Facial-to-Hypoglossal Nerve Anastomosis with Parotid Release

Hypogiossal-facial nerve anastomosis was carried out in 20 adult guinea pigs. Electromyographic responses of orbicularis oculi muscle evoked by blink reflex were recorded 2, 4, and 6 months after surgery. Then the anastomotic site was reopened, and a segment of buccal branch and the anastomotic trunk were resected for detailed histologic study. Regenerated axons were counted, and the cross-sectional area of axons and fasciculi was measured. Data obtained from both blink reflex measurement and histologic study demonstrate a good quality of regeneration of the facial nerve from the hypoglossal nerve completed 6 months after the operation. In addition a new nerve bundle was regenerated from the proximal stump of the facial nerve connecting to the anastomotic site in 80% of the animals. Postoperative change in innervation pattern of the facial nerve was also Illustrated.

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Outcomes and complications of direct end-to-side facial-hypoglossal nerve anastomosis according to the modified May technique

Journal of Neurosurgery ◽

10.3171/2008.9.jns08769 ◽

2009 ◽

Vol 110 (4) ◽

pp. 786-791 ◽

Cited By ~ 25

Author(s):

Frederic Venail ◽

Pascal Sabatier ◽

Michel Mondain ◽

François Segniarbieux ◽

Christophe Leipp ◽

...

Keyword(s):

Facial Palsy ◽

Cerebellopontine Angle ◽

Hypoglossal Nerve ◽

Late Complications ◽

Mastoid Process ◽

Surgical Removal ◽

Nerve Anastomosis ◽

The Mean ◽

Facial Synkinesis ◽

Facial Function

Object The aim of this study was to address the efficiency and safety of direct end-to-side facial-hypoglossal nerve anastomosis for facial palsy rehabilitation. Methods The authors conducted a retrospective study of 12 consecutive procedures performed between December 2000 and February 2006. Facial palsies were caused by the surgical removal of tumors in the brainstem, cerebellopontine angle, or mastoid process. Direct end-to-side facial-hypoglossal anastomosis was performed in each case. Facial function (evaluated using the overall percentage of facial function and House-Brackmann scale grades), as well as tongue trophicity and mobility, were assessed at 6, 12, and 24 months after surgery. Postoperative early and late complications were systematically reviewed. Results The mean delay between tumoral and reparative surgery was 15.9 ± 4 months (median 11 months). Preoperatively, the mean percentage facial function score was 11.6 ± 1.7% (45% of patients with House-Brackmann Grade 5 facial palsy and 55% of patients with House-Brackmann Grade 6). Mean facial function scores increased to 19.3, 32.2, and 43.8% at 6, 12, and 24 months after surgery, respectively. Twenty-four months after surgery, 50% of cases had House-Brackmann Grade 3 facial palsy and 50% had Grade 4. A significantly better recovery at 24 months was observed postoperatively for neural lesions occurring in the mastoid or the brainstem compared with those in the cerebellopontine angle. Tongue hemiparesis was observed in 5 patients (41.7%), 2 of whom had tongue hypotrophy (16.7%). No patient complained of swallowing or speech disturbance. Facial synkinesis was noted in 1 patient (8.3%). Conclusions Facial recovery after direct end-to-side facial-hypoglossal nerve anastomosis is similar to results observed with end-to-end or end-to-side facial-hypoglossal nerve anastomosis with an interpositional graft. Tongue hypotrophy and palsy were observed in a small number of cases. This procedure allows one to minimize, although not fully prevent, facial synkinesis. The site of the neural lesion appears to be an important factor in the prognosis of recovery.

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Hypoglossal-facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique

Neurosurgical FOCUS ◽

10.3171/foc.1996.1.2.9 ◽

1996 ◽

Vol 1 (2) ◽

pp. E8 ◽

Cited By ~ 3

Author(s):

Yutaka Sawamura ◽

Hiroshi Abe

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Hypoglossal Nerve ◽

Mastoid Process ◽

Mastoid Cavity ◽

Distal Stump ◽

Delayed Treatment ◽

Stylomastoid Foramen ◽

Facial Reanimation ◽

Nerve Anastomosis

This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of nerve grafts or hemihypoglossal nerve splitting. Using this technique, the mastoid process is partially resected to open the stylomastoid foramen and the descending portion of the facial nerve in the mastoid cavity is exposed by drilling to the level of the external genu and then sectioning its most proximal portion. The hypoglossal nerve beneath the internal jugular vein is exposed at the level of the axis and dissected as proximally as possible. One-half of the hypoglossal nerve is transected: use of less than one-half of the hypoglossal nerve is adequate for approximation to the distal stump of the atrophic facial nerve. The nerve endings, the proximally cut end of the hypoglossal nerve, and the distal stump of the facial nerve are approximated and anastomosed without tension. This technique was used in four patients with long-standing facial paralysis (greater than 24 months), and it provided satisfactory facial reanimation, with no evidence of hemitongue atrophy or dysfunction. Because it completely preserves glossal function, the hemihypoglossal-facial nerve anastomosis described here constitutes a successful approach in patients with long-standing facial paralysis who do not wish to have tongue function compromised.

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Facial Reanimation by Means of the Hypoglossal Nerve: Anatomic Comparison of Different Techniques

Operative Neurosurgery ◽

10.1227/01.neu.0000289710.95426.19 ◽

2007 ◽

Vol 61 (suppl_3) ◽

pp. ONS-41-ONS-50 ◽

Cited By ~ 5

Author(s):

Alvaro Campero ◽

Mariano Socolovsky

Keyword(s):

Facial Nerve ◽

Hypoglossal Nerve ◽

Average Length ◽

Average Distance ◽

External Auditory Meatus ◽

Nerve Transfer ◽

Mastoid Process ◽

Digastric Muscle ◽

Facial Reanimation ◽

Nerve Anastomosis

Abstract Objective: The goal of this study was to determine the various anatomical and surgical relationships between the facial and hypoglossal nerves to define the required length of each for a nerve transfer, either by means of a classical hypoglossal-facial nerve anastomosis or combined with any of its variants developed to reduce tongue morbidities. Methods: Five adult cadaver heads were bilaterally dissected in the parotid and submaxillary regions. Two clinical cases are described for illustration. Results: The prebifurcation extracranial facial nerve is found 4.82 ± 0.88 mm from the external auditory meatus, 5.31 ± 1.50 mm from the mastoid tip, 15.65 ± 0.85 mm from the lateral end of C1, 17.19 ± 1.64 mm from the border of the mandible condyle, and 4.86 ± 1.29 mm from the digastric muscle. The average lengths of the mastoid segment of the facial nerve and the prebifurcation extracranial facial nerve are 16.35 ± 1.21 mm and 18.93 ± 1.41 mm, respectively. The average distance from the bifurcation of the facial nerve to the hypoglossal nerve turn is 31.56 ± 2.53 mm. For a direct hypoglossal-facial nerve anastomosis, a length of approximately 19 mm of the hypoglossal nerve is required. For the interposition nerve graft technique, a 35 mm-long graft is required. For the technique using a longitudinally dissected hypoglossal nerve, an average length of 31.56 mm is required. Exposure of the facial nerve within the mastoid process drilling technique requires 16.35 mm of drilling. Conclusion: This study attempts to establish the exact graft, dissection within the hypoglossal nerve, and mastoid drilling requirements for hypoglossal to facial nerve transfer.

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Aberrant anatomy of the hypoglossal nerve

The Journal of Laryngology & Otology ◽

10.1017/s0022215111003343 ◽

2012 ◽

Vol 126 (5) ◽

pp. 538-540 ◽

Cited By ~ 9

Author(s):

S Islam ◽

G M Walton ◽

D Howe

Keyword(s):

Head And Neck ◽

Hypoglossal Nerve ◽

Neck Surgery ◽

Main Trunk ◽

Iatrogenic Complications ◽

Facial Reanimation ◽

Nerve Anastomosis ◽

Surgery Department ◽

Variant Anatomy ◽

Base Of The Tongue

AbstractObjective:Variant anatomy of the hypoglossal nerve is very rare. We report an unusual intra-operative finding of an aberrant branch of the hypoglossal nerve, encountered during a facial reanimation procedure.Case report:A 50-year-old man was referred to the head and neck surgery department by the neurosurgeons for hypoglossal-facial nerve anastomosis to treat his facial paralysis, which had occurred following the removal of an intracranial neoplasm. During surgery, we identified an aberrant branch of the hypoglossal nerve, which took a more ventral and superior course in the carotid triangle, prior to entering the base of the tongue. Following further dissection, we found the main trunk of the ‘true’ hypoglossal nerve. Several interconnecting strands were seen in the proximal aspect of both the aberrant branch and the main trunk of the hypoglossal nerve. These interconnecting fibres appeared to have tethered the main trunk into an abnormal anatomical position.Conclusion:As far as we can ascertain, this is the first report of an aberrant branch of the hypoglossal nerve. Although this variant would appear to be extremely rare, surgeons must consider all variations of this nerve during head and neck procedures, in order to minimise iatrogenic complications.

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Synaptic remodeling in the dorsal motor nucleus of the vagus nerve following vagal-hypoglossal nerve anastomosis in the cat

The Journal of Comparative Neurology ◽

10.1002/cne.10576 ◽

2003 ◽

Vol 458 (2) ◽

pp. 195-207 ◽

Cited By ~ 3

Author(s):

Chyn-Tair Lan ◽

Jee-Ching Hsu ◽

Chen-Nen Chang ◽

Huo-Li Chuang ◽

Eng-Ang Ling

Keyword(s):

Vagus Nerve ◽

Hypoglossal Nerve ◽

Motor Nucleus ◽

Synaptic Remodeling ◽

Dorsal Motor Nucleus ◽

Nerve Anastomosis

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Evaluation of recent experience in hypoglossal-facial nerve anastomosis in the treatment of facial palsy

The Journal of Laryngology & Otology ◽

10.1017/s0022215100108047 ◽

1989 ◽

Vol 103 (1) ◽

pp. 63-65 ◽

Cited By ~ 10

Author(s):

M. I. Clayton ◽

R. P. Rivron ◽

D. R. Hanson ◽

J. D. Fenwick

Keyword(s):

Facial Nerve ◽

Acoustic Neuroma ◽

Facial Palsy ◽

Hypoglossal Nerve ◽

Recent Experience ◽

Facial Symmetry ◽

Nerve Anastomosis

AbstractThis evaluation of recent experience of hypoglossal-facial nerve anastomosis in ten patients who had undergone acoustic neuroma resection, indicates that this procedure may have a role to play in the treatment of this disfiguring condition. Facial symmetry at rest is satisfactory in the majority of patients, who suffered little long term deficit from the loss of their hypoglossal nerve. This procedure is ideally suited to otolaryngological practice.

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Hemihypoglossal nerve transfer for acute facial paralysis

Journal of Neurosurgery ◽

10.3171/2012.9.jns1270 ◽

2013 ◽

Vol 118 (1) ◽

pp. 160-166 ◽

Cited By ~ 19

Author(s):

Ayato Hayashi ◽

Masanobu Nishida ◽

Hisakazu Seno ◽

Masahiro Inoue ◽

Hiroshi Iwata ◽

...

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Hypoglossal Nerve ◽

Severe Infection ◽

Nerve Transfer ◽

Average Period ◽

Success Rates ◽

Functional Deficits ◽

Facial Reanimation ◽

Nerve Anastomosis

Object The authors have developed a technique for the treatment of facial paralysis that utilizes anastomosis of the split hypoglossal and facial nerve. Here, they document improvements in the procedure and experimental evidence supporting the approach. Methods They analyzed outcomes in 36 patients who underwent the procedure, all of whom had suffered from facial paralysis following the removal of large vestibular schwannomas. The average period of paralysis was 6.2 months. The authors used 5 different variations of a procedure for selecting the split nerve, including evaluation of the split nerve using recordings of evoked potentials in the tongue. Results Successful facial reanimation was achieved in 16 of 17 patients using the cephalad side of the split hypoglossal nerve and in 15 of 15 patients using the caudal side. The single unsuccessful case using the cephalad side of the split nerve resulted from severe infection of the cheek. Procedures using the ansa cervicalis branch yielded poor success rates (2 of 4 cases). Some tongue atrophy was observed in all variants of the procedure, with 17 cases of minimal atrophy and 14 cases of moderate atrophy. No procedure led to severe atrophy causing functional deficits of the tongue. Conclusions The split hypoglossal-facial nerve anastomosis procedure consistently leads to good facial reanimation, and the use of either half of the split hypoglossal nerve results in facial reanimation and moderate tongue atrophy.

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Hemihypoglossal—facial nerve anastomosis in treating unilateral facial palsy after acoustic neurinoma resection

Journal of Neurosurgery ◽

10.3171/jns.1995.82.1.0051 ◽

1995 ◽

Vol 82 (1) ◽

pp. 51-54 ◽

Cited By ~ 76

Author(s):

Hajime Arai ◽

Kiyoshi Sato ◽

Akira Yanai

Keyword(s):

Facial Nerve ◽

Facial Palsy ◽

Hypoglossal Nerve ◽

Tumor Resection ◽

Postoperative Recovery ◽

Acoustic Neurinoma ◽

Content Type ◽

Facial Reanimation ◽

Nerve Anastomosis

✓ Eight patients underwent hemihypoglossal—facial nerve anastomosis (anastomosis of a split hypoglossal nerve to the facial nerve) for treatment of unilateral facial palsy. All patients previously had undergone resection of a large acoustic neurinoma and the facial nerve had been resected at that time. The interval between tumor resection and hemihypoglossal—facial nerve anastomosis ranged from 1 to 6 months, with an average of 2.1 months. Postoperative recovery of facial movement was good in all cases during an average follow-up period of 4.2 years. In all eight patients, the degree of hypoglossal nerve atrophy on the operated side was graded mild or moderate, but not severe. It was concluded that hemihypoglossal—facial nerve anastomosis results in good facial reanimation as long as the procedure is performed early after the onset of facial palsy and that this procedure may reduce the degree of hemiglossal atrophy in comparison with classic hypoglossal—facial nerve anastomosis.

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