Comparison of Lengthening Temporalis Myoplasty and Hypoglossal-Facial Nerve Anastomosis for Facial Rehabilitation

Purpose: The aim of the study was to evaluate and compare different surgical techniques for rehabilitation of facial palsy, by using four grading systems and the quality of life (QOL) questionnaire.

Material and Methods: This retrospective study reviewed 96 consecutive patients who underwent facial rehabilitation between 1998 and 2006. Facial palsy was severe, mostly secondary to skull base, middle ear, or parotid surgery or temporal bone fracture. Facial rehabilitation was either a hypoglossal-facial anastomosis (classical (n = 34), interpositional-jump graft (n = 22), or modified (n = 7) procedure) or lengthening temporalis myoplasty (n = 33). Evaluation was done according to facial nerve grading systems (Freyss, House-Brackmann, Sunnybrook, and Yanagira) and QOL estimated by a questionnaire with physical, social, and professional questions.

Results: The population was classified into four groups according to the surgical technique. The groups were comparable in age and sex distribution. The mean duration of the facial palsy was less than 1 year in the anastomosis groups and more than 7 years in the myoplasty group. Grading systems could be done on 41 patients and QOL was evaluated on 39 patients. Evaluation according to the grading system showed better scores in XII-VII anastomosis groups than in the myoplasty group. The three anastomosis groups had similar mobility results, but differed in synkinesis results, which were prominent in the classical group. QOL evaluation (facial disability index, Glasgow Benefit score, satisfaction index, expression of emotions) brought two major conclusions:(1) myoplasty led to a better QOL than anastomosis, and (2) patients with classical anastomosis were dissatisfied as compared with jump or modified anastomosis.

Conclusions: (1) The partial XII-VII (jump or modified) anastomosis brings better results than the classical one. (2) Results of myoplasty as evaluated by grading system are inferior to those of anastomosis. (3) Surprisingly, QOL is better after myoplasty. The latter result might be related to the longer duration of the facial palsy in this group, which led to a greater satisfaction when facial rehabilitation was performed.