Hypoglossal-Facial Nerve Anastomosis: Patients’ Self-Assessment of Facial Function

Abstract

Objectives: In a retrospective study, we tried to evaluate the recovery of facial function as well as the resulting discomfort and the role of priming tongue movements in voluntary facial movement after hypoglossal-facial nerve anastomosis (HFA) predominantly from the point of view of concerned patients. Patients and Methods: Our analysis was based upon a questionnaire, which was returned by 27 patients who had undergone HFA. Twenty-four of the 27 patients (89%) could be re-examined at our department where postoperative facial function was evaluated by the investigators using the nerve grading system as described by House and Brackmann. Results: The mean time interval between HFA and first voluntary movements as estimated by the patients was 5.5 months (range: 3–18). The patients’ main complaints consisted of mimic deficit (41%), dysphagia (26%), eye symptoms (22%), oral incontinence (19%), synkinesis (15%) and speech problems (11%). Twenty-one patients (78%) reported to perform facial training regularly. Priming tongue movements could be evaluated as necessary for voluntary facial function in 25 patients (92.5%). As a result of re-examination, a statistically significant correlation (p < 0.05) between the grade of facial nerve function and the time interval from onset of the facial palsy to HFA was evident. Conclusions: Despite the fact that HFA seems to be a good option for mimic rehabilitation in cases in which a direct nerve repair is not possible, there are some special functional and aesthetic deficits after reinnervation which can be minimized by surgical modifications or other additional therapeutic options.