Hypoglossal-facial nerve anastomosis for facial paralysis resulting from vestibular schwannoma surgery

Abstract

Objective To evaluate the results of hypoglossal-facial nerve anastomosis (HFA) for facial paralysis following vestibular schwannoma surgery,and to discuss the surgical techniques.Methods A retrospective study of 16 consecutive cases who underwent HFA operation between January 2000 and January 2010 was done.All the patients had undergone surgery for excision of vestibular schwannomas and had suffered facial paralysis as a consequence of this procedure.Classical end-to-end HFA was performed in all cases,and in 9 cases the classical HFA is combined with an anastomosis of the descending branch of the hypoglossal nerve to the distal stump of the same hypoglossal nerve.The pre-and postoperative facial nerve function of all patients was evaluated with the House-Brackmann (HB) grading.Results There were 9 female and 7 male patients with a mean age of 42.5 years (Range 31 ～ 61 years).The mean time interval between tumoral and reparative surgery was 7.6 months (Range 1-13 months).The preoperative HB grades were Ⅵ in 13 patients,Ⅴ in 3 patients.In the majority of the cases the first sign of reinnervation were detected between 3 and 6 months after surgery.All but one patient recovered facial muscle tone and some voluntary movement and exhibited complete restoration of facial symmetry at rest and regained complete voluntary eye closing ability.The final HB grades were Ⅱ in 2 patients,Ⅲ in 10 patients and Ⅳ in 4 patients.Conclusions HFA is a useful procedure for facial reanimation and can produce good clinical results as well as leading to an improvement in the quality of life in patients with facial paralysis. Key words: Facial nerve; Facial paralysis; Hypoglossal nerve; Nerve anastomosis