Die Hypoglossus-Fazialisanastomose*

Zusammenfassung

Anhand von 10 Fällen mit Hypoglossus-Fazialis-Anastomose werden Methode, Ergebnis und die Stellung zur Nerventransplantation besprochen. Unter strenger Indikation stellt das genannte Verfahren einen effektiven Eingriff zur Rehabilitation der gelähmten Gesichtshälfte dar. Die Ergebnisse in diesem Bereich sind um so besser, je mehr eine solche Operation dem Zeitpunkt des Nervenausfalles angeschlossen wird. Die oralen Behinderungen sind gering und stehen in keinem Verhältnis zum Gewinn des wiedererlangten Gesichtsmuskeltonus.

Summary

Ten patients with unilateral facial nerve paralysis had been treated by hypoglossal-facial nerve approximation in the years 1971-1979. The proximal part of the facial nerve inside the petrous bone and at the inner ear entrance had been destroyed by tumor or accident without chance for repair. Therefore the hypoglossal nerve had been used to contact the intact main tunk and its intact peripheral nerve and mimic muscle system. 3 to 4 epineural nerve sutures had been placed with 8/0 vicryl suture material for approximation. In one patient anastomosis could be obtained by splitting the hypoglossal nerve with remarkable result to the mimic function, while the muscular atrophy of the tongue was minimal.

With regard to the results the achieved mimic reinnervation took place in 3,5 to 6 months, but was found to be refined up to 2 years. Oral discomfort, swallowing, and speech disorders lasted 2œ to 6 weeks postoperatively, depending upon the age and the patients mental activity, since the patient has to learn by using his tongue for mimical expressions. The final result obtained a balanced closure of the mouth and eyes, a complete movement of the lips and cheeks, a rarely delayed innervation of the frontal muscles. Due to reinnervation the denervated half of the tongue had developed a marked increase of activity from nerve fiber in growth of the intact side. The patient finally feels little to complain about the favourable facial result.