title: Hemihypoglossal nerve transfer for acute facial paralysis.
abstract: OBJECTIVE
  The authors have developed a technique for the treatment of facial paralysis that utilizes anastomosis of the split hypoglossal and facial nerve. Here, they document improvements in the procedure and experimental evidence supporting the approach.
  
  
  METHODS
  They analyzed outcomes in 36 patients who underwent the procedure, all of whom had suffered from facial paralysis following the removal of large vestibular schwannomas. The average period of paralysis was 6.2 months. The authors used 5 different variations of a procedure for selecting the split nerve, including evaluation of the split nerve using recordings of evoked potentials in the tongue.
  
  
  RESULTS
  Successful facial reanimation was achieved in 16 of 17 patients using the cephalad side of the split hypoglossal nerve and in 15 of 15 patients using the caudal side. The single unsuccessful case using the cephalad side of the split nerve resulted from severe infection of the cheek. Procedures using the ansa cervicalis branch yielded poor success rates (2 of 4 cases). Some tongue atrophy was observed in all variants of the procedure, with 17 cases of minimal atrophy and 14 cases of moderate atrophy. No procedure led to severe atrophy causing functional deficits of the tongue.
  
  
  CONCLUSIONS
  The split hypoglossal-facial nerve anastomosis procedure consistently leads to good facial reanimation, and the use of either half of the split hypoglossal nerve results in facial reanimation and moderate tongue atrophy.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan. ayhayasi@juntendo.ac.jp
authors.forename: Ayato
authors.initials: A
authors.lastname: Hayashi
authors.forename: Masanobu
authors.initials: M
authors.lastname: Nishida
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Seno
authors.forename: Masahiro
authors.initials: M
authors.lastname: Inoue
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Iwata
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shirasawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Arai
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kayamori
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Komuro
authors.forename: Akira
authors.initials: A
authors.lastname: Yanai
mesh_terms: D000328:Adult; D000368:Aged; 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 / Q000379:methods*; D014059:Tongue / Q000294:innervation; D016896:Treatment Outcome