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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The HB grading system House and Brackmann, was used to evaluate the severity of paralysis before the anastomosis, at the anasto,osis rehabilitation assessment and at follow-up sessions 12, 18 and 36 months after surgery. At approximately 7 to 8 months postoperatively the upper orbicularis oculi muscle is also functioning, and a good symmetric blinking reflex is present. One or two stitches and fibrin glue are applied Fig. Larger randomized clinical trials should be considered in order to provide more conclusive evidence.
Ann Chir Plast Esthet. Ann Otol Rhinol Laryngol.
At only 3 months muscle tone is excellent at rest, and at 6 months facial muscle function is very good during controlled speaking or laughing. Surgical results of the hypoglossal-facial nerve jump graft technique. Good or fair results were achieved in 17 Eur J Phys Rehabil Med.
Depending on its condition, a ruptured proximal stump might not always be considered the best choice for reinnervation.
Surgical Technique Via a transmastoid fossa approach, the intratemporal facial nerve is exposed from the vertical third portion up to the external genu.
The median HB score at different time points was compared using the Friedman test. The meta-analysis conducted by Yetiser and Karapinarbased on data of patients derived from 23 studies, reported a median improvement of two levels on the HB grading system in patients who underwent surgery alone. The same process is then used to learn other voluntary movements such as snarling and lip puckering.
Global assessment of outcomes after varying reinnervation techniques for patients with facial paralysis subsequent to acoustic neuroma excision.
We thank Charlotte Buckmaster for her linguistic expertise. 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has an overall better quality than that with the seventh—12th cranial nerve jump graft 26 cases in our previous series, unpublished data.
National Center for Biotechnology InformationU. Results An accurate evaluation of the results is hindered by two important factors. Many surgical series show a hypogloesal correlation between early surgery and outcome Yetiser and Karapinar, ; Celis-Aguilar et al. Time to reinnervation was associated with the final House-Brackmann grade. The goals of the present retrospective analysis of 22 cases of hypoglossal-facial nerve anastomosis were to anadtomosis the extent of the functional recovery and to analyze the factors affecting this recovery.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
Facial nerve function had to be reported according to the House-Brackmann scale. A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. Preliminary studies suggest a favorable effect of electromyographic biofeedback rehabilitation Brudny et al.
Eighteen patients had hypoacusis, due to the removal of a neuroma of the eighth cranial nerve in 16 fackal, and to an expansive lesion in two. The 22 cases of complete facial palsy were gleaned from a series of cases of cerebellopontine angle tumors treated surgically by one of the authors.
Our patients demonstrated good synkinesis control, which can be strongly influenced by the rehabilitation process, as suggested by Brudny et al. The use of home rather than hospital-based rehabilitation offered certain advantages: Electromyographic rehabilitation of facial function and introduction of a facial paralysis grading scale for hypoglossal-facial nerve anastomosis. Numerous authors of fafial studies hyypoglossal pointed out that XII-VII anastomosis patients can benefit from a long-term rehabilitation program, yet without describing such programs Magliulo et aanstomosis.
As originally demonstrated by Oberlin and colleagues, 10 and confirmed by our recent experience 4 in microsurgical repair of peripheral nerves, a perfectly functioning secondary nerve has extraordinary power of regeneration, sometimes preferable to a damaged proximal hypogloswal of the proper nerve.
Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. Clinical assessment 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.
Only one patient, whose palsy was caused by a brain hemorrhage, did not show signs of reinnervation after the surgery. Rehabilitation treatment The objectives of rehabilitation are i for the patient to become aware of being able to perform new movements, ii for the patient then to learn the tongue movements that produce facial muscle faciall, and iii to render the newly acquired movements automatic Dalla Toffola and Petrucci, ; Ross et al.
Conclusions In light of 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. This use of the new motor circuit is accompanied by a reorganization of brain activation patterns: Long-term facial nerve function following facial reanimation after translabyrinthine vestibular achwannoma surgery: No branch coming off the facial nerve is interrupted during this procedure.
Suture with fibrin glue. Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
A very important issue is still to be ascertained: The main trunk of the nerve is progressively gently pulled using multiple epineurial stay sutures and is anchored to the surrounding connective tissue in an upward and lateral position Fig.
The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. Hypoglossofacial anastomosis for facial palsy after resection of acoustic neuroma.