title: Rehabilitation of central facial paralysis with hypoglossal-facial anastomosis.
abstract: OBJECTIVE
  To evaluate the ability of hypoglossal-facial nerve anastomosis to reanimate the face in patients with complete nuclear (central) facial nerve palsy.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  Four patients with complete facial nerve paralysis due to lesions of the facial nucleus in the pons caused by hemorrhage due to arteriovenous or cavernous venous malformations, stroke, or injury after tumor resection.
  
  
  METHODS
  All patients underwent end-to-end hypoglossal-facial nerve anastomosis.
  
  
  METHODS
  Facial nerve function using the House-Brackmann (HB) scale and physical and social/well-being function using the facial disability index.
  
  
  RESULTS
  The mean age of the patients was 53.3 years (range, 32-73). There were 3 female and 1 male patients. All patients had preoperative facial function HB VI/VI. With a minimum of 12 months' follow-up after end-to-end hypoglossal-facial anastomosis, 75% of patients regained function to HB grade III/VI, and 25% had HB grade IV/VI. Average facial disability index scores were 61.25 for physical function and 78 for social/well-being, comparable to results from complete hypoglossal-facial anastomosis after peripheral facial nerve palsy after acoustic neuroma resection.
  
  
  CONCLUSIONS
  Patients with nuclear facial paralysis who undergo end-to-end hypoglossal-facial nerve anastomosis achieve similar degrees of reanimation compared with those with peripheral facial nerve palsies. This raises the intriguing possibility that reinnervation may also be of benefit in patients with the vastly more common facial dysfunction because of cortical stroke or injury.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California 94305-5739, USA.
authors.forename: C Eduardo
authors.initials: CE
authors.lastname: Corrales
authors.forename: Richard K
authors.initials: RK
authors.lastname: Gurgel
authors.forename: Robert K
authors.initials: RK
authors.lastname: Jackler
mesh_terms: D020434:Abducens Nerve Diseases / Q000209:etiology; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000150:complications; D003399:Craniotomy; D004172:Diplopia / Q000209:etiology; D004185:Disability Evaluation; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000534:rehabilitation* / Q000601:surgery*; D005260:Female; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration; D009460:Neurologic Examination; D013506:Otologic Surgical Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D054079:Vascular Malformations / Q000150:complications / Q000473:pathology