{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T19:14:55Z","timestamp":1775330095499,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T00:00:00Z","timestamp":1738540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Oncological surgery of the parotid gland or of the temporal bone may require the contemporary sacrifice of the facial nerve (FN). In such cases, the immediate repair of the sacrificed FN is recommended. The aim of this study is to evaluate the impact of facial rehabilitation (FR) and, secondarily, of post-operative radiotherapy (PORT) on the FN outcome after FN sacrifice and reconstruction via cable graft. Methods: This is a multicentric retrospective study including patients affected by malignant tumors whose surgical excision required FN sacrifice and contextual FN reconstruction with a cable graft. Other FN reconstruction techniques were excluded. FN function was assessed using both House\u2013Brackmann and Sunnybrook grading systems. Results: A total of 28 patients were included. Most of the patients underwent a total parotidectomy. The greater auricular nerve was the main donor for cable graft. FR and PORT were performed in 22 and 15 patients, respectively. In particular, 20 patients underwent neuro-muscular retraining (NMR). Patients who underwent FR had better FN outcomes compared to those who did not (p = 0.02 at 12 months and p = 0.0002 at 24 months). In contrast, there was no statistically significant difference between patients who underwent PORT and those who did not (p &gt; 0.05). Pre-operative FN palsy is a risk factor of worse FN function outcomes after cable graft. Conclusions: Our study, even though it was limited to only 28 cases, may demonstrate that cable graft failure is not due to PORT, as widely believed among clinicians, but to the absence of a rehabilitation program. Moreover, we suggest that the key to obtaining the best possible FN function results after FN sacrifice is the association of a technically correct FN reconstruction with a proper and targeted FR.<\/jats:p>","DOI":"10.3390\/jcm14030968","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T05:55:22Z","timestamp":1738648522000},"page":"968","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Facial Nerve Graft in Malignant Tumors: The Role of Facial Rehabilitation"],"prefix":"10.3390","volume":"14","author":[{"given":"Francesco","family":"Mattioli","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Costanza","family":"Galloni","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7705-9484","authenticated-orcid":false,"given":"Chiara","family":"Alberti","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Bonali","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2928-2051","authenticated-orcid":false,"given":"Alfredo","family":"Lo Manto","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Ospedale Infermi, 47923 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stella","family":"Baraldi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Tonelli","sequence":"additional","affiliation":[{"name":"Ph.D. Program, Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy"},{"name":"Respiratory Disease Unit and Center for Rare Lung Disease, Department of Surgical and Medical Sciences, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0384-938X","authenticated-orcid":false,"given":"Federica","family":"Nizzoli","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Reggiani","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Barbazza","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, IRCCS Azienda Ospedaliero\u2014Universitaria Di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4285-6862","authenticated-orcid":false,"given":"Carlotta","family":"Liberale","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, University of Verona, 37134 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4023-0121","authenticated-orcid":false,"given":"Marco","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Otolaryngology Section, Department of Neuroscience (DNS), University of Padova, 35123 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2727-0321","authenticated-orcid":false,"given":"Matteo","family":"Fermi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, IRCCS Azienda Ospedaliero\u2014Universitaria Di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Alicandri-Ciufelli","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9120-6586","authenticated-orcid":false,"given":"Ignacio Javier","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Ospedale Santa Maria delle Croci, 48121 Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Zanoletti","sequence":"additional","affiliation":[{"name":"Otolaryngology Section, Department of Neuroscience (DNS), University of Padova, 35123 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piero","family":"Nicolai","sequence":"additional","affiliation":[{"name":"Otolaryngology Section, Department of Neuroscience (DNS), University of Padova, 35123 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Marchioni","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Azienda Ospedaliero\u2014Universitaria Policlinico di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1002\/lary.22335","article-title":"Parotid tumor size predicts proximity to the facial nerve","volume":"121","author":"Domenick","year":"2011","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s00405-009-0968-x","article-title":"Predicting facial nerve invasion by parotid gland carcinoma and outcome of facial reanimation","volume":"267","author":"Preis","year":"2010","journal-title":"Eur. 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