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.