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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This procedure involves the use of only a portion of the hypoglossal nerve and has the enormous advantage of avoiding the tongue dysfunction that results from resection of the entire hypoglossal nerve. When the patient is emotionally upset sudden burst of crying or laughingthe responses are uncoordinated and the sequelae of the palsy are clearly visible.
The HB grading system House and Brackmann, was used to evaluate the severity of paralysis before the anastomosis, at the first rehabilitation assessment and at follow-up sessions 12, 18 and 36 months after surgery. Despite anatomical preservation of the nerve, complete facial paralysis House—Brackmann Grade VI ensued postoperatively.
The recovery continues for at least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable. Based on our experience, this procedure is quick and reliable, and recovery has an overall better quality than that with the seventh—12th cranial nerve jump graft 26 cases in our previous series, unpublished data.
End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face
Acta Neurochir Wien ; R eanimation of a recently injured facial nerve when the proximal hypkglossal is unavailable is generally performed using the seventh—12th cranial nerve jump graft, in which only one half of the hypoglossal nerve is joined to the extracranial facial nerve by a single cable graft.
After surgery, the facial muscles are reinnervated by the twelfth cranial nerve, therefore patients have to learn how to control facial motility through the use of voluntary tongue movements Rinn, Photographs depicting the procedure. Many surgical series show a significant correlation between early surgery and outcome Yetiser and Karapinar, ; Celis-Aguilar et al.
Following XII-VII anastomosis, patients frequently undergo a rehabilitation program to learn how to use the new motor circuit and faccial to prevent or control synkinesis Magliulo et al. Facial reanimation with end-to-end hypoglossofacial anastomosis: To prevent eye complications related to incomplete eyelid closure, eight patients had gold weight implants and six patients had undergone tarsorrhaphy.
Nuovo Trattato di Medicina Fisica e Riabilitazione. The same process is then used to learn other voluntary movements such as snarling and lip puckering.
Percent distribution of HB grades at surgery 0at first rehabilitation assessment 1and at 12, 18 and 36 months after the anastomosis. An accurate evaluation of the results is hindered by two important factors. Drawing illustrating the surgical procedure. Our patients demonstrated good synkinesis control, which can be strongly influenced by the rehabilitation process, as suggested by Brudny et al.
The importance of sparing part of the hypoglossal nerve was originally emphasized by Zehm and Nypoglossal 12 inbut in May, et al. Preliminary studies suggest a favorable effect of electromyographic biofeedback rehabilitation Brudny et al.
Our study demonstrates that patients undergoing XII-VII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The hypoglossal-facial nerve repair as Method to improve recovery of motor function after facial nerve injury.
As originally demonstrated by Oberlin and colleagues, 10 and confirmed by our recent experience 4 in fadial repair of peripheral nerves, a perfectly functioning secondary nerve has extraordinary power of regeneration, sometimes preferable to a damaged proximal hypoflossal of the proper nerve. Use of this procedure gains an additional length of 3. This interruption is proven by the observation that either the graft or the facial nerve stump has a square section, which is exactly one half of the hypoglossal nerve.
Author information Copyright and License information Disclaimer. For post-hoc comparisons, the exact McNemar test was used, as well as a test for linear trend of the log-relative risk to exploit the ordinal nature of the score. It is technically safe, and the results are consistent and durable.
La terapia occupazionale nella paralisi periferica del nervo faciale. Efficacy of feedback training in long-standing facial nerve paresis.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
Facial nerve anasstomosis had to be reported according to the House-Brackmann scale. Our study used a long-term follow-up period to confirm that XII-VII anastomosis combined with targeted rehabilitation produces a good functional recovery Brudny et al. At this point the patients are taught to use mirror visual feedback to dose the strength of tongue thrust necessary to achieve symmetry of muscle contraction between the reinnervated and the healthy side and to prevent the onset of synkinesis.
Finally, no scarring or morbidity due to graft harvesting is part of the process. Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded articles. Results Thirty patients were included in the study. Via a transmastoid fossa approach, faciall intratemporal facial nerve is exposed from the vertical third portion up to the external genu.
Our study demonstrates that patients treated with XII-VII anastomosis followed by a rehabilitation program show a progressive improvement of facial function: