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

2009 ◽  
Vol 110 (4) ◽  
pp. 786-791 ◽  
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.

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

1996 ◽  
Vol 1 (2) ◽  
pp. E8 ◽  
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.

Transmastoid Retrosigmoid Approach to the Cerebellopontine Angle: Surgical Technique

2012 ◽  
Vol 73 (suppl_1) ◽  
pp. ons16-ons23 ◽  
Author(s):  
Mohammad Abolfotoh ◽  
Ian F. Dunn ◽  
Ossama Al-Mefty
Keyword(s):  
Surgical Technique ◽  
Cerebellopontine Angle ◽  
Traditional Approach ◽  
Senior Author ◽  
Retrosigmoid Approach ◽  
Mastoid Process ◽  
Suboccipital Craniotomy ◽  
Cerebellar Retraction ◽  
The Mean ◽  
Working Distance

Abstract BACKGROUND: The traditional suboccipital craniotomy in the retrosigmoid approach gives limited exposure to the cerebellopontine angle (CPA) structures and necessitates cerebellar retraction, whereas the addition of drilling of the mastoid process with reflection of venous sinuses offers wider exposure of the CPA and avoids cerebellar retraction. We describe the details of the surgical technique and provide radiological measurements substantiating the advantages of this approach. OBJECTIVE: To validate the usefulness of partial mastoidectomy in the retrosigmoid approach and to evaluate the complications of this maneuver. METHODS: Radiological CPA measurements on computed tomography bone window films were made on the last consecutive 20 patients who underwent CPA surgery via the transmastoid retrosigmoid approach. We measured the distance and angle of work by this approach and compared the measurements with those using the traditional retrosigmoid approach if that would have been used in each case. We also reviewed 432 patients from the records of the senior author to evaluate possible complications of this approach. RESULTS: The mean working distance for the transmastoid approach was 23.06 mm, whereas the working distance in the traditional approach was 46.44 mm. The mean increase in the angle of work after drilling of the mastoid was 25.39 degrees, and the simple average of increased distance in lateral exposure was 26.66 mm. CONCLUSION: The transmastoid retrosigmoid approach increases the exposure and gives better access to the CPA targets. This approach alleviates cerebellar retraction, facilitates surgery in the supine position, promotes the use of the endoscope, and is associated with negligible complications.

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.

Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors

1992 ◽  
Vol 77 (5) ◽  
pp. 724-731 ◽  
Author(s):  
Luis F. Pitty ◽  
Charles H. Tator
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Cerebellopontine Angle ◽  
Surgical Techniques ◽  
Content Type ◽  
Factors Affecting ◽  
Cerebellopontine Angle Tumors ◽  
Nerve Anastomosis ◽  
Fair Poor ◽  
Fine Print

✓ Hypoglossal-facial nerve anastomosis is one of the procedures frequently performed to restore function after facial palsy secondary to surgery for removal of cerebellopontine angle tumors. The published results of hypoglossal-facial nerve anastomosis have been variable, and there are still questions about the indications, timing, and surgical techniques for this procedure. The goals of the present retrospective analysis of 22 cases of hypoglossal-facial nerve anastomosis were to assess the extent of the functional recovery and to analyze the factors affecting this recovery. The 22 cases of complete facial palsy were gleaned from a series of 245 cases of cerebellopontine angle tumors treated surgically by one of the authors. Twenty patients had an acoustic neuroma (average size 3.5 cm), one patient had a petrous meningioma, and one patient had a facial neuroma. The average age of the patients was 47.3 years (range 19 to 69 years). The average interval from tumor surgery to hypoglossal-facial nerve anastomosis was 6.4 months (range 12 days to 17 months), and the average follow-up period after the procedure was 65 months. The results were graded as good, fair, poor, or failure according to a new method of classifying facial nerve function after hypoglossal-facial nerve anastomosis. The results were good in 14 cases (63.6%), fair in three (13.6%), and poor in four (18.2%); one (4.5%) was a failure. Good and fair results occurred with higher frequency in younger patients who were operated on within shorter intervals, although these relationships were not statistically significant. There were no surgical complications. Good or fair results were achieved in 17 (77.3%) of the 22 cases, and thus hypoglossal-facial nerve anastomosis is considered an effective procedure for most patients with facial palsy after surgery for cerebellopontine angle tumors.

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.

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.

Effect of Corticosteroids on Facial Function after Cerebellopontine Angle Tumor Removal: A Double-Blind Study versus Placebo

2015 ◽  
Vol 20 (4) ◽  
pp. 213-221 ◽  
Author(s):  
Alexis Bozorg Grayeli ◽  
Evelyne Ferrary ◽  
Florence Tubach ◽  
Isabelle Bernat ◽  
Olivier Deguine ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Facial Palsy ◽  
Cerebellopontine Angle ◽  
Tumor Resection ◽  
Blind Study ◽  
Double Blind Study ◽  
Tumor Removal ◽  
Double Blind ◽  
To Receive ◽  
Facial Function

The aim of this study was to assess the effect of corticosteroids administered intra- and postoperatively on the occurrence of facial palsy after a cerebellopontine angle (CPA) tumor resection, and to investigate pre- and intraoperative prognostic factors. A multicenter, prospective, randomized, double-blind and versus-placebo study was conducted between 2006 and 2010. Three hundred and ten patients operated on for a CPA tumor (96% vestibular schwannomas, 4% miscellaneous) were included by five participating centers. The population was stratified into patients with small (≤15 mm CPA on axial MRI views) and large tumors. In each group, patients were randomized to receive corticosteroid (1 mg/kg/day i.v. methylprednisolone intraoperatively and at postoperative days 1-5) or placebo. Steroids did not affect the facial function at postoperative days 1, 8 and 30 in patients with small or large tumors as evaluated by House and Brackmann grading.

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

1997 ◽  
Vol 86 (2) ◽  
pp. 203-206 ◽  
Author(s):  
Yutaka Sawamura ◽  
Hiroshi Abe
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Hypoglossal Nerve ◽  
Mastoid Process ◽  
Mastoid Cavity ◽  
Distal Stump ◽  
Content Type ◽  
Stylomastoid Foramen ◽  
Nerve Anastomosis ◽  
Fine Print

✓ 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.

One-stage Removal of Residual Intracanalicular Acoustic Neuroma and Hemihypoglossal-intratemporal Facial Nerve Anastomosis: Technical Note

Neurosurgery ◽  
2003 ◽  
Vol 53 (6) ◽  
pp. 1444-1448 ◽  
Author(s):  
Renato Donzelli ◽  
Gaetano Motta ◽  
Luigi Maria Cavallo ◽  
Francesco Maiuri ◽  
Enrico de Divitiis
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Facial Palsy ◽  
Residual Tumor ◽  
Surgical Removal ◽  
Translabyrinthine Approach ◽  
One Stage ◽  
Incomplete Removal ◽  
Nerve Anastomosis ◽  
Suboccipital Approach

Abstract OBJECTIVE AND IMPORTANCE Incomplete removal of residual intracanalicular tumor and injury to the facial nerve are the main problems associated with surgery of large acoustic neuromas via the retromastoid suboccipital approach. In patients with residual or recurrent intracanalicular neuromas, the translabyrinthine approach is the preferred surgical route, allowing complete tumor removal; it may eventually also be used for exposure of the intratemporal portion of the facial nerve for a hemihypoglossal-facial nerve anastomosis when a postoperative facial palsy exists This one-stage procedure has not been described previously. CLINICAL PRESENTATION Three patients with postoperative facial palsy and residual intracanalicular tumor after surgical removal of a large acoustic neuroma via the retromastoid suboccipital approach underwent reoperation via the translabyrinthine approach and one-stage removal of the residual tumor and hemihypoglossal-facial nerve anastomosis. All three patients had a complete facial palsy of House-Brackmann Grade VI and a residual tumor of 8 to 12 mm. TECHNIQUE A classic translabyrinthine approach was used to open the internal auditory canal and remove the residual intracanalicular tumor. The facial nerve was exposed in its mastoid and tympanic parts, mobilized, and transected; then, the long nerve stump was transposed into the neck and used for an end-to-side anastomosis into the hypoglossal nerve. The operation resulted in variable improvement of the facial muscle function up to Grade III (one patient) and Grade IV (two patients). CONCLUSION Reoperation via the translabyrinthine approach is indicated for removal of residual intracanalicular acoustic neuroma and realization of a hypoglossal-facial nerve anastomosis in a single procedure. It is suggested that this type of anastomosis may also be used during the initial operation for acoustic neuroma removal when the facial nerve is inadvertently sectioned.

Facial-to-Hypoglossal Nerve Anastomosis with Parotid Release

Skull Base ◽  
2008 ◽  
Vol 18 (S 01) ◽  
Author(s):  
J. Roland Jr ◽  
Joel Jacobson ◽  
Jordon Rihon
Keyword(s):  
Hypoglossal Nerve ◽  
Nerve Anastomosis
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