The Price of Paralysis: Analyzing the Direct Cost of Facial Rehabilitation after Vestibular Schwannoma Resection

Abstract To estimate the direct costs associated with facial nerve rehabilitation for patients with facial paralysis after vestibular schwannoma (VS) resection. Retrospective cohort study. Academic tertiary referral center. Patients treated sequentially between September 2016 and May 2021 who experienced any degree of facial nerve dysfunction after VS resection and received rehabilitative interventions. Estimated costs calculated based on institutional billing data. A total of 15 patients (67% female, median age at surgery of 56 years) were identified. Of the patients 14 (93%) had tumors with cerebellopontine angle extension, with a median size of 20.7 mm (interquartile range [IQR] 13.8–23.5). The median House-Brackmann (HB) grade immediately after surgery was 6 (IQR 3–6), and the median HB grade at most recent evaluation was 5 (IQR 4–6) with a median follow-up of 29 months (IQR 17–44). A total of 11 patients (73%) underwent periocular procedures; 4 (27%) underwent extensive rehabilitative surgeries, including nerve transfer and static sling procedures; 5 (33%) underwent chemodenervation therapy; and 9 (60%) performed facial retraining therapy with treatment being initiated at a median of 6.2 months (IQR 3.2–9.3) after surgery. The median cost for all patients was $3,125 (IQR $1,120–14,843), with the median cost of extensive rehabilitative surgery being $15,970 (IQR $14,907–29,289). The median cost associated with facial rehabilitation is relatively low at $3,125; however, this amount varies based on the type of procedures pursued and individual need. Ultimately, a dedicated team of specialists is required to appropriately manage postoperative facial dysfunction in a cost-effective manner.