Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes

Am J Otolaryngol. 2016 Nov-Dec;37(6):493-496. doi: 10.1016/j.amjoto.2016.05.001. Epub 2016 May 17.


Purpose: Reanimation of facial paralysis is a complex problem with multiple treatment options. One option is hypoglossal-facial nerve grafting, which can be performed in the immediate postoperative period after nerve transection, or in a delayed setting after skull base surgery when the nerve is anatomically intact but function is poor. The purpose of this study is to investigate the effect of timing of hypoglossal-facial grafting on functional outcome.

Materials and methods: A retrospective case series from a single tertiary otologic referral center was performed identifying 60 patients with facial nerve injury following cerebellopontine angle tumor extirpation. Patients underwent hypoglossal-facial nerve anastomosis following facial nerve injury. Facial nerve function was measured using the House-Brackmann facial nerve grading system at a median follow-up interval of 18months. Multivariate logistic regression analysis was used determine how time to hypoglossal-facial nerve grafting affected odds of achieving House-Brackmann grade of ≤3.

Results: Patients who underwent acute hypoglossal-facial anastomotic repair (0-14days from injury) were more likely to achieve House-Brackmann grade ≤3 compared to those that had delayed repair (OR 4.97, 95% CI 1.5-16.9, p=0.01).

Conclusions: Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.

MeSH terms

  • Adult
  • Facial Nerve Injuries / etiology
  • Facial Nerve Injuries / rehabilitation
  • Facial Nerve Injuries / surgery*
  • Facial Paralysis / etiology
  • Facial Paralysis / rehabilitation
  • Facial Paralysis / surgery*
  • Female
  • Humans
  • Hypoglossal Nerve / transplantation*
  • Intraoperative Complications / etiology
  • Intraoperative Complications / rehabilitation
  • Intraoperative Complications / surgery*
  • Male
  • Middle Aged
  • Neuroma, Acoustic / surgery*
  • Recovery of Function
  • Retrospective Studies
  • Time Factors
  • Time-to-Treatment*
  • Treatment Outcome