title: Cortical representation sites of mimic movements after facial nerve reconstruction: a functional magnetic resonance imaging study.
abstract: OBJECTIVE
  To describe cortical reorganization after classic hypoglossal-facial nerve anastomosis (HFA) (four patients), hypoglossal-facial nerve jump anastomosis (HFJA) (three patients), and facial nerve interpositional graft (FNIG) (three patients).
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Functional magnetic resonance imaging (fMRI) was performed during lip and tongue movement using a block or an event-related design.
  
  
  RESULTS
  Despite the presence of some intersubject variability, the following general brain activation patterns were revealed: As expected, lip movements after FNIG led to selective brain activation in the original facial motor cortex, and lip movements after HFA were associated with activation in the hypoglossal motor cortex. Following HFJA, lip movements resulted in overlapping activation encompassing both the original facial and the hypoglossal motor cortex, but tongue movements led solely to strong activation within the original hypoglossal motor cortex. In contrast, tongue movements after HFA were associated with strong activation in the original hypoglossal motor cortex and weaker activation in the facial motor cortex.
  
  
  CONCLUSIONS
  Direct facial nerve repair (FNIG) leads to restoration of the original cortical activation. A cross nerve suture (HFA or HFJA) changes cortical activation and leads to different patterns of cortical activation during lip and tongue movements.
authors.affiliation: Department of Otorhinolaryngology, Friedrich-Schiller-University Jena, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bitter
authors.forename: Bettina
authors.initials: B
authors.lastname: Sorger
authors.forename: Volker
authors.initials: V
authors.lastname: Hesselmann
authors.forename: Barbara
authors.initials: B
authors.lastname: Krug
authors.forename: Klaus
authors.initials: K
authors.lastname: Lackner
authors.forename: Orlando
authors.initials: O
authors.lastname: Guntinas-Lichius
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D004292:Dominance, Cerebral; D005152:Facial Muscles / Q000294:innervation*; D005154:Facial Nerve / Q000503:physiopathology / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000503:physiopathology / Q000601:surgery*; D007091:Image Processing, Computer-Assisted; D008046:Lip / Q000294:innervation; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology*; D016067:Nerve Transfer / Q000379:methods*; D009473:Neuronal Plasticity / Q000502:physiology*; D010039:Otorhinolaryngologic Neoplasms / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology; D014059:Tongue / Q000294:innervation