Microsurgical Approach for Early Excision of Neurofibroma in the Head and Neck Areas

BACKGROUND: Neurofibroma has a variety of manifestations. The major complications are deformities with overgrowth of bone and malignant changes. Repetitive surgeries are necessary for recurrent neurofrbromas in head and neck area. In the past, facial nerve palsy was often observed after surgery. Because of the development of reconstructive microsurgery, anesthesiology, pediatrics and pediatric ICU care, early surgical intervention has been advocated to minimize the progressive development of facial deformities and to preserve facial nerve function.   

PATIENTS AND METHODS: A retrospective study was done for a total of 9 patients with neurofibromatosis type I in head and neck area. The age to start surgical intervention was from 2 months to 67 years. The mean follow-up time was 38 months (2months to 8 years). Serial pictures, image study and facial expressions were record.  

RESULTS: (1) For facial contour, early and multiple surgical interventions could avoid severe asymmetry as well as distortion of mandible which are difficult to correct, in contrast to the patients operated late. (2) For the facial nerve function, maximal tumor excision and identification of facial nerve with microscope can reduce tumor-compression injury and result in better facial expression.    

CONCLUSION: Close observation and early operation for neurofibroma will be the tendency of treatment in the future. If necessary, repetitive operation can be done with guidance of suture marked around the facial nerve branch.