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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Hypoglossal-facial nerve anastomosis: a meta-analytic study.
A reduced rate of synkinesis after a true end-to-side coaptation has also been confirmed by the observations of Yoleri, et al. A report of 60 cases. Of particular interest are the normalization of the sagging face as early as 2 months after nerve hypoglossao and the definitive resolution of the eye problem. If there was more than 1 article by the same faacial sonly the most recent article and those that did not overlap and that matched the above criteria were accepted. At approximately 7 to 8 months postoperatively the upper faacial oculi muscle is hypoglossal functioning, and a good symmetric blinking reflex is present.
Journal List Funct Neurol v. Global assessment of outcomes after varying reinnervation techniques for patients with facial paralysis subsequent to acoustic neuroma excision. Both these rehabilitation techniques have been demonstrated to produce equivalent results in patients with idiopathic and post-surgical long-term paralysis Ross et al.
Compared with other previously described techniques, we used a true end-to-side suture in that no nerve fascicle was interrupted. To do this they must learn how to produce a voluntary smile; again they need to use a mirror, dosing the strength of their tongue thrust and repeating the movement several times a day.
The published results of hypoglossal-facial nerve anastomosis have been variable, and there are still questions about the indications, timing, and surgical techniques for this procedure.
The fallopian canal is then carefully opened using a diamond bur under continuous suction and irrigation, and the distal facial nerve is extracted and rerouted outside the stylomastoid foramen.
This result can be attributed to the number of fibers contained in this branch of the seventh cranial nerve Chang and Shen, Analysis of the reports indicates that early repair, before 12 months, provides a better outcome.
Our study is the first to report results obtained by combining XII-VII anastomosis with a prolonged anasstomosis rehabilitation program in a large clinical series.
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Very soon the lower part of the muscle is perfectly active and lagophthalmos is no longer visible. Good and fair results occurred with higher frequency in faacial patients who were operated on within shorter intervals, although these relationships were not statistically significant. Summary Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis House-Brackmann grade VI treated with hypoglossal-facial nerve XII-VII anastomosis and a long-term rehabilitation program, consisting of exercises hypoglosdal facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback.
The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. The results were good in 14 cases The tongue was normal at this time. All post-hoc comparisons showed a significant reduction in scores test for trend: Good or fair results were achieved in 17 Our patients demonstrated good synkinesis control, which can be strongly influenced by the rehabilitation process, as suggested by Brudny et al.
One or two stitches and fibrin glue are applied Fig. Photographs depicting the procedure. Discussion Our study demonstrates that patients treated with XII-VII anastomosis followed by a rehabilitation program show a anawtomosis improvement of facial function: 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.
Through repetition of these exercises the movements become automatic, i. Modification of the anastomosis technique seems to resolve this problem.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
This may be due to an unrecognized injury to the hypoglossal donor nerve following the brain hemorrhage that damaged the sixth and seventh cranial nerves. Treating facial nerve palsy by true termino-lateral hypoglossal-facial nerve anastomosis. Articles that reported facial nerve function anastoosis surgery and timing of repair were included.
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. Epiendoneurial opening—note the herniating fascicles still in continuity. First, regardless of the scale used, data somehow depend on the personal evaluation of the surgeon or the team. Long-term facial nerve function following facial reanimation after translabyrinthine vestibular achwannoma surgery: The use of home rather than hospital-based rehabilitation offered certain advantages: Eighteen patients had hypoacusis, due to the removal of a neuroma of the eighth cranial nerve in 16 patients, and to an expansive lesion in two.
Open in a separate window. At 1 year postresection, electromyography and clinical examination results showed evidence of irreversible damage and surgery was undertaken. 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. Support Center Support Center. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis.
For the first four to five months after surgery, before the first signs of reinnervation appear, patients who have undergone this procedure have complete facial paralysis. Preliminary studies suggest a favorable effect of electromyographic biofeedback rehabilitation Brudny et al. As reinnervation improves, the tongue thrust does not have to be so strong in order to achieve symmetry. Dalla Toffola E, Petrucci L. Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy.
Elena Dalla Toffola, E-mail: We thank Charlotte Buckmaster for her linguistic expertise.