title: Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve.
abstract: OBJECTIVE
  To describe results in a large series of patients using a recent variation of hypoglossal-facial nerve anastomosis (HFA) in which the intratemporal facial nerve segment is used, obviating the need for a sensory nerve "jump graft."
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary neurotologic referral center.
  
  
  METHODS
  Nineteen patients (12 female/7 male subjects) with facial paralysis because of posterior fossa surgery for tumor (n = 15), Bell's palsy (n = 1), facial neuroma (n = 1), hemangioma (n = 1), and trauma (n = 1) who underwent HFA from 1997 to 2011, with at least 1-year follow-up. Mean age at surgery is 47.4 years (range, 11.2-83 yr). Mean follow-up is 4.0 years.
  
  
  METHODS
  Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve (swingdown HFA).
  
  
  METHODS
  House-Brackmann (H-B) facial nerve grade.
  
  
  RESULTS
  Seven patients (36.8%) achieved an H-B Grade III, 9 patients (47.4%) a grade IV, and 3 patients (15.8%) a grade V at last follow-up. No patients complained of dysphagia, dysarthria, or had evidence of oral incompetence. One patient complained of mild tongue weakness. Age at time of HFA (p ≤ 0.049, III younger than V) and time from facial nerve injury to HFA (p ≤ 0.02, III<IV and V) were significant factors for ultimate facial nerve outcome. All patients with an H-B III result had HFA within 6 months of injury. Other factors were not significant.
  
  
  CONCLUSIONS
  The HFA swingdown technique is a safe and effective method to restore facial nerve function in patients with facial paralysis and obviates the need for an interposition jump graft.
authors: *House Clinic and House Research Institute; †Massachusetts Eye and Ear Infirmary, Boston, MA; previously, Clinical Fellow, House Clinic and House Research Institute, Los Angeles; and ‡House Research Institute, Marina del Rey, California, U.S.A.
authors: William H
authors: WH
authors: Slattery
authors: Adam M
authors: AM
authors: Cassis
authors: Eric P
authors: EP
authors: Wilkinson
authors: Felipe
authors: F
authors: Santos
authors: Karen
authors: K
authors: Berliner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult