Hydrogel sutureless facial nerve repair: pilot clinical investigation.

INTRODUCTION Facial nerve injury leads to significant disability and impairment in quality of life. Nerve repair is the best treatment for facial nerve injury. Suture neurorrhaphy under microscopic magnification has been considered the gold standard for repair, but this method can be technically challenging and time consuming. Furthermore, sutures are traumatic, leading to scar formation that contributes to postoperative complications of synkinesis and neuroma formation. Nerve repair at the cerebellopontine angle is further complicated by limited exposure and a lack of epineurium, which provides the tissue strength to hold the suture. To address these concerns, surgeons have investigated sutureless techniques using fibrin sealants and similar materials. The primary concern with fibrin sutureless techniques is poor tensile strength. To address these concerns we utilized a hydrogel sutureless nerve repair (HSNR) technique. Initial coaptation of the nerve ends is performed with fibrin sealant. Previously published biochemical data have demonstrated excellent holding strength of polyethylene glycol (PEG) hydrogels with less scar formation compared to fibrin glues. We therefore encased the initial fibrin repair with PEG hydrogel to provide additional strength to the repair. This study retrospectively evaluated facial nerve recovery in two patients who underwent repair with this novel technique.