Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release

ABSTRACT

Objective: Facial nerve paralysis or compromise can be caused by lesions of the temporal bone and cerebellopontine angle and their treatment. When the facial nerve is transected or severely compromised and primary end-to-end repair is not possible, hypoglossal-facial nerve anastomosis remains the most popular method for accomplishing three main goals: restoring facial tone, restoring facial symmetry, and facilitating return of voluntary facial movement. Our objectives are to evaluate the surgical feasibility and long-term outcomes of our technique of direct facial-to-hypoglossal neurorrhaphy with a parotid-release maneuver. Design: Prospective cohort. Setting: Academic tertiary care referral center. Patients: Ten patients with facial paralysis from proximal nerve injury underwent the facial-hypoglossal neurorrhaphy with a parotid-release maneuver. Main outcome measures: The Repaired Facial Nerve Recovery Scale, questionnaires, and photographs. Results: Facial-hypoglossal neurorrhaphy with parotid release was technically feasible in all cases, and anastomosis was performed distal to the origin of the ansa hypoglossi. All patients had good return of facial nerve function. Nine patients had scores of C or better, indicating strong eyelid and oral sphincter closure and mass motion. There was no hemilingual atrophy and no subjective tongue dysfunction. Conclusions: The parotid-release maneuver mobilizes additional length to the facial nerve, facilitating a tensionless communication distal to the ansa hypoglossi. The technique is a viable option for facial reanimation, and our patients achieved good clinical outcomes with continual improvement.

Facial paralysis - facial reanimation - hypoglossal-to-facial anastomosis

REFERENCES

• 1 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
• 2 Gidley P W, Gantz B J, Rubinstein J T. Facial nerve grafts: from cerebellopontine angle and beyond.  Am J Otol. 1999;  20 781-788
• 3 Conley J, Baker D C. Hypoglossal-facial nerve anastomosis for reinnervation of the paralyzed face.  Plast Reconstr Surg. 1979;  63 63-72
• 4 Pitty L F, Tator C H. Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors.  J Neurosurg. 1992;  77 724-731
• 5 Dellon A L. Restoration of facial nerve function: an approach for the twenty-first century.  Neurosurgery Quarterly. 1992;  2 199-222
• 6 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
• 7 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
• 8 Hammerschlag P E. Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: evolution in management of facial paralysis.  Laryngoscope. 1999;  109(2 Pt 2 Suppl 90) 1-23
• 9 Yarbrough W G, Brownlee R E, Pillsbury H C. Primary anastomosis of extensive facial nerve defects: an anatomic study.  Am J Otol. 1993;  14 238-246
• 10 Hitselberger W E. Hypoglossal-facial anastomosis. In: House WF, Luetje CM Acoustic Tumors, Volume II: Management. Baltimore, MD; University Park Press 1979: 97-103
• 11 Spector J G, Lee P, Peterein J, Roufa D. Facial nerve regeneration through autologous nerve grafts: a clinical and experimental study.  Laryngoscope. 1991;  101 537-554
• 12 Atlas M D, Lowinger D S. A new technique for hypoglossal-facial nerve repair.  Laryngoscope. 1997;  107 984-991
• 13 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
• 14 House J W, Brackmann D E. Facial nerve grading system.  Otolaryngol Head Neck Surg. 1985;  93 146-147