Shredded Cables

Question: A 38 year old male is involved in a motor vehicle accident.  In addition to multiple extremity injuries, he sustains a right parietal subdural hematoma and a right temporal bone fracture.  When sedation is lifted, the patient exhibits House-Brackmann 6/6 facial function on the right side.  After 3 days, ENoG testing shows 95% degeneration.  You elect to explore the intratemporal facial nerve.  In the mastoid, you find an edematous nerve segment with hemorrhage and a partial-thickness nerve injury.  What is the most appropriate repair technique?

a) Resect the injured segment and place a cable graft
b) Complete the transection and perform end-to-end reanastomosis
c) Perform reanastomosis the injured segment leaving the intact portion intact
d) Decompress only

    [Answer will be posted with next week's new question]

Answer to last week's question, "Plug It In" (December 4, 2017)

Ansa cervicalis.