Hemihypoglossal-Facial Nerve Transfer: Technical Description and Key Points: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E53-E54
Author(s):  
Guido Caffaratti ◽  
Sebastián Juan María Giovannini ◽  
Daniel Orfila ◽  
Mariano Socolovsky
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
High Speed ◽  
Hypoglossal Nerve ◽  
Nerve Transfer ◽  
Point Of View ◽  
Detailed Knowledge ◽  
Key Points ◽  
Psychological Point ◽  
Cervical Segment

ABSTRACT Irreversible facial palsy, generally post-traumatic or postsurgical, can have devastating consequences for the patient from a functional, aesthetic, and psychological point of view. Among all of the reconstructive techniques, the hemihypoglossal-facial nerve transfer, which avoids the complete section of the hypoglossal nerve, is preferred by senior authors because of its excellent results and very low morbidity.1-5 This technique can be carried out in any neurosurgical center because it requires only basic instruments of microsurgery and a high-speed drill. However, detailed knowledge of the anatomy of the facial nerve in both its intrapetrosal and extracranial segments and of the hypoglossal nerve in its cervical segment is essential.1,6,7 Thus, previous practice in a cadaveric laboratory is recommended. The purpose of this video is to describe the technical nuances and key points of hemihypoglossal-facial nerve transfer. It was made using the surgical videos of 5 patients with a complete and irreversible facial paralysis who were operated using this technique in our institution between May and September 2019, all of whom consented to the procedure and to use for scientific purposes. The footages were edited, making a film in which the surgical technique is described in a stepwise fashion, emphasizing its most important features. To conclude, we would like to emphasize that the timing of surgery is of utmost importance and that this technique is both effective and reliable. Figures in the video at 00:54 and 01:35 are reprinted by permission from CCC: Springer Nature, Acta Neurochirurgica, Treatment of complete facial palsy in adults: comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihipoglossal-facial neurorrhaphy with grafts, and massater to facial nerve transfer. Socolovsky M, Martins RS, di Masi G, Bonilla G, Siqueira M, vol 158, 945-957, copyright 2016.

Early Outcomes in an Emerging Facial Nerve Center: The Oregon Health and Science University (OHSU) Experience

2020 ◽  
pp. 000348942095737
Author(s):  
Natalie A. Krane ◽  
Jimmy S. Chen ◽  
Haley Hanseler ◽  
Wenelia Baghoomian ◽  
John Ng ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Head And Neck Carcinoma ◽  
Nerve Transfer ◽  
Life Outcomes ◽  
Subjective Quality Of Life ◽  
Neck Carcinoma ◽  
Face Scale ◽  
Measuring Outcomes ◽  
Oral Commissure

Objectives: Nerve transfer (NT) and free gracilis muscle transfer (FGMT) are procedures for reanimation of the paralyzed face. Assessing the surgical outcomes of these procedures is imperative when evaluating the effectiveness of these interventions, especially when establishing a new center focused on the treatment of patients with facial paralysis. We desired to discuss the factors to consider when implementing a facial nerve center and the means by which the specialist can assess and analyze outcomes. Methods: Patients with facial palsy secondary to multiple etiologies, including cerebellopontine angle tumors, head and neck carcinoma, and trauma, who underwent NT or FGMT between 2014 and 2019 were included. Primary outcomes were facial symmetry and smile excursion, calculated using FACE-gram and Emotrics software. Subjective quality of life outcomes, including the Facial Clinimetric Evaluation (FaCE) Scale and Synkinesis Assessment Questionnaire (SAQ), were also assessed. Results: 14/22 NT and 6/6 FGMT patients met inclusion criteria having both pre-and postoperative photo documentation. NT increased oral commissure excursion from 0.4 mm (SD 5.3) to 2.9 mm (SD 6.8) ( P = 0.05), and improved symmetry of excursion ( P < 0.001) and angle ( P < 0.001). FGMT increased oral commissure excursion from −1.4 mm (SD 3.9) to 2.1 mm (SD 3.7), ( P = 0.02), and improved symmetry of excursion ( P < 0.001). FaCE scores improved in NT patients postoperatively ( P < 0.001). Conclusions: Measuring outcomes, critical analyses, and a multidisciplinary approach are necessary components when building a facial nerve center. At our emerging facial nerve center, we found NT and FGMT procedures improved smile excursion and symmetry, and improved QOL following NT in patients with facial palsy secondary to multiple etiologies.

Intratemporal Facial Nerve Transfer With Direct Coaptation to the Hypoglossal Nerve

2007 ◽  
Vol 28 (4) ◽  
pp. 546-550 ◽  
Author(s):  
Willem P. Godefroy ◽  
Martijn J. A. Malessy ◽  
Aimee A. M. Tromp ◽  
Andel G. L. van der Mey
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Nerve Transfer

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

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-41-ONS-50 ◽  
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.

Anatomy and physiology of the facial nerve and aetiology of facial nerve palsy

2021 ◽  
pp. 963-968
Author(s):  
Onur Gilleard ◽  
Kalliroi Tzafetta
Keyword(s):  
Natural History ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Facial Palsy ◽  
Nerve Palsy ◽  
Social Consequences ◽  
Detailed Knowledge ◽  
Anatomy And Physiology ◽  
History Of ◽  
Facial Nerve Anatomy

Facial paralysis can have significant functional and social consequences and presents a challenging reconstructive problem for plastic surgeons. Detailed knowledge of facial nerve anatomy and an understanding of the natural history of the different conditions which result in facial palsy is a prerequisite for clinicians who are involved in the management of this devastating affliction.

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

1989 ◽  
Vol 103 (1) ◽  
pp. 63-65 ◽  
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.

Masseter-to-Facial Nerve Transfer in Facial Palsy

2014 ◽  
Vol 30 (S 01) ◽  
Author(s):  
Marta Salgueiro ◽  
Tiago Toscano ◽  
Manuel Caneira
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Nerve Transfer

Differential Reanimation of the Midface and Lower Face Using the Masseteric and Hypoglossal Nerves for Facial Paralysis

2017 ◽  
Vol 15 (2) ◽  
pp. 174-178 ◽  
Author(s):  
Nobutaka Yoshioka
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Hypoglossal Nerve ◽  
Donor Site ◽  
Mass Movement ◽  
Nerve Transfer ◽  
Short Term ◽  
Lower Face ◽  
Masseteric Nerve

Abstract BACKGROUND Hypoglossal nerve transfer is frequently employed to reanimate the paralyzed facial muscles after irreversible proximal facial nerve injury. However, it can cause significant postoperative synkinesis because it involves the reinnervation of the whole mimetic musculature using a single motor source. OBJECTIVE To describe our experience with differential reanimation of the midface and lower face using separate motor sources in patients with short-term facial paralysis after brain surgery. METHODS Seven patients underwent combined nerve transfer (the masseteric nerve to the zygomatic branch and the hypoglossal nerve to the cervicofacial division of the facial nerve) and cross-facial nerve grafting with the aim of achieving a spontaneous smile. The median duration of paralysis before surgery was 7 mo and follow-up ranged from 7 to 31 mo (mean: 18 mo). For evaluation, both physical examination and video analysis were performed. RESULTS In all patients, reanimation of both the midface and the lower face was successful. A nearly symmetrical resting lip was achieved in all patients, and they were able to voluntarily elevate the corners of their mouths without visible synkinesis and to close their eyes while biting. No patient experienced impairment of masticatory function or tongue atrophy. CONCLUSION Differential reanimation of the midface and lower face with the masseteric and hypoglossal nerves is an alternative method that helps to minimize synkinetic mass movement and morbidity at the donor site.

Hemihypoglossal nerve transfer for acute facial paralysis

2013 ◽  
Vol 118 (1) ◽  
pp. 160-166 ◽  
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.

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

1995 ◽  
Vol 82 (1) ◽  
pp. 51-54 ◽  
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.

scholarly journals Comparative analysis of the nerve transfer methodologies used during surgical treatment of peripheral facial paresis

2020 ◽  
Vol 33 (3) ◽  
pp. 139-143
Author(s):  
Iaroslav Tsymbaliuk ◽  
Volodymyr Medvediev ◽  
Vitalii Tsymbaliuk ◽  
Igor Tretyak ◽  
Oleksandr Gatskiy ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Clinical Status ◽  
Nerve Transfer ◽  
Sternocleidomastoid Muscle ◽  
Accessory Nerve ◽  
Group 2 ◽  
Surgical Treatments ◽  
Stated Problem ◽  
Group 1

AbstractIntroduction. When considering the array of biomedical problems associated with facial nerve palsy (FNP), it is apparent that the problem of choosing an effective type of facial nerve transfer is of paramount relevance. Hence, it is to the pursuit of a solution to the above stated problem that our study is devoted.Materials and methods. We analyzed the data obtained as a result of assessing the outcome of 149 patients with trauma-caused FNP who had undergone surgical treatments in the period between 2001-2018. The FN nerve transfer techniques utilized were as such: for group 1 – the use as a donor nerve the branch of the accessory nerve innervating the sternocleidomastoid muscle (n=87); group 2 – the descending branch of the hypoglossal and the branch of the accessory nerve (n=62).Results. In groups 1–2, the FN nerve transfer significantly improved FN function (p <0.01; Wilcoxon Matched Pairs Test), and most patients (n=135; 90.6%) noted an improvement in the clinical status up to degree II-III on the House-Brackmann scale (good result).Conclusion. The use of the accessory nerve branches to the sternocleidomastoid muscle, as donated, ensures restoration of FN function to levels II-III on the House-Brackmann scale in 89.7% of all operated patients, and the results it achieves do not differ from those of the technically more complex nerve transfer of FN by descending branch of the hypoglossal nerve with combination of branches of the accessory nerve.

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