Facial Nerve Reconstruction Using a Split Hypoglossal Nerve with Preservation of Tongue Function

ABSTRACT

A prospective study conducted on 13 patients suffering from complete facial nerve injury (for 4 months up to 2 years) aimed to show that using the split hypoglossal nerve allows for reconstruction of the facial nerve with preservation of tongue function. The hypoglossal nerve was split longitudinally. For each half, a split of the hypoglossal nerve's response was measured intraoperatively by recording the compound muscle action potential of the tongue muscle. The half that showed the least response was selected for anastomosis. The facial nerve was transected at the stylomastoid foramen, and its distal part underwent a direct anastomosis with the selected half of the hypoglossal nerve. The six grades of the House-Brackman grading system were used to analyze the results. The average postoperative follow-up period was 3 years. Before surgery, 12 patients in this study were graded VI, with total paralysis, and 1 was graded V. After surgery, 2 of the 13 patients showed mild dysfunction (grade II), 7 patients showed moderate dysfunction (grade III), 3 patients showed moderately severe dysfunction (grade IV), and 1 patient showed a severe dysfunction (grade V). Microsurgical facial nerve reconstruction using a split hypoglossal nerve results in functional facial nerve improvement with preservation of tongue function.

KEYWORDS

Facial nerve paralysis - split hypoglossal–facial anastomosis

REFERENCES

• 1 May M, Sobol S M, Mester S J. Hypoglossal–facial nerve interpositional-jump graft for facial reanimation without tongue atrophy.  Otolaryngol Head Neck Surg. 1991;  104 818-825
• 2 Arai H, Sato K, Yanai A. Hemihypoglossal–facial nerve anastomosis in treating unilateral facial palsy after acoustic neurinoma resection.  J Neurosurg. 1995;  82 51-54
• 3 Cusimano M D, Sekhar L. Partial hypoglossal to facial nerve anastomosis for reinnervation of the paralyzed face in patients with lower cranial nerve palsies: technical note.  Neurosurgery. 1994;  35 532-533
• 4 Atlas M D, Lowinger D SG. A new technique for hypoglossal–facial nerve repair.  Laryngoscope. 1997;  107 984-991
• 5 Sawamura Y, Abe H. Hypoglossal–facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique.  J Neurosurg. 1997;  86 203-206
• 6 Conley J, Baker D C. Hypoglossal–facial nerve anastomosis for reinnervation of the paralyzed face.  Plast Reconstr Surg. 1979;  63 63-72
• 7 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147
• 8 Sood S, Anthony R, Homer J J, Van Hille P, Fenwick J D. Hypoglossal–facial nerve anastomosis: assessment of clinical results and patient benefit for facial nerve palsy following acoustic neuroma excision.  Clin Otolaryngol Allied Sci. 2000;  25 219-226
• 9 Pensak M L, Jackson C G, Glasscock III M E, Gulya A J. Facial reanimation with the VII–XII anastomosis: analysis of the functional and psychologic results.  Otolaryngol Head Neck Surg. 1986;  94 305-310
• 10 Hammerschlag P E. Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: evolution in management of facial paralysis.  Laryngoscope. (suppl 90) 1999;  109 1-23
• 11 Hitselberger W E. Hypoglossal–facial anastomosis.  Otolaryngol Clin North Am. 1974;  7 545-550
• 12 Salame K, Masharawi Y, Rochkind S, Arensburg B. Surgical anatomy of the cervical segment of the hypoglossal nerve.  Clin Anat. 2006;  19(1) 37-43
• 13 Salame K, Quaknine G ER, Arensburg B, Rochkind S. Microsurgical anatomy of the facial nerve trunk.  Clin Anat. 2002;  15 93-99
• 14 Asaoka K, Sawamura Y, Nagashima M, Fukushima T. Surgical anatomy for direct hypoglossal–facial nerve side-to-end “anastomosis”.  J Neurosurg. 1999;  91 268-275
• 15 Kunihiro T, Kanzaki J, Yoshihara S, Satoh Y. Analysis of the prognosis and the recovery process of profound facial nerve paralysis secondary to acoustic neuroma resection.  ORL J Otorhinolaryngol Relat Spec. 1994;  56 331-333
• 16 Linnet J, Madsen F F. Hypoglosso-facial nerve anastomosis.  Acta Neurochir (Wien). 1995;  133 112-115
• 17 Sawamura Y, Abe H. Hypoglossal–facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique.  J Neurosurg. 1997;  86 203-206
• 18 Gagnon N B, Molina-Negro P. Facial reinnervation after facial paralysis: is it ever too late?.  Arch Otorhinolaryngol. 1989;  246 303-307
• 19 Samii M, Matthies C. Indication, technique and results of facial nerve reconstruction.  Acta Neurochir (Wien). 1994;  130 125-139