title: Comparison of 3 procedures for hypoglossal-facial anastomosis.
abstract: OBJECTIVE
  We aimed to evaluate rehabilitation of complete facial palsy with 3 procedures for hypoglossal-facial anastomosis: end-to-end ("original"), partial end-to-end with interpositional jump grafting ("jump") and the new partial end to end without grafting ("modified").
  
  
  METHODS
  A medical jury reviewed videos of 36 patients with complete facial palsy who underwent surgery from 1998 to 2008 by original (n = 13), jump (n = 13), and modified (n = 10) procedures. The jury of 5 ear, nose, and throat surgeons who were blinded to the procedure evaluated rehabilitation by 3 facial nerve grading systems-House and Brackman (HB), Sunnybrook, and Freyss scales-and 3 subjective scores for the face at rest and during voluntary and emotional motions.
  
  
  RESULTS
  Recovery time was shorter with the modified and original procedures than jump procedure (5, 6, and 8 mo, respectively). All patients achieved at least good results. Scores on the HB scale (I-VI) were mainly III. HB and Sunnybrook scores did not differ by procedure. Freyss score was better for the modified procedure than original and jump procedures. Scores for the face at rest did not differ by procedure, but those during voluntary and emotional movements were worse for the jump procedure than for other procedures. Synkinesis was more severe with the original procedure than other procedures.
  
  
  CONCLUSIONS
  The 3 procedures give satisfactory results for rehabilitation after surgery for facial palsy. The original procedure should be performed in patients with strong mimic or long-standing facial palsy. The jump procedure is delicate and entails risk of weak reinnervation. The modified procedure is a good compromise in terms of muscle tone and side effects.
authors.affiliation: Department of Oto-Rhino-Laryngology, Lariboisière Hospital, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Le Clerc
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.forename: Romain
authors.initials: R
authors.lastname: Kania
authors.forename: Hugo
authors.initials: H
authors.lastname: Tran
authors.forename: Khaled
authors.initials: K
authors.lastname: Altabaa
authors.forename: Patrice
authors.initials: P
authors.lastname: Tran Ba Huy
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sauvaget
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D020127:Recovery of Function; D016896:Treatment Outcome