Reconstruction of complex peripheral facial nerve defects by a combined approach using facial nerve interpositional graft and hypoglossal-facial jump nerve suture.
OBJECTIVE
To describe a modified facial nerve reconstruction technique for complex defects of the facial fan after parotid surgery that avoids synkinesis between upper and lower face.


METHODS
Retrospective case series.


METHODS
Patients who had undergone radical parotidectomy with a large defect of the facial fan, reconstruction of the upper face by facial nerve interpositional graft, and reconstruction of the lower face by hypoglossal-facial nerve jump nerve suture were included in this series.


RESULTS
Four patients underwent the modified combined approach after tumor resection and prior to postoperative radiotherapy in three of the four cases. Surgery was combined with an upper lid weight implantation. Regeneration of the face was successful in all cases within 12 to 16 months. Most important, the separated reanimation of the upper and lower face circumvented synkinesis of the upper and lower face. This factor was essential for good functional results. Using the hypoglossal jump technique instead of a classical cross-nerve suture technique prevented the sacrifice of ipsilateral tongue function.


CONCLUSIONS
The presented method offers satisfactory results for facial reanimation and avoids synkinesis between the upper and lower face. Using the jump technique instead of a classic hypoglossal transfer as it was described originally for the combined approach avoids long-term sequelae for the tongue.
Department of Otorhinolaryngology, University of Jena, Jena, Germany.
Gerd Fabian
GF
Volk
Mira
M
Pantel
Michael
M
Streppel
Orlando
O
Guntinas-Lichius
D003390:Cranial Nerve Neoplasms / Q000473:pathology / Q000601:surgery*; D004576:Electromyography; D005143:Eyelids / Q000294:innervation; D005152:Facial Muscles / Q000294:innervation; D005154:Facial Nerve / Q000473:pathology / Q000601:surgery*; D005155:Facial Nerve Diseases / Q000473:pathology / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D037981:Neck Dissection; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009416:Nerve Regeneration / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D009442:Neurilemmoma / Q000473:pathology / Q000601:surgery*; D010306:Parotid Gland / Q000473:pathology / Q000601:surgery; D010307:Parotid Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D013536:Suture Techniques