with complete facial palsy due to facial nerve transection during surgery for acoustic neuroma removal followed by a hypoglossal-facial nerve anastomosis. This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of. This procedure allows a straight end-to-side hypoglossal–facial anastomosis without interruption of the 12th cranial nerve or the need for graft interposition.
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Noticeable, however, is the fact that the orbicularis oculi muscle is also reinnervated. Reinnervation occurred in 29 patients, on average at 5.
Only one patient did not show signs of reinnervation after surgery. Our study demonstrates that patients treated with XII-VII anastomosis followed by a rehabilitation program show a progressive improvement of facial function: Following XII-VII anastomosis, patients frequently undergo a rehabilitation program to learn how to use the new motor circuit and how to prevent or control synkinesis Magliulo et al.
Two young women 31 and 34 years old each underwent removal of a large 4-cm vestibular schwannoma via the suboccipital retrosigmoid approach. Our results support this assumption: Introduction Hypoglossal-facial nerve XII-VII anastomosis is a surgical procedure that has long been used to restore movement to the facial muscles in cases of paralysis of the seventh cranial nerve Ozsoy et al. Both the jump graft technique and the intratemporal hemihypoglossal—facial attachment described by other authors Table 2 entail the interruption of approximately one half of the hypoglossal nerve to attach the recipient facial nerve.
Acoustic Neuroma and Skull Base Surgery.
Good and fair results occurred with higher frequency in younger patients who were operated on within shorter intervals, although these relationships were not statistically significant. Our study demonstrates that patients undergoing XII-VII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement.
End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face
Despite anatomical preservation of the nerve, complete facial paralysis House—Brackmann Grade VI ensued postoperatively. Our study did not reveal either of these correlations, which may be due to the fact that our patients were operated on by different surgeons. Three years after the anastomosis, The importance of sparing part of the hypoglossal nerve was originally emphasized by Zehm anastomosus Hartenau 12 inbut in May, et al.
Only one patient, whose palsy was caused by a brain hemorrhage, did not show signs of reinnervation after the surgery. Hypoglossal-facial nerve anastomosis is one of the procedures frequently performed to restore function after facial palsy secondary to surgery for removal of cerebellopontine angle tumors. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports.
At first, they need to use a strong tongue thrust to achieve static and dynamic facial symmetry. At approximately 7 to 8 months postoperatively the upper orbicularis oculi muscle is also functioning, and a good symmetric blinking reflex is present.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
In light anastoomosis the results obtained and the absolute lack of any morbidity associated with our procedure, one wonders whether the technique may be even better than a direct intracranial repair of the seventh cranial nerve when a wear-and-tear interruption of the proximal facial nerve occurs, as might happen in the course of removing large acoustic tumors. One of the aims of rehabilitation is to recover a spontaneous smile, however whether this is feasible is still a hypoglosaal of debate.
Based on our experience, this procedure is quick and reliable, and recovery has an overall better quality than hypoglosal with the seventh—12th cranial nerve jump graft 26 cases in our previous series, unpublished data. Author information Copyright and License information Disclaimer. Once patients have mastered static symmetry, they need to improve dynamic symmetry. Long-term facial nerve function following abastomosis reanimation after translabyrinthine vestibular achwannoma surgery: Our study evaluates the grade and timing of recovery in 30 patients with hypoglozsal facial paralysis House-Brackmann grade VI treated with hypoglossal-facial nerve XII-VII anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback.
This use of the new motor circuit is accompanied by a reorganization of brain activation patterns: Given the speedy results the technique could be applied in cases referred late, probably even 2 years after nerve damage.
Compared with other previously described techniques, we used a true end-to-side suture in that no nerve fascicle was interrupted. In reporting the results of an extrafacial neurotization technique, one inevitably underestimates the quality of even the best results: When the patient is emotionally upset sudden burst of crying or laughingthe responses are uncoordinated and the sequelae of the palsy are clearly visible.
Finally, no scarring or morbidity due to graft harvesting is part of the process. Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy.
Independent of us and on anasromosis different basis, the same technique was described by Donzelli, et al.
Chang and Shen showed that the proximity between the cortical area of the hypoglossal and facial nerves favors rehabilitation after surgery. It is technically safe, and the results are consistent and durable.