Hemihypoglossal-facial neurorrhaphy after mastoid dissection of the facial nerve: results in 24 patients and comparison with the classic technique.
OBJECTIVE
Hypoglossal-facial neurorrhaphy has been widely used for reanimation of paralyzed facial muscles after irreversible proximal injury of the facial nerve. However, complete section of the hypoglossal nerve occasionally results in hemiglossal dysfunction and interferes with swallowing and speech. To reduce this morbidity, a modified technique with partial section of the hypoglossal nerve after mastoid dissection of the facial nerve (HFM) has been used. We report our experience with the HFM technique, retrospectively comparing the outcome with results of the classic hypoglossal-facial neurorrhaphy.


METHODS
A retrospective review was performed in 36 patients who underwent hypoglossal-facial neurorrhaphy with the classic (n = 12) or variant technique (n = 24) between 2000 and 2006. Facial outcome was evaluated with the House-Brackmann grading system, and tongue function was evaluated with a new scale proposed to quantify postoperative tongue alteration. The results were compared, and age and time between nerve injury and surgery were correlated with the outcome.


RESULTS
There was no significant difference between the two techniques concerning facial reanimation. A worse outcome of tongue function, however, was associated with the classic technique (Mann-Whitney U test; P < 0.05). When HFM was used, significant correlations defined by the Spearman test were identified between preoperative delay (rho = 0.59; P = 0.002) or age (rho = 0.42; P = 0.031) and results of facial reanimation evaluated with the House-Brackmann grading system.


CONCLUSIONS
HFM is as effective as classic hypoglossal-facial neurorrhaphy for facial reanimation, and it has a much lower morbidity related to tongue function. Better results are obtained in younger patients and with a shorter interval between facial nerve injury and surgery.
Martins
Roberto S
RS
Department of Neurosurgery, Peripheral Nerve Surgery Unit, University of São Paulo Medical School, and Hospital Santa Marcelina, São Paulo, Brazil. robar@ig.com.br
Socolovsky
Mariano
M
Siqueira
Mario G
MG
Campero
Alvaro
A
D000328:Adult; D000368:Aged; D005154:Facial Nerve / Q000473:pathology / Q000601:surgery*; D020220:Facial Nerve Injuries / Q000473:pathology / Q000601:surgery; D005158:Facial Paralysis / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007002:Hypoglossal Nerve / Q000473:pathology / Q000601:surgery*; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D014059:Tongue / Q000294:innervation / Q000473:pathology; D016896:Treatment Outcome