Dynamic facial reanimation in the elderly using masseteric-to-facial nerve transfer

Background: Masseteric-to-facial nerve (MTF) transfer offers the advantages of primary nerve coaptation, a high density of motor axons, and the potential connectedness between facial and trigeminal central cortical centres. Despite these benefits, its use in individuals aged greater than 60 years has not been widely described. Methods: A PubMed literature review from 1 January 1978 through to 31 December 2018 was performed to identify individuals older than 60 years who underwent a masseteric-to-facial nerve transfer. In addition, a retrospective chart review of all elderly patients who underwent a masseteric-to-facial nerve transfer at a single institution was conducted. Details on patient demographics, surgical techniques, outcomes and complications were recorded. Ethics approval for the study was obtained through the Monash Health Human Research Ethics Committee (RES-18-0000-768Q). Results: For the literature review, 12 out of 506 articles met the study criteria, with 28 patients identified and analysed. The average time to first facial movement was 5.5 months. Average improvement on oral commissure excursion was 11 mm. Of the eleven patients included in the clinical series, 27 per cent of patients experienced postoperative complications and there were no reported mortalities. Conclusion: Masseteric-to-facial nerve transfer is a safe and viable option for midface and perioral reanimation in the elderly with short term facial nerve palsies.

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Facial Reanimation after Facial Nerve Injury

Neurosurgery ◽

10.1227/00006123-199110000-00014 ◽

1991 ◽

Vol 29 (4) ◽

pp. 568-574 ◽

Cited By ~ 28

Author(s):

Robert H. Rosenwasser ◽

Emil Liebman ◽

Fernando D. Jimenez ◽

William A. Buchheit ◽

David W. Andrews

Keyword(s):

Facial Nerve ◽

Nerve Repair ◽

Surgical Techniques ◽

Nerve Transfers ◽

Muscle Transfers ◽

Facial Reanimation ◽

Nerve Anastomosis ◽

Difficult Challenge ◽

And Function ◽

Regional Muscle

Abstract Patients with facial paralysis are often seen in neurosurgical practice. Obtaining full facial symmetry and function after facial nerve damage presents the neurosurgeon with a difficult challenge. Various surgical techniques have been developed to deal with this problem. These include primary nerve repair, nerve to nerve anastomosis, nerve grafting, neurovascular pedicle grafts, regional muscle transposition, microvascular muscle transfers, and nerve transfers. Patient selection, timing of surgery, and details of surgical technique are discussed. The results of hvpoglossal-facial anastomosis in 24 patients are described.

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G6PD deficiency and severity of COVID19 pneumonia and acute respiratory distress syndrome: tip of the iceberg?

10.21203/rs.3.rs-72639/v1 ◽

2020 ◽

Author(s):

Jihad G. Youssef ◽

Faisal Zahiruddin ◽

George Youssef ◽

Sriram Padmanabhan ◽

Joe Ensor ◽

...

Keyword(s):

G6pd Deficiency ◽

Chart Review ◽

Ventilatory Support ◽

Severe Pneumonia ◽

Retrospective Chart Review ◽

The Elderly ◽

Supplemental Oxygen ◽

Redox Status ◽

Clinical Series ◽

Viral Proliferation

Abstract The severe pneumonia caused by human coronavirus (hCoV)-SARS-CoV-2 has inflicted heavy causalities, especially among the elderly and those with comorbid illnesses irrespective of age. The high mortality in African Americans and males, in general, raises concern for a possible X-linked mediated process that could affect viral pathogenesis and the immune system. We hypothesized that G6PD, the most common X-linked enzyme deficiency associated with redox status, may have a role in the severity of pneumonia. A retrospective chart review was performed in hospitalized patients with COVID19 pneumonia needing supplemental oxygen. A total of 17 patients were evaluated: six with G6PD deficiency and 11 with normal levels. The two groups (normal and G6PD def) were comparable in terms of age, sex and comorbidities and laboratory parameters LDH, IL-6, CRP, and ferritin. Thirteen patients needed ventilatory support, with 6 in the G6PD group (83% vs. 72%). The main differences indicating increasing severity in the G6PD def group included G6PD levels (12.2 vs. 5.6, P=0.0002), PaO2/FiO2 ratio (159 vs. 108, P=0.05), days before intubation (2.5 vs. 4.8 P= 0.03), days on mechanical ventilation (10.25 vs. 21 days P=0.04), hemoglobin level (10 vs. 8.1 P=0.03) and hematocrit (32 vs. 26 P=0.015). Only one patient with G6PD deficiency died; 16 were discharged home. Our clinical series ascribes a possible biological role for G6PD deficiency in SARS-CoV2 viral proliferation. It is imperative that further studies be performed to understand the interplay between the viral and host factors in G6PD deficiency that may lead to disparity in outcomes.

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Facial nerve transfer for facial reanimation with parotidoplasty approach

Microsurgery ◽

10.1002/micr.30674 ◽

2020 ◽

Vol 40 (8) ◽

pp. 868-873

Author(s):

Chase J. Wehrle ◽

Margaret A. Sinkler ◽

Jimmy J. Brown ◽

Edmond F. Ritter

Keyword(s):

Facial Nerve ◽

Nerve Transfer ◽

Facial Reanimation

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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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Deep Temporal Nerve Transfer for Facial Reanimation: Anatomic Dissections and Surgical Case Report

Operative Neurosurgery ◽

10.1093/ons/opx190 ◽

2017 ◽

Vol 15 (1) ◽

pp. 81-88

Author(s):

Mark A Mahan ◽

Walavan Sivakumar ◽

David Weingarten ◽

Justin M Brown

Keyword(s):

Case Report ◽

Facial Nerve ◽

Nerve Transfer ◽

Lateral Approach ◽

Multiple Sources ◽

Facial Muscles ◽

First Case ◽

The Face ◽

Facial Reanimation ◽

History Of

Abstract BACKGROUND Facial nerve palsy is a disabling condition that may arise from a variety of injuries or insults and may occur at any point along the nerve or its intracerebral origin. OBJECTIVE To examine the use of the deep temporal branches of the motor division of the trigeminal nerve for neural reconstruction of the temporal branches of the facial nerve for restoration of active blink and periorbital facial expression. METHODS Formalin-fixed human cadaver hemifaces were dissected to identify landmarks for the deep temporal branches and the tension-free coaptation lengths. This technique was then utilized in 1 patient with a history of facial palsy due to a brainstem cavernoma. RESULTS Sixteen hemifaces were dissected. The middle deep temporal nerve could be consistently identified on the deep side of the temporalis, within 9 to 12 mm posterior to the jugal point of the zygoma. From a lateral approach through the temporalis, the middle deep temporal nerve could be directly coapted to facial temporal branches in all specimens. Our patient has recovered active and independent upper facial muscle contraction, providing the first case report of a distinct distal nerve transfer for upper facial function. CONCLUSION The middle deep temporal branches can be readily identified and utilized for facial reanimation. This technique provided a successful reanimation of upper facial muscles with independent activation. Utilizing multiple sources for neurotization of the facial muscles, different potions of the face can be selectively reanimated to reduce the risk of synkinesis and improved control.

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Hypoglossal-Facial Side-to-End Neurorrhaphy With Concomitant Masseteric-Zygomatic Nerve Branch Coaptation and Muscle Transfer for Facial Reanimation: Technique and Case Report

Operative Neurosurgery ◽

10.1093/ons/opaa128 ◽

2020 ◽

Vol 19 (3) ◽

pp. E230-E235

Author(s):

Nobutaka Yoshioka

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Mass Movement ◽

Nerve Transfer ◽

Nerve Graft ◽

Gracilis Muscle ◽

Muscle Transfer ◽

Nerve Branch ◽

Facial Reanimation ◽

Healthy Side

Abstract BACKGROUND Hypoglossal-facial direct side-to-end neurorrhaphy has become widely used for facial reanimation in patients with irreversible facial nerve damage. Although this procedure achieves good restoration of facial function, it has disadvantages such as mass movement and lack of spontaneity. OBJECTIVE To present a new facial reanimation technique using hypoglossal-facial direct side-to-end neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and secondary muscle transfer to reduce mass movement and achieve a spontaneous smile in patients with facial paralysis. METHODS This article describes a novel facial reanimation technique that employs hypoglossal and masseteric nerve transfer combined with secondary vascularized functional gracilis muscle transfer. RESULTS Details of the technique are reported in a patient with complete facial paralysis after brain surgery. The hypoglossal nerve was partially served and connected to the mastoid segment of the facial nerve by side-to-end anastomosis to restore facial symmetry. A nerve supplying the masseter muscle was coapted with a zygomatic branch by end-to-end anastomosis to restore voluntary movement of the oral commissure, as well as to assist with eye closure. A cross face sural nerve graft was connected to zygomatic branches on the healthy side. In the second stage, a vascularized functional gracilis muscle graft was transplanted using the cross face nerve graft as the donor nerve to restore a natural smile. CONCLUSION Hypoglossal-facial neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and muscle transfer is an alternative facial reanimation technique that reduces mass movement and achieves a natural smile.

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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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