Hypoglossal-facial Anastomosis Research Articles

Long-Term Results of Side-to-End Hypoglossal-Facial Anastomosis with Intratemporal Facial Nerve Rerouting. A 12-Year Experience of 15 Cases

Long-Term Results of Side-to-End Hypoglossal-Facial Anastomosis with Intratemporal Facial Nerve Rerouting. A 12-Year Experience of 15 Cases

Comparison of Lengthening Temporalis Myoplasty and Hypoglossal-Facial Nerve Anastomosis for Facial Rehabilitation

Purpose: The aim of the study was to evaluate and compare different surgical techniques for rehabilitation of facial palsy, by using four grading systems and the quality of life (QOL) questionnaire.

Long-Term Results of Side-to-End Hypoglossal-Facial Anastomosis with Intratemporal Facial Nerve Rerouting. A 12-Year Experience of 15 Cases

Long-Term Results of Side-to-End Hypoglossal-Facial Anastomosis with Intratemporal Facial Nerve Rerouting. A 12-Year Experience of 15 Cases

Primary tumours of the facial nerve: diagnostic and surgical treatment experience in Chinese PLA General Hospital

Conclusions. The commonest manifestation of facial nerve tumours was facial paralysis, followed by hearing loss. During tumour resection facial nerve continuity should be maintained and reconstructed in one stage wherever possible. If this is not a viable option, second-stage surgery should be performed as soon as possible after surgery. Objective. To summarize the clinical characteristics of tumours of the facial nerve and discuss their diagnosis and treatment. Patients and methods. Twenty-two cases of primary facial nerve tumours were reviewed. These cases were confirmed pathologically and treated in the Chinese PLA General Hospital during the period 1986–2003, where the clinical manifestations, diagnosis and treatment of this series were analysed. Results. Among the 22 cases, 14 were facial neurilemmomas, 6 were facial neurofibromas and 2 were facial nerve haemangiomas. The commonest presenting symptom in all cases was facial paralysis (14/22) followed by hearing loss (10/22). Facial paralysis was also the commonest sign of a facial nerve tumour (18/22), followed by a swollen mass in the tympanic cavity (8/22) and a swollen mass in the external auditory canal (5/22). The 22 tumours were totally resected surgically. The function of the facial nerve was normal (grade I) in two cases where the integrity of the nerve was preserved during the operation, grade II in one case and grade III in another case where it was possible to maintain partial continuity of the facial nerve. The facial nerve was reconstructed in one stage when the tumours were resected, with facial–great auricular–facial nerve cable grafting (10 cases) and facial–lateral femoral cutaneous–facial nerve cable grafting (1 case). The facial nerve function consequently recovered to grade II–IV. The second stage facial–hypoglossal nerve anastomosis was carried out in two cases, and facial function consequently recovered to grade II in one case at 3 years and grade III in another with 2 years follow-up. In five cases, the facial nerve remained discontinuous and the facial nerve function showed no recovery (grade VI).

Comparison of Lengthening Temporalis Myoplasty and Hypoglossal-Facial Nerve Anastomosis for Facial Rehabilitation

Comparison of Lengthening Temporalis Myoplasty and Hypoglossal-Facial Nerve Anastomosis for Facial Rehabilitation

Facial-Hypoglossal Nerve Anastomosis Using Laser Nerve Welding

The aim of this study is to compare laser nerve welding to microsurgical suturing of hypoglossal-facial nerve anastomosis (HFA), and a result of immediate to delayed repair, and to evaluate the effect of laser nerve welding on HFA for reanimation of facial palsy. The first group of five rats underwent immediate HFA by microsurgical suturing and the second group of five rats by CO2 laser welding. The third group of five rats underwent delayed HFA by microsurgical suturing, and the fourth group of five rats by laser nerve welding. The fifth group of five rats served as controls, with intact hypoglossal and facial nerve. In all rats of the four different treatment groups, cholera toxin B subunit (CTb) was injected in the epineurium distal to the anastomosis site on the postoperative 6th week and in the normal hypoglossal nerve in the five rats of the control group. Neurons labeled CTb of hypoglossal nuclei were positive immunohistochemically, and the numbers were counted. In the immediate HFA groups, CTb-positive neurons were 751 +/- 247 in the laser welding group (n = 5) and 888 +/- 60 in the microsurgical suturing group (n = 5). There was no significant difference (P = 0.117). In the delayed HFA groups, CTb-positive neurons were 749 +/- 54 in the laser welding group (n = 5) and 590 +/- 169 in the microsurgical suturing group (n = 5). The difference was not significant (P = 0.116). There was no significant difference between immediate and delayed anastomosis in the laser welding group (P = 0.600), but there was significance between immediate and delayed anastomosis in the microsurgical suturing group (P = 0.009). Injected CTb in intact hypoglossal neurons (n = 5) were labeled 1,003 +/- 52. No dehiscence in the laser welding site of nerve anastomosis was seen at the time of re-exploration for injection of CTb in all 10 rats. This study shows that the regeneration of anastomosed hypoglossal-facial nerve was affected similarly by laser welding and microsurgical suturing, and more effective, especially in delayed repair.

Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release

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. Prospective cohort. Academic tertiary care referral center. Ten patients with facial paralysis from proximal nerve injury underwent the facial-hypoglossal neurorrhaphy with a parotid-release maneuver. The Repaired Facial Nerve Recovery Scale, questionnaires, and photographs. 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. 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.

Commentary

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.

End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face

The aim of this paper was to report on further experience with a new technique for reanimation of the facial nerve. This procedure allows a straight end-to-side hypoglossal-facial anastomosis without interruption of the 12th cranial nerve or the need for graft interposition. It is technically demanding and time consuming but offers an effective, reliable, and extraordinarily quick means of reinnervating the facial muscles, including the orbicularis oculi muscle, thus avoiding the need for a gold weight in the eyelid or a fascial sling.

Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve

The technique of facial nerve repair with side-to-end hypoglossal-facial anastomosis is presented and evaluated in five patients who were operated on for facial nerve paralysis after acoustic schwannoma surgery, or had cranial base trauma. The end-to-end hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing and speaking. In this new technique, the facial nerve is mobilised in the temporal bone, transected at the second genu and transposed to the hypoglossal nerve where a tensionless side-to-end anastomosis is performed. The hypoglossal nerve is transected in oblique fashion to about one third of its circumference. We were able to achieve a tensionless anastomosis in all patients. The idea is to bring about re-innervation of the previously denervated tissue via a collateral sprouting of axons of the donor nerve through the site of coaptation without sacrificing the innervation of the donor nerve's original targets. With side-to-end hypoglossal-facial anastomosis, two patients attained a House- Brackmann grade of III (one of them with independent movement of eyelids and mouth); one achieved grade IV, another grade V and grade VI. No patient had hemilingual atrophy nor any problems associated with swallowing or chewing.

Microsurgical repair of the facial nerve

Objective To report a series of 18 patients who underwent microsurgical repair of the facial nerve using different techniques and to discuss the indications and results of facial reinnervation procedures. Methods Eighteen patients with post-surgical facial palsy underwent facial reinnervation using different techniques. These included classic hypoglossal-facial anastomosis in 13 cases, one-stage hemihypoglossal-intratemporal facial nerve anastomosis and translabyrinthine removal of residual intracanalar acoustic schwannoma in 3, hemihypoglossal-facial nerve anastomosis in one, and neurotization of facial muscles through a nerve graft in one. Results The facial muscle function improved in all patients, up to grade III in 7 cases (39%), grade IV in 9 (50%) and grade V in 2 (11%). The tongue atrophy was minimal in 70.5%, moderate in 17.5% and severe in 12%. The outcome was better in younger patients (less than 40 years of age) and in those with a lesser grade of preoperative facial impairment. Conclusions The classic hypoglossal-facial anastomosis is the technique of choice in most cases. The use of the intratemporal facial nerve is indicated when removal of an intracanalar residual schwannoma must also be performed. The neurotization of the facial muscles through a nerve graft may be used when there is no distal trunk of the facial nerve avaible for the anastomosis.

Role of the trigeminal nerve in regrowth of hypoglossal motoneurons after hypoglossal-facial anastomosis

Conclusion. Functional recovery of facial muscles following hypoglossal-facial anastomosis (HFA) may be dependent not only on sensory information, relayed via the trigeminal nuclei to the hypoglossal nucleus, but also on extratrigeminal fibers, originating from the hypoglossal nucleus that travel in the infraorbital nerve (ION). This fact helps to explain the ability of hypoglossal neurons, after HFA, to induce contractions of muscles originally innervated from other nervous structures. Objective. The aim of the study was to better understand the role of the trigeminal nerve in reinnervation of facial muscles by hypoglossal motoneurons following HFA. Materials and methods. Central afferences of the ION were analyzed in rats by labeling the exposed nerve with horseradish peroxidase (HRP), whereas central organization of the efferent projections to the vibrissal area was analyzed by labeling the whisker pad muscles of the rat with a 5% solution of 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (Dil) in N,N-dimethylformamide. Results. The results show that extratrigeminal fibers, originating in the hypoglossal nucleus, travel along the ION. Retrograde tracing applied to ION or injected into the whisker pad showed labeled neurons in the Pr5 nucleus and all Sp5 trigeminal subnuclei. Small labeled neurons (10–15 µm diameter; 10–12 neurons per section), were also found in the hypoglossal nucleus.

Postoperative functional evaluation of different reanimation techniques for facial nerve repair

Background The facial nerve function after facial-facial nerve anastomosis, grafting, hypoglossal-facial nerve anastomosis, hypoglossal-facial interpositional jump nerve anastomosis, or a combined approach was analyzed. Methods Facial function was assessed after operation using a 7-point visual analog scale (VAS) and by electromyography (EMG) in 53 patients. The final result was judged by May’s facial nerve grading system. Results Voluntary EMG activity occurred on average 4.52 ± 1.31 months after operation. Initial facial movements were visible after 5.41 ± 1.80 months. Facial function related to the VAS finally reached 44% of normal value. The result was judged May’s grade I in 13%, grade II in 34%, grade III in 28%, and grade IV in 25% of patients. A significant difference in outcome between different reconstruction types was not seen. Age over 60 years was related to worse outcome. Conclusions A correct selection of the best method in the individual situation presumed, all analyzed facial reanimation techniques seem to lead nearly similar and satisfactory results.

Related timing for peripheral and central plasticity in hypoglossal–facial nerve anastomosis

The aim of this work was to determine the role of peripheral facial muscle reinnervation in the central reorganization of the blink reflex (BR) after hypoglossal-facial anastomosis (HFA). An electrophysiological study was performed on seven patients who underwent HFA after facial nerve transection during surgery for acoustic neuroma. HFA was performed within 15 days after surgery in five patients (group 1) and later for the two others (group 2). We studied the motor responses (MR) and the BR evoked on the affected side, before and over 3 years after the HFA. The MR appeared by the third month for the first group, and by the sixth and twelfth for the second group. After 36 months, the amplitude of MR was significantly higher than its control value, showing hyperinnervation of the facial muscles. Study of the BR evoked only an R1-type blink response that was observed 4 and 6 months after the MR for groups 1 and 2, respectively. This central reorganization appeared closely correlated with muscle reinnervation and its related timing. The occurrence of peripheral nerve-muscle contacts seems to be a necessary condition for reorganization of the trigemino-hypoglossal-facial reflex.

Side-to-End Hypoglossal-Facial Anastomosis via Transposition of the Intratemporal Facial Nerve

Introduction: The classic hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing, and speaking. In this new technique, the facial nerve is mobilized in the temporal bone, transected at the second genu, and transposed to the hypoglossal nerve, where a tensionless side-to-end anastomosis is performed.

Microsurgical Repair of the Facial Nerve

To report a series of 18 patients who underwent microsurgical repair of the facial nerve using different techniques and to discuss the indications and results of facial reinnervation procedures. Eighteen patients with post-surgical facial palsy underwent facial reinnervation using different techniques.'These included classic hypoglossal-facial anastomosis in 13 cases, one-stage hemihypoglossal-intratemporal facial nerve anastomosis and translabyrinthine removal of residual intra-canalar acoustic schwannoma in 3, hemihypoglossal-facial nerve anastomosis in one, and neurotization of facial muscles through a nerve graft in one. The facial muscle function improved in all patients, up to grade III in 7 cases (39 %), grade IV in 9 (50 %) and grade V in 2 (11 %). The tongue atrophy was minimal in 70.5 %, moderate in 17.5 % and severe in 12 %. The outcome was better in younger patients (less than 40 years of age) and in those with a lesser grade of preoperative facial impairment. The classic hypoglossal-facial anastomosis is the technique of choice in most cases. The use of the intratemporal facial nerve is indicated when removal of an intra-canalar residual schwannoma must also be performed. The neurotization of the facial muscles through a nerve graft may be used when there is no distal trunk of the facial nerve available for the anastomosis.

Reanimation of facial nerve after skull base surgery by anastomosis with the cervical anse of the hypoglossal nerve

Objectives: To describe the surgical procedure and results of hypoglossal-facial nerve anastomosis using the inferior radix in patients with facial nerve paralysis following skull base surgery in contrast to direct hypoglossal-facial anastomosis. This technique preserves tongue functionality. Alternative procedures are side-to-end/jump hypoglossal-facial anastomosis with free nerve grafts. Methods: In a retrospective study, tongue function was assessed in 14 patients who underwent this procedure; facial reanimation was assessed in 11 of these patients after at least 12 months of follow-up. Facial nerve function was assessed by House-Brackmann (HB) facial nerve grading system according to AAO-HNS (1994). Results: Tongue movements were normal in all treated patients; 1 patient had mild homolateral atrophy. Initial facial movements occurred on average 8 months postoperatively (range, 4 to 17 months) in all cases. Results were graded HB II in 6 patients (55%), HB III in 4 (36%), HB IV in 1 (9%). Hemifacial synkineses were noticeable. However, no mass movements or gross hypertonia were observed (like often present in total hypoglossal-facial anastomosis). Results of facial reanimation were significantly better with younger patients or short period between paralysis and surgery. HB grade II was achieved only in cases where the paralysis lasted less than 12 months. Reinnervation of frontal facial nerve branch was delayed. Simultaneous transposition of temporal muscle strips into eyelids gives immediate protection to eyes. Conclusion: Hypoglossal-facial anastomosis of inferior radix allows preservation of tongue function with good overall facial reanimation and should be preferred to classical total hypoglossal-facial cable anastomosis or indirect hypoglossal-facial anastomosis by nerve graft.

Motoneurons innervating facial muscles after hypoglossal and hemihypoglossal-facial nerve anastomosis in rats

Hypoglossal-facial nerve anastomosis (HFA) is the most popular surgical procedure to reinnervate facial muscles after injury of the facial nerve. Section of the hypoglossus causes paralysis and atrophy of the hemi-tongue. In the attempt to overcome this consequence, the hemihypoglossal-facial nerve anastomosis (HHFA) has been proposed and only a half of the main trunk of the hypoglossus is connected to the distal stump of the facial nerve. In the rat, we have studied experimentally the anatomical nuclear changes after HFA and HHFA with the aim of establishing the quantitative motoneuron innervation of facial muscles obtained with each one of the two operative options. Horseradish peroxidase (HRP) injected in both types of anastomosis labeled not only hypoglossal motoneurons, but also facial motoneurons. HFA appeared to offer a significant quantitative motoneuron innervation higher than HHFA and then a higher probable better functional recovery. Both HFA and HHFA performed immediately after section of the facial nerve in rats did not result in a phenomenon of motor hyperinnervation. In our experimental model, the proximal facial nerve stump was coagulated at the stylomastoid foramen to avoid regeneration. Then, the labeled motoneurons into the facial nucleus could really be the expression of axonal projections from facial motoneurons to the hypoglossus nerve and facial muscles. No labeled motoneurons were seen contralaterally as we observed previously after section and repair of several nerves.

Masseteric-Facial Nerve Anastomosis: Case Report

When a viable proximal facial nerve is not accessible, facial nerve paralysis has been managed with hypoglossal facial anastomosis, which results in varying degrees of hemiglossal atrophy and its sequelae. These authors have used the masseteric nerve to neurotize the facial nerve in one patient.

顔面神経舌下神経端側吻合術の経験

Hypoglossal-facial nerve anastomosis is a procedure for restoring facial nerve function after facial palsy caused by surgery for removal of cerebellopontine angle tumors. Classical hypoglossal-facial nerve anastomosis, however, sacrifices the hypoglossal nerve, inevitably causing hemitongue atrophy. To preserve hypoglossal nerve function, we tried hypoglossal-facial nerve side-to-end anastomosis for a 67-year-old woman who suffered from complete facial nerve palsy due to the removal of an acoustic neuroma. In this technique, the facial nerve in the mastoid cavity is exposed to the level of the external genu and then transected. The hypoglossal nerve is also exposed at the level of the axis and dissected as proximally as possible. One-third of the hypoglossal nerve is transected and the distal stump of the facial nerve is anastomosed without tension. In the postoperative stage, this technique provided facial reanimation without hypoglossal nerve dysfunction within one year. In conclusion, hypoglossal-facial nerve side-to-end anastomosis is a useful treatment for patients with long-standing facial palsy who do not want to have tongue dysfunction.