Commentary

Dr. Roland and his colleagues have done an excellent job of describing a procedure that improves facial animation and tone without sacrificing tongue mobility. Their article certainly answers the question of whether a partial anastomosis has enough “horsepower” to rehabilitate facial palsy, even years after the event. Because the procedure does not appear to affect glossal function, it may be a good option for patients with other lower cranial nerve palsies.

It may be argued that a unilateral 12th cranial nerve deficit is rapidly rehabilitated in an otherwise normal patient. In patients who have mastoid cavities that are potentially exposed to cerebrospinal fluid (CSF), it will be important to balance the relative disability of the 12th cranial nerve palsy against the longer operating time and risk of CSF leakage in the procedure described here compared to a traditional end-to-end anastomosis, which may not require reopening the mastoid.