[Successful reanimation of facial paralysis with an indirect anastomosis between hypoglossal nerve and facial nerve, without loss of function of the tongue].
OBJECTIVE
To describe the surgical procedure and the results of the indirect hypoglossal-facial nerve anastomosis using a free nerve graft in patients with facial nerve paralysis. This technique leaves the tongue function intact.


METHODS
Prospective study.


METHODS
Tongue function was assessed in 39 consecutive patients who underwent this procedure and facial reanimation was assessed in 29 of these patients who had completed at least 24 months follow-up. Facial nerve function was judged using the House-Brackmann (HB) facial nerve grading system.


RESULTS
Tongue movements were normal in all operated patients; one patient had mild homolateral atrophy. Initial facial movements occurred on average 7.5 months postoperatively (range 4 to 18 months) in all but one patient. The results were graded HB II in 6 patients (20.9%), HB III in 13 (44.6%), HB IV in 7 (24.1%), HB V in 2 (6.8%) and HB VI in 1 patient (3.4%). Hemifacial synkineses were noticeable but no mass movements or gross hypertonia were observed (as are often present in direct hypoglossal-facial anastomosis). The results of facial reanimation were significantly better in young patients and when a short time interval between paralysis and surgery existed. HB grade II was achieved only if the duration of paralysis was less than 12 months.


CONCLUSIONS
Indirect hypoglossal-facial anastomosis with interposition of a nerve graft allows preservation of tongue function together with good overall facial reanimation, and is therefore to be preferred to the classical direct hypoglossal-facial anastomosis.
Manni
J J
JJ
Afd. Keel-, Neus- en Oorheelkunde, Academisch Ziekenhuis, Postbus 5800, 6202 AZ Maastricht. j.j.manni@kno.azm.nl
Beurskens
C B
CB
van de Velde
C
C
Stokroos
R J
RJ
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer; D011446:Prospective Studies; D020127:Recovery of Function; D014059:Tongue / Q000294:innervation*; D016896:Treatment Outcome