve would have to go to all of the branches of the facial nerve. That's why, unless the nerve is cur during AN surgery, they want to give enough time to see if the facial nerve shows signs of healing.

Sara

[Cheryl R]

Between reading posts here and what has been said at the AN symposium, there is a varying in time in how soon one should have surgery to help have some improvement in the facial paralysis.          I have heard some drs say wait at least 18 mos and we have also heard here how even longer past that, has been some improvement in several.            Makes it hard to know what is the best way.         
  I well know too, Lori, about how even just having the closed mouth smile works and you get by.               I wouldn't know what it was like to have the big smile anymore.        Maddening to see pics of everyone who does but just glad that my paralysis did improve with my type of nerve graft.              To the newbies.     My surgeon is one who takes a piece of nerve from by the ear and grafts in when a facial nerve is severed,during that surgery.      Mine was a facial neuroma.     I don't think many surgeons do go ahead with this but leave some tumor on the facial nerve.               I was just told at my last dr appt that the mouth area returns more than the eye area which is my case.   
                                                                   Cheryl R

[Kaybo]

I responded to your other post...

K 

[jilljpower]

Thank you everyone for awesome information and advise on the 7/12 surgery... I also really appreciate your insights, questions, and feelings.  Michelle- In regards to your daughter; I too was very hopeful about recovering on my own with acupuncture and massage.  It is the Dr's who really broke it to me, that most of your spontaneous recovery happens within the first 9-12 months.  It was hard to hear, but at least there are surgeries to help like the 7/12.  I'd love to have a partial smile after all of this!  I have an appt. next week with the nerve specialist to book my 7/12.  Thanks to all of you, I am more comfortable and have a lot more knowledge than before.  So, thank you! Jill 

One more question?  Is the 7/12 a big surgery with lots of recovery time?  Or were you able to pop back out of it with in a couple of weeks?  Any information, whether good or bad would be greatly appreciated.

[Kaybo]

Jill~
I was in the hospital one night (but that was a long time ago) and then home.  I took it easy on eating - couldn't open mouth too wide for a while.  I remember going back to work but still taking "bite-sized" things in my lunch.  MUCH easier & less involved that AN surgery!

K   

[lori67]

I spent the night in the hospital too, but only because my surgery was done in the mid to late afternoon.  If it had been in the morning, I could have gone home that night.  I had to eat soft food for about a week or so - mashed potatoes, oatmeal, ice cream (  ).  But once you get hungry enough, you figure out a way to get something more substantial down.

I had my surgery on a Friday, came home Saturday and was back to my usual routine of being mom by Monday morning.    I didn't have any pain that tylenol couldn't handle and like Kay, eating was probably the biggest issue.  My speech was a little slurred for a week or two also, but once your tongue gets used to the whole idea, that gets better too.

The doctors do a good job of hiding the scar also, so you don't need to be overly concerned about that.  If you made it through your AN surgery in relatively good shape, you'll do great with this one.

Lori

[rsteph]

I had 3.7 cm AN totallly removed in Aug 08'.  My nerve was stretched but not cut.  I had absolutely no facial movement for 11 months and had all the nerve tests performed at six months post op and was told by my doctors at six months that the prognosis for any movement to return was not likely and to have a 7/12.  I refused and waited and waited and researched the 7/12, T3, and other surgical options.   At 11 months I noticed the slightest movement on my paralyzed side that really only I could see.  I didn't think much of it and went to the doctor who intially did not see it until I pointed it out.  When he saw it, he came out of his chair and could not believe it.   They look at me now and say there is no surgery that could have given me what I am getting back.  My face is symmetrical and I can almost smile now.  I have a gold weight and may be getting another because they placed this weight out to far so it is superficial and people can see it.  The weight certainly has helped me and I was blinking after surgery and the doctors saw it but still decided to put a gold weight in.  That surgery is irritating for a couple of weeks and you will look like you been mugged but I believe it helped me.

A co-worker had 4.0 cm with cut nerve and the 7/12 two years post op did not give him good results he wanted.  The 7/12 surgery is like cutting a network cable (your facial nerve) with 6000 wires and then taking another cut cable and tying the two together in hopes that most of the wires connnect. A few do have very good results.   He also had a T3 that gave him instant results he was satisfied with.  Understand that the 7/12 involves cutting the facial nerve once and for all.  T3 does not but is quite a surgery or two in itself. 

[moe]

Jill,
I too was discharged the day after surgery. They put a drain in my neck during surgery and pulled it the next day- little drainage.
I was just fatigued, per my usual, little pain. All in all a real easy surgery.

[jilljpower]

Awesome information!!!  I love this site and I thank you for your input.  So, what is the T3?  Can you get the T3 instead of the 7/12?
Jill

[Kaybo]

T3 = Temporalis Tendon Transfer - does not involve the nerves at all so it can be done at ANY time - I was 12 years out at the time!!     You can do either...I had the 12/7 many years ago and didn't great results (but again, I was like the 12th my doc had ever done - med has come a LONG way since then) so I didn't have anything to lose.  I think I would want to know FOR SURE that I had NO chance of any movement before I did the 12/7.  I do know that nerves can regenerate much more than they think of the "1 year" that you hear all the time but once they do the 12/7 it is CUT!!  In my case, I had NO (NADA, ZIPPO, nuthin') movement - not even a twitch - in that 1st year...
Hope that helps...ask more questions...that is why we are here!

K   

[jilljpower]

T3 = Temporalis Tendon Transfer - does not involve the nerves at all so it can be done at ANY time - I was 12 years out at the time!!     You can do either...I had the 12/7 many years ago and didn't great results (but again, I was like the 12th my doc had ever done - med has come a LONG way since then) so I didn't have anything to lose.  I think I would want to know FOR SURE that I had NO chance of any movement before I did the 12/7.  I do know that nerves can regenerate much more than they think of the "1 year" that you hear all the time but once they do the 12/7 it is CUT!!  In my case, I had NO (NADA, ZIPPO, nuthin') movement - not even a twitch - in that 1st year...
Hope that helps...ask more questions...that is why we are here!

K   

Thank you K for all of your information and advice.  I now feel much more empowered with what to do about my paralysis.  I really appreciate it. Jill