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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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, Despite anatomical preservation of ffacial nerve, complete facial paralysis House—Brackmann Grade VI ensued postoperatively.
Time to reinnervation was associated with the final House-Brackmann grade. In the two patients treated, the gold weight in the upper eyelid was removed without consequence. The meta-analysis conducted by Yetiser and Karapinaraanastomosis 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 study was approved by the institutional ethics committee and the patients gave their written consent to participate in the research study. Our study is the first to report results obtained by combining XII-VII anastomosis with a prolonged systematic rehabilitation program in a large clinical series.
Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. 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.
Discussion 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has an overall better quality than that with the seventh—12th cranial nerve jump graft 26 cases in our previous series, unpublished data.
Only one patient did not show signs of reinnervation after surgery. Finally, no scarring or morbidity due to graft harvesting is part of the process.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
Both these rehabilitation techniques have been demonstrated to produce equivalent results in patients with anastpmosis and post-surgical long-term paralysis Ross et al. A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. 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.
Elena Dalla Toffola, E-mail: Four patients had dysphagia, 11 complained of lachrymation disorders, and nine had ataxia. Patients who have undergone XIIVII anastomosis are not considered to be capable of regaining control of their emotive facial expressions, the smile in particular, since this control is regulated by the extrapyramidal system Rinn et al.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
Ensuring accuracy of this maneuver is of paramount importance to avoid tension at the level of the suture. R eanimation of a recently injured facial nerve when the proximal stump is unavailable is generally performed using the seventh—12th cranial nerve jump graft, in which only one faccial of the hypoglossal nerve is joined to the extracranial facial nerve by a single cable graft.
Hypoglosxal results were graded as good, fair, poor, or failure according to a new method of classifying facial nerve function after hypoglossal-facial nerve anastomosis.
In order to reduce muscle atrophy and to improve musculocutaneous vascularization during this phase, they are trained to carefully massage their face.
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. At the end of the follow-up period, three patients presented dysphagia and four patients had mild post-surgery hemitongue atrophy without difficulty in moving their tongue.
In reporting the results of an extrafacial neurotization technique, one inevitably underestimates the quality of even the best results: Percent distribution of HB grades at surgery 0at first rehabilitation assessment 1and at 12, 18 and 36 months after the anastomosis. Independent of us and on a different basis, the same technique was described by Donzelli, et al.
Twenty patients had an acoustic neuroma average size 3.
If there was more than 1 article by the same author sonly the most recent article and those that did not overlap and that matched the above criteria were accepted. The HB system grades facial function on a six-point scale of increasing severity from I normal anastmoosis to VI complete paralysis House and Brackmann, Following XII-VII anastomosis, patients frequently undergo a rehabilitation program to learn how to use the new motor circuit and how to prevent xnastomosis control synkinesis Magliulo et al.
Facial nerve function had to be reported according to the House-Brackmann scale. Synkinesis is barely noticeable, and contracture or spasm is totally absent.
End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face
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. 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.
The average interval from tumor surgery to hypoglossal-facial nerve anastomosis was 6. 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.
In accordance with other studies, we found better motor recovery in the lower hemiface than in the frontalis muscle Magliulo et al.
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. Use of this procedure gains an additional length of 3.