Evaluation of Three Different Types of Hypoglossal-Facial Nerve Coaptation in the Surgical Rehabilitation of Facial Palsy

Background: To compare the results of 3 techniques of hypoglossal-facial (XII–VII) nerve coaptation for facial rehabilitation as evaluated by a medical team.

Material and Method: Videos of 34 consecutive patients with complete facial palsy who underwent surgery from 1998 to 2007 were reviewed. Facial palsy duration was less than 1 year and mostly secondary to skull base surgery. Facial rehabilitation was either the classical end-to-end (n = 14); the end-to-side with a jump interpositional graft (n = 13); or, during the last years, the end-to-side without interpositional graft (n = 7) XII–VII nerve coaptation. Evaluation was made by a medical jury using 4 facial nerve grading systems and 3 other measurements for the face at rest and during voluntary and emotional motions.

Results: The first signs of recovery occurred, at the best, 3 months after surgery, with a mean that ranged from 4 months for the end-to-side without jump to 9 months for end-to-side with jump coaptation. Whatever the grading systems used, the scores did not significantly differ between the 3 types of coaptation: synkinesis was severe with the classical end-to-end and almost absent with both types of end-to-side coaptations. However, muscle tone was stronger in the end-to-end than in the end-to-side with jump coaptation and slightly stronger compared with the end-to-side without jump coaptation.

Conclusions: The emotional expression and the duration of facial palsy should be considered for the choice of the type of XII–VII coaptation. End-to-end coaptations should be restricted to patients with a strong emotional expression or those with a long-standing facial palsy because it provides a strong muscle tone but also significant synkinesis. However, the last technique, the end-to-side without jump is in our opinion the procedure of choice because it leads to good muscle tone without synkinesis.