During excision of a temple lesion, the frontal branch of the facial nerve is sharply divided and recognised immediately. The ends approximate without tension. What is the best repair?
A clean recognised extratemporal transection has the best prospect with immediate aligned primary repair. If tension-free apposition is impossible, an interposition graft is preferable to stretching the nerve.
A. Immediate tension-free primary epineurial coaptation under magnification: A clean recognised extratemporal transection has the best prospect with immediate aligned primary repair. If tension-free apposition is impossible, an interposition graft is preferable to stretching the nerve.
B. Mark the ends and perform delayed primary repair after Wallerian degeneration: Delay adds scarring and retraction without benefit when a clean tension-free repair is possible now.
C. Interpose a great-auricular nerve graft despite tension-free apposition: A graft adds two coaptation sites and is reserved for a gap that prevents direct repair.
D. Perform immediate masseteric-to-facial nerve transfer: A nerve transfer is valuable when the proximal facial input is unavailable, not when both fresh ends can be directly joined.
E. Decompress the temporal facial nerve without repairing the divided branch: Proximal decompression does not restore continuity at the recognised extratemporal transection.
If a 3 cm gap remained after mobilisation, an autologous interposition nerve graft or selected nerve transfer would be required rather than repair under tension.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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