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.

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.

Surgical anatomy for direct hypoglossal—facial nerve side-to-end “anastomosis”

1999 ◽  
Vol 91 (2) ◽  
pp. 268-275 ◽  
Author(s):  
Katsuyuki Asaoka ◽  
Yutaka Sawamura ◽  
Masabumi Nagashima ◽  
Takanori Fukushima
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Surgical Anatomy ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Pes Anserinus ◽  
Nearest Point ◽  
Facial Nerves ◽  
Nerve Anastomosis ◽  
Fine Print

Object. In this study the authors investigated the histomorphometric background and microsurgical anatomy associated with surgically created direct hypoglossal—facial nerve side-to-end communication or nerve “anastomosis.”Methods. Histomorphometric analyses of the facial and hypoglossal nerves were performed using 24 cadaveric specimens and three surgically obtained specimens of severed facial nerve. Both the hypoglossal nerve at the level of the atlas and the facial nerve just distal to the external genu were monofascicular. The number of myelinated axons in the facial nerve (7228 ± 950) was 73.2% of those in the normal hypoglossal nerve (9778 ± 1516). Myelinated fibers in injured facial nerves were remarkably decreased in number. The cross-sectioned area of the normal facial nerve (0.948 mm2) accounted for 61.5% of the area of the hypoglossal nerve (1.541 mm2), whereas that of the injured facial nerve (0.66 mm2) was less than 50% of the area of the hypoglossal nerve. Surgical dissection and morphometric measurements were performed using 18 sides of 11 adult cadaver heads. The length of the facial nerve from the pes anserinus to the external genu ranged from 22 to 42 mm (mean 30.5 ± 4.4 mm). The distance from the pes anserinus to the nearest point on the hypoglossal nerve ranged from 14 to 22 mm (mean 17.3 ± 2.5 mm). The former was always longer than the latter; the excess ranged from 6 to 20 mm (mean 13.1 ± 3.4 mm). Surgical anatomy and procedures used to accomplish the nerve connection are described.Conclusions. The size of a half-cut end of the hypoglossal nerve matches a cut end of the injured facial nerve very well. By using the technique described, a length of facial nerve sufficient to achieve a tensionless communication can consistently be obtained.

Hemifacial spasm

1982 ◽  
Vol 57 (6) ◽  
pp. 753-756 ◽  
Author(s):  
Tsutomu Iwakuma ◽  
Akihisa Matsumoto ◽  
Nishio Nakamura
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Nerve Root ◽  
Posterior Inferior Cerebellar Artery ◽  
Content Type ◽  
Stylomastoid Foramen ◽  
Root Exit Zone ◽  
Selective Neurectomy ◽  
Fine Print

✓ Patients with hemifacial spasm were treated by three different surgical procedures: 1) partial sectioning of the facial nerve just distal to the stylomastoid foramen; 2) selective neurectomy of facial nerve branches; and 3) microvascular decompression. A retromastoid craniectomy with microvascular decompression was most effective in relieving hemifacial spasm and synkinesis. In a postmorten examination on one patient, microscopic examination of the facial nerve, which was compressed by an arterial loop of the posterior inferior cerebellar artery at the cerebellopontine angle, revealed fascicular demyelination in the nerve root. On the basis of surgical treatment, electromyography, and neuropathological findings, the authors conclude that compression of the facial nerve root exit zone by vascular structures is the main cause of hemifacial spasm and synkinesis.

Percutaneous radiofrequency facial nerve coagulation in the management of facial spasm

1981 ◽  
Vol 54 (5) ◽  
pp. 655-658 ◽  
Author(s):  
Tomokatsu Hori ◽  
Takanori Fukushima ◽  
Hideo Terao ◽  
Kintomo Takakura ◽  
Keiji Sano
Keyword(s):  
Facial Nerve ◽  
Age Of Onset ◽  
Facial Weakness ◽  
Content Type ◽  
Operative Results ◽  
Stylomastoid Foramen ◽  
Blunt Needle ◽  
Facial Spasm ◽  
Fine Print

✓ The authors have developed a fluoroscopy-assisted technique of percutaneous radiofrequency facial nerve coagulation at or near the stylomastoid foramen for management of facial spasm. The details of the procedure and the operative results in the initial series of 27 cases of facial spasm are described. The series included six men and 21 women, aged from 16 to 73 years. Twenty-four patients had classical, intractable, persistent hemifacial spasm, one had an unusual bilateral facial spasm, and one a postparalytic facial spasm. The age of onset varied from 16 years to 70 years. The duration of the symptoms ranged from 3 months to 11 years. Ten patients had undergone previous blunt-needle compression of the facial nerve from one to 10 times. The operative results in the 27 patients have so far been excellent. The longest follow-up has been 1½ years. Although partial facial weakness was present in 60% of the cases, it invariably disappeared within 1 to 4 months. Only three patients experienced recurrence of spasm. In two of them, recurrence followed lowtemperature coagulation. The procedure is simple, easy to perform, and extremely effective. It can be performed under local anesthesia in the outpatient clinic.

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.

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.

Long-term results of spinal accessory nerve-facial nerve anastomosis

1992 ◽  
Vol 77 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Michael J. Ebersold ◽  
Lynn M. Quast
Keyword(s):  
Facial Nerve ◽  
Functional Disability ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Long Term Results ◽  
Content Type ◽  
Spinal Accessory ◽  
Nerve Anastomosis ◽  
Facial Function ◽  
Fine Print

✓ A number of methods have been developed to reduce the cosmetic and functional disability resulting from facial nerve loss. It has often been suggested that the major trunk of the spinal accessory nerve should not be sacrificed for providing dynamic facial function because of shoulder disability and pain. A review of Mayo Clinic records has revealed that, between the years of 1975 and 1983, 25 patients underwent spinal accessory nerve-facial nerve anastomosis using the major division (branch to the trapezius muscle) of the spinal accessory nerve. There were 11 males and 14 females, ranging in age from 16 to 60 years (mean 41 years). The interval between facial nerve loss and anastomosis was 1 week to 34 months (mean 4.62 months). The duration of follow-up study ranged from 7 to 15 years (mean 10.8 years). Twenty patients had no complaints or symptoms related to their shoulder or arm at the time of this review and no patient had significant shoulder morbidity. The facial function achieved was “minimal” in five cases, “moderate” in six, and good to excellent in 14. Most patients appeared to benefit significantly from the spinal accessory nerve-facial nerve anastomosis. The morbidity of the procedure seemed quite minimal even in the young and active. The authors continue to believe that the spinal accessory nerve-facial nerve anastomosis, even when using the major trunk of the spinal accessory nerve, is a very useful and beneficial procedure.

The widened retrolabyrinthine approach: a new concept in acoustic neuroma surgery

1997 ◽  
Vol 86 (5) ◽  
pp. 812-821 ◽  
Author(s):  
Vincent Darrouzet ◽  
Jean Guerin ◽  
Naaman Aouad ◽  
Jaromir Dutkiewicz ◽  
Alexander W. Blayney ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hearing Aids ◽  
Postoperative Mortality ◽  
Fistula Formation ◽  
Content Type ◽  
Nerve Anastomosis ◽  
Postoperative Meningitis ◽  
Retrolabyrinthine Approach ◽  
Functional Surgery ◽  
Fine Print

✓ For many years, the retrolabyrinthine approach has been limited to functional surgery of the cerebellopontine angle (CPA). As a result of the increased surgical exposure, particularly the opening of the internal auditory meatus (IAM), the widened retrolabyrinthine technique permits tumor excision from both the CPA and the IAM, regardless of the histological nature of the tumor. The authors have treated 60 acoustic neuromas of varying sizes via this approach (6% intrameatal tumors; 30% > 25 mm in diameter). The postoperative mortality rate was 0%. The risk of fistula formation was 3.3%, and 3.3% of the patients suffered from postoperative meningitis. The results for facial nerve function were equivalent to those obtained previously via a widened translabyrinthine approach and those in a series treated via a suboccipital approach (80% with Grades I and II, 15% with Grade III, and 5% with Grades V and VI). One patient (1.7%) required a secondary hypoglossal—facial nerve anastomosis and had attained a Grade IV result 6 months later. Postoperatively 21.7% of these patients maintained socially useful hearing and 20% had mediocre hearing. Socially useful hearing was preserved in 50% of a subgroup of 20 patients who had both good preoperative hearing and a tumor that involved less than half of the IAM regardless of its volume. Additionally, 15% had mediocre hearing that could be improved with hearing aids. Because of its efficacy in preserving hearing, the authors favor the retrolabyrinthine over the occipital approach, with the latter being considered less subtle and more aggressive.

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