Hemihypoglossal-facial nerve anastomosis for facial nerve palsy

Neurol Neurochir Pol. 2011 Sep-Oct;45(5):452-60. doi: 10.1016/s0028-3843(14)60313-3.

Abstract

Background and purpose: Commonly used classic hypoglossal (CN XII) to facial nerve (CN VII) anastomosis has the disadvantage of tongue hemiatrophy. Thus, various attempts have been made to modify this method to reduce the tongue damage. The aim of this report was to present the results of hemihypoglossal-facial nerve anastomosis (HHFA) technique in relation to facial muscles reanimation and hemitongue atrophy.

Material and methods: The first 7 consecutive patients who underwent CN VII anastomosis with half of the CNXII, for which the follow-up period exceeded 12 months, were analysed. During the procedure, CN VII was transected as proximally as possible after drilling the mastoid process. CN XII was separated longitudinally into two parts at a short distance to allow suture of the stumps without any tension. One half of CN XII was transected and sutured to the distal stump of CN VII. Recovery from facial palsy was quantified with the House-Brackmann grading system (HB). Tongue function was assessed according to the scale proposed by Martins.

Results: Features of initial reinnervation of facial muscles were visible after 6 months in all 7 patients. All patients achieved satisfactory outcome of CN VII regeneration (HB grade III) until the last control examination (12-27 months after surgery, mean 16). No or minimal tongue atrophy without deviation (grades I-II according to the Martins scale) was found in 4 patients. Mild hemiatrophy with tongue deviation < 30 degrees (grade III) was visible in 3 patients.

Conclusions: In our experience, HHFA is effective treatment of facial palsy and gives a chance to reduce damage of the tongue.

MeSH terms

  • Adult
  • Anastomosis, Surgical / methods*
  • Facial Nerve / pathology
  • Facial Nerve / surgery*
  • Facial Nerve Injuries / complications
  • Facial Nerve Injuries / surgery
  • Facial Paralysis / etiology
  • Facial Paralysis / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypoglossal Nerve / pathology
  • Hypoglossal Nerve / surgery*
  • Male
  • Middle Aged
  • Nerve Transfer
  • Neurosurgical Procedures / methods
  • Recovery of Function
  • Tongue / innervation*
  • Tongue / pathology
  • Treatment Outcome