title: Treatment of complete facial palsy in adults: comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihipoglossal-facial neurorrhaphy with grafts, and masseter to facial nerve transfer.
abstract: BACKGROUND
  The hypoglossal (with or without grafts) and masseter nerves are frequently used as axon donors for facial reinnervation when no proximal stump of the facial nerve is available. We report our experience treating facial nerve palsies via hemihypoglossal-to-facial nerve transfers either with (HFG) or without grafts (HFD), comparing these outcomes against those of masseteric-to-facial nerve transfers (MF).
  
  
  METHODS
  A total of 77 patients were analyzed retrospectively, including 51 HFD, 11 HFG, and 15 MF nerve transfer patients. Both the House-Brackmann (HB) scale and our own, newly-designed scale to rate facial reanimation post nerve transfer (quantifying symmetry at rest and when smiling, eye occlusion, and eye and mouth synkinesis when speaking) were used to enumerate the extent of recovery.
  
  
  RESULTS
  With both the HB and our own facial reanimation scale, the HFD and MF procedures yielded better outcome scores than HFG, though only the HGD was statistically superior. HGD produced slightly better scores than MF for everything but eye synkinesis, but these differences were generally not statistically significant. Delaying surgery beyond 2 years since injury was associated with appreciably worse outcomes when measured with our own but not the HB scale. The only predictors of outcome were the surgical technique employed and the duration of time between the initial injury and surgery.
  
  
  CONCLUSIONS
  HFD appears to produce the most satisfactory facial reanimation results, with MF providing lesser but still satisfactory outcomes. Using interposed grafts while performing hemihypoglossal-to-facial nerve transfers should likely be avoided, whenever possible.
authors.affiliation: Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, Buenos Aires, 1428, Argentina. marianosocolovsky@gmail.com.
authors.forename: Mariano
authors.initials: M
authors.lastname: Socolovsky
authors.affiliation: Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Roberto S
authors.initials: RS
authors.lastname: Martins
authors.affiliation: Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, Buenos Aires, 1428, Argentina.
authors.forename: Gilda
authors.initials: G
authors.lastname: di Masi
authors.affiliation: Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, Buenos Aires, 1428, Argentina.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Bonilla
authors.affiliation: Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Mario
authors.initials: M
authors.lastname: Siqueira
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000601:surgery*; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000601:surgery*; D008297:Male; D008406:Masseter Muscle / Q000294:innervation; D008875:Middle Aged; D016067:Nerve Transfer / Q000009:adverse effects / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*
keywords: Facial nerve; Facial paralysis; Hypoglossal nerve; Hypoglossal-facial anastomosis; Masseter to facial nerve transfer; Nerve graft