The surgical management of extra-cranial trigeminal nerve palsies: A retrospective case series

Objectives: To assess for functional improvement in outcomes following supermicrosurgical restoration across a cohort of patients with a spectrum of trigeminal nerve disorders.

Patients & methods: In a retrospective case series over three years (2016-18), twenty patients were included in a cohort of trigeminal nerve palsy patients. Eleven patients with corneal anaesthesia underwent corneal neurotisation procedures and were followed up using Cochet-Bonnet aesthesiometry. Six patients with sensory trigeminal nerve injuries had direct nerve coaptation and neuroma excision. Three patients with trigeminal motor nerve palsies were followed up with photography for contour improvement.

Results: Regarding corneal neurotisation, there was evidence of significant improvement in protective corneal sensation and also blinking frequency. Regarding facial sensory disturbances, all patients had full resolution of painful trigeminal neuroma symptoms. In two cases of iatrogenic trigeminal motor palsies with contour defects, adipo-fascial variants of the superficial circumflex iliac artery (SCIP) free flap achieved excellent restoration of facial contour in lieu of facial lipofilling. In another case of a necrotising infection of the head and neck with loss of all masticatory muscles, a free functional muscle using a chimaeric vastus lateralis-ALT flap was used to restore masticatory and facial movement in a single stage procedure.

Conclusion: Using combinations and permutations of current surgical techniques, it is possible to successfully restore both form and function for patients with sensory as well as motor trigeminal nerve palsies. This sets a precedent for the expansion of cranial nerve surgery as an evolving sub-speciality.