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Hamdi OA, Jones MK, Ziegler J, Basu A, Oyer SL. Hypoglossal Nerve Transfer for Facial Nerve Paralysis: A Systematic Review and Meta-Analysis. Facial Plast Surg Aesthet Med 2024; 26:219-227. [PMID: 38153410 DOI: 10.1089/fpsam.2023.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background: Hypoglossal-facial nerve (12-7) anastomosis can restore symmetry and voluntary movement on the face in patients with facial nerve paralysis. Traditional 12-7 transfer includes direct end-to-end nerve anastomosis, sacrificing the entire hypoglossal nerve. Contemporary, end-to-side anastomosis, or split anastomosis techniques limit tongue morbidity by preserving some hypoglossal nerve. Direct outcome comparisons between these techniques are limited. Objective: To compare reported outcomes of facial movement, tongue, speech, and swallow outcomes among the different types of hypoglossal-facial nerve anastomosis schemes. Evidence Review: For this systematic review and meta-analysis, a comprehensive strategy was designed to search PubMed, Scopus, and the Cochrane Database from inception to January 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, reporting guideline yielding 383 results. Any participant who underwent 12-7 transfer using any of the three techniques, with or without an interposition graft, and had documented preoperative and postoperative evaluation of facial nerve function with a validated instrument such as House-Brackmann (HB), was considered for inclusion. Secondary outcomes of synkinesis, tongue atrophy, and speech or swallowing dysfunction were also compared. Forty-nine studies met inclusion criteria, representing data from 961 total patients who underwent 12-7 transfer. Results: The proportion of good HB outcomes (HB I-III) did not differ by anastomosis type: End-to-side and end-to-end anastomosis (73% vs. 59%, p = 0.07), split and end-to-end anastomosis (62% vs. 59%, p = 0.88), and end-to-side anastomosis and split anastomosis (73% vs. 62%, p = 0.46). There was no difference in reported synkinesis rates between the anastomosis types. However, end-to-side anastomosis (z = 6.55, p < 0.01) and split anastomosis (z = 3.58, p < 0.01) developed less tongue atrophy than end-to-end anastomosis. End-to-side anastomosis had less speech/swallowing dysfunction than end-to-end anastomosis (z = 3.21, p < 0.01). Conclusion: End-to-side and split anastomoses result in similar HB facial nerve outcomes as the traditional end-to-end 12-7 anastomosis. End-to-side anastomosis has decreased complications of tongue atrophy and speech/swallow dysfunction compared to end-to-end anastomosis. In addition, split anastomosis has decreased rates of tongue atrophy compared to end-to-end anastomosis.
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Affiliation(s)
- Osama A Hamdi
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Marieke K Jones
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - John Ziegler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Annesha Basu
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel L Oyer
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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Liu Y, Yao L, Li C, Huang X, Tan Y, Wei J, Chen P. The Selective Trigeminal Nerve Motor Branching Transfer: an Preliminary Clinical Application for Facial Reanimation. J Craniofac Surg 2023; 34:2077-2081. [PMID: 37315290 DOI: 10.1097/scs.0000000000009389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/26/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To investigate the effectiveness and feasibility of selective trigeminal nerve motor branching in the repair of facial palsy. MATERIALS AND METHODS The clinical data of patients with advanced facial palsy from 2016 to 2021 were retrospectively analyzed, including pictures and videos before and 18 months after surgery. The House-Brackmann grading system was used to evaluate facial nerve function before and after repair, and the symmetry scale of oral commissure at rest and Terzis' smile functional evaluation scale were used to qualitatively assess the symmetry of the mouth angle and smile function. The distance of oral commissure movement was assessed to evaluate the dynamic repair effect, and the FaCE facial muscle function scale was used to assess patients' subjective perception before and after surgery. RESULTS A total of four patients were included in the study, all of whom showed signs of recovery of facial nerve function within six months. In all four cases, significant improvements were observed in House-Brackmann ratings, the smile function score and the symmetry scale of oral commissure at rest. Compared to the pre-operative period, the four patients demonstrated various degrees of eye-closing function recovery, and a significant improvement in oral commissure movement was observed ( P <0.001). FaCE scores also improved significantly after surgery ( P =0.019). CONCLUSION Concurrent selective facial nerve repair with trigeminal branch-facial nerve anastomosis resulted in eye-closing function recovery while improving static and dynamic symmetry, yielding acceptable postoperative results.
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Affiliation(s)
- Yuchao Liu
- Department of Otolaryngology & Head and Neck Surgery, Wuhan No.1 Hospital, Wuhan, China
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Millesi E, Suchyta M, Wang H, Mardini S. Anatomic Analysis of Masseteric-to-zygomatic Nerve Transfer in Rat and Pig Models. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5344. [PMID: 37859639 PMCID: PMC10584298 DOI: 10.1097/gox.0000000000005344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 10/21/2023]
Abstract
Background Nerve transfer from the masseteric branch of the trigeminal nerve is a widely performed procedure for facial reanimation. Despite achieving powerful muscle force, clinical and aesthetic results leave room for improvement. Preclinical animal models are invaluable to establishing new therapeutic approaches. This anatomical study aimed to establish a masseteric-to-zygomatic nerve transfer model in rats and pigs. Methods The masseteric branch of the trigeminal nerve and the zygomatic branch of the facial nerve were dissected in 30 swine and 40 rat hemifaces. Both nerves were mobilized and approximated to achieve an overlap between the nerve ends. Over the course of dissecting both nerves, their anatomy, length, and branching pattern were documented. At the coaptation point, diameters of both nerves were measured, and samples were taken for neuromorphometric analysis. Results Anatomic details and landmarks were described. Tension-free coaptation was possible in all rat and pig dissections. In rats, the masseteric branch had an average diameter of 0.36 mm (±0.06), and the zygomatic branch average diameter was 0.46 mm (±0.13). In pigs, the masseteric branch measured 0.52 (±0.16) mm and the zygomatic branch, 0.59 (±0.16) mm. No significant differences were found between the diameters and axon counts of both nerves in pigs. In rats, however, their diameters, axon counts, and fascicular areas were significantly different. Conclusion Our study demonstrated the feasibility of direct masseteric-to-zygomatic nerve transfer in rats and pigs and provided general anatomic knowledge of both nerves.
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Affiliation(s)
- Elena Millesi
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
- Division of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marissa Suchyta
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Huan Wang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minn
| | - Samir Mardini
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
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4
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Lassaletta L, Morales-Puebla JM, Molnar D, González-Otero T, Gavilán J. Side-to-End Intratemporal Hypoglossal-to-Facial Transfer. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:9-17. [PMID: 36754510 DOI: 10.1016/j.cxom.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Luis Lassaletta
- Department of Otolaryngology, Hospital Universitario La Paz, IdiPAZ Research Institute, Paseo de la Castellana, 261, Madrid 28046, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), (CIBERER-U761), Institute of Health Carlos III, Madrid, Spain.
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, Hospital Universitario La Paz, IdiPAZ Research Institute, Paseo de la Castellana, 261, Madrid 28046, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), (CIBERER-U761), Institute of Health Carlos III, Madrid, Spain
| | - David Molnar
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical Centre Hungarian Defence Forces, Róbert Károly körút 44, Budapest 1134, Hungary; Department of Anatomy, Histology and Embryology, Semmelweis University, Tűzoltó utca 58, Budapest 1094, Hungary
| | - Teresa González-Otero
- Department of Maxillofacial Surgery, Hospital Universitario La Paz, IdiPAZ Research Institute, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Javier Gavilán
- Department of Otolaryngology, Hospital Universitario La Paz, IdiPAZ Research Institute, Paseo de la Castellana, 261, Madrid 28046, Spain
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Assessing the Efficacy of Anastomosis between Ansa Cervicalis and Facial Nerve for Patients with Concomitant Facial Palsy and Peripheral Neuropathy. J Pers Med 2022; 13:jpm13010076. [PMID: 36675739 PMCID: PMC9863281 DOI: 10.3390/jpm13010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/29/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
Background: For decades, patients with facial asymmetry have experienced social interaction difficulties, leading them to seek treatment in the hope of restoring facial symmetry and quality of life. Researchers evaluated numerous surgical techniques, but achieving results remains a significant hurdle. Specifically, anastomosis between the ansa cervicalis (AC) and facial nerve (FN) can hinder the patient's physical appearance. Objective: Our study goal was to examine the efficiency of anastomosis between AC and FN for facial motor function recovery even in the presence of peripheral neuropathy. Materials and Methods: Four patients diagnosed with facial palsy grade VI on the House & Brackmann Scale (HB) after vestibular schwannoma (VS) resection (Koos grade IV) via the retrosigmoid approach underwent AC and FN anastomosis. Outcomes were related to tumor grade, previous therapy, and the time between postoperative facial palsy and anastomosis. Images and neurophysiological data were evaluated. Results: After vs. resection, all four patients demonstrated HB grade VI facial palsy for an average of 17 months. During the follow-up program, lasting between 6 and 36 months, two patients were evaluated as having HB grade III facial palsy; the other two patients were diagnosed with grade IV HB facial palsy. None of the patients developed tongue atrophy, speech disorder, or masticatordys function. Conclusions: Anastomosis between the AC and FN is a safe and effective treatment for facial paralysis after cerebellopontine tumor resection. Nerve reanimation may be feasible even for patients with peripheral polyneuropathy. This study also offers a new option for patients with a progression-free status.
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Mato-Patino T, Morales-Puebla JM, Moraleda S, Sánchez-Cuadrado I, Calvino M, Gonzalez-Otero T, Peñarrocha J, Hernández B, Gavilan J, Lassaletta L. Contribution and safety of the side-to-end hypoglossal-to-facial transfer in multidisciplinary facial reanimation. Head Neck 2022; 44:1678-1689. [PMID: 35506436 DOI: 10.1002/hed.27076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study evaluates facial and tongue function in patients undergoing side-to-end hypoglossal-to-facial transfer (HFT) with additional techniques. METHODS Thirty-seven patients underwent a side-to-end HFT. Twelve had additional cross-face grafts, and 9 had an additional masseter-to-facial transfer. Facial was assessed with House-Brackmann (HB), Sunnybrook Facial Grading Scale (SFGS), and eFACE. Martins scale and the Oral-Pharyngeal Disability Index (OPDI) were used to assess tongue function. RESULTS Ninety-four percent of cases reached HB grades III-IV. Mean total SFGS score improved from 16 ± 15 to 59 ± 11, while total eFACE score from 52 ± 13 to 80 ± 5. Dual nerve transfers were a predictor for a better eFACE total score p = 0.034, β = 2.350 [95% CI, 0.184-4.516]), as well as for a higher SFGS total score (p = 0.036, β = 5.412 [95% CI, 0.375-10.449]). All patients had Martin's grade I. Mean postoperative OPDI scores were 84 ± 17 (local physical), 69 ± 16 (simple and sensory motor components), 82 ± 14 (complex functions), and 73 ± 22 (psychosocial). CONCLUSIONS The side-to-end HFT offers predictable facial function outcome and preserves tongue function in nearly all cases. Dual nerve transfers appear to improve the final outcome.
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Affiliation(s)
- Teresa Mato-Patino
- Department of Otolaryngology, Hospital Universitario La Paz, Madrid, Spain
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, Hospital Universitario La Paz, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Susana Moraleda
- Department of Physical Medicine and Rehabilitation, Hospital Universitario La Paz, Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, Hospital Universitario La Paz, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain
| | - Miryam Calvino
- Department of Otolaryngology, Hospital Universitario La Paz, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Teresa Gonzalez-Otero
- IdiPAZ Research Institute, Madrid, Spain.,Department of Maxillofacial Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Julio Peñarrocha
- Department of Otolaryngology, Hospital Universitario La Paz, Madrid, Spain
| | - Borja Hernández
- IdiPAZ Research Institute, Madrid, Spain.,Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain
| | - Javier Gavilan
- Department of Otolaryngology, Hospital Universitario La Paz, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, Hospital Universitario La Paz, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
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Yoshioka N. Partial hypoglossal-facial end-to-end neurorrhaphy for nonflaccid facial palsy with severe hypertonicity. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Abstract
BACKGROUND Craniofacial microsomia is associated with maxillomandibular hypoplasia, microtia, soft-tissue deficiency, and variable severity of cranial nerve dysfunction, most often of the facial nerve. This study evaluated the incidence of patients with craniofacial microsomia and facial paralysis and their outcomes after free functioning muscle transfer for dynamic smile reconstruction. METHODS A single-center, retrospective, cross-sectional study was performed from 1985 to 2018 to identify pediatric patients with craniofacial microsomia and severe facial nerve dysfunction who underwent dynamic smile reconstruction with free functioning muscle transfer. Preoperative and postoperative facial symmetry and oral commissure excursion during maximal smile were measured using photogrammetric facial analysis software. RESULTS This study included 186 patients with craniofacial microsomia; 41 patients (21 male patients, 20 female patients) had documented facial nerve dysfunction (22 percent), affecting all branches (51 percent) or the mandibular branch only (24 percent). Patients with severe facial paralysis (n = 8) underwent midfacial (i.e., smile) reconstruction with a free functioning muscle transfer neurotized either with a cross-face nerve graft (n = 7) or with the ipsilateral motor nerve to masseter (n =1). All patients achieved volitional muscle contraction with improvement in symmetry and oral commissure excursion (median, 8 mm; interquartile range, 3 to 10 mm). The timing of orthognathic surgery and facial paralysis reconstruction was an important consideration in optimizing patient outcomes. CONCLUSIONS The authors' institution's incidence of facial nerve dysfunction in children with craniofacial microsomia is 22 percent. Free functioning muscle transfer is a reliable option for smile reconstruction in children with craniofacial microsomia. To optimize outcomes, a novel treatment algorithm is proposed for craniofacial microsomia patients likely to require both orthognathic surgery and facial paralysis reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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9
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End-to-Trunk Masseteric to Facial Nerve Transfer With Selective Neurectomy for Facial Reanimation. J Craniofac Surg 2021; 32:2864-2866. [PMID: 34727487 DOI: 10.1097/scs.0000000000007995] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine functional outcomes following end-to-trunk masseteric to facial nerve transfer in patients with chronic flaccid facial paralysis. DESIGN Retrospective chart review. SETTING Tertiary-care private practice setting. PARTICIPANTS Patients with complete unilateral facial paralysis of less than 24 months duration. INTERVENTIONS Direct end-to-trunk masseteric to facial nerve anastomosis. OUTCOME MEASURES Outcome measures included time to first movement, development of synkinesis, and an objective assessment of the resting tone and dynamic movement that was achieved. RESULTS Patient age at the time of transfer ranged from 6 to 61. Follow-up ranged from 12 to 24 months. No patients had any perioperative complications. No patient experienced significant mass movement or synkinetic facial movement with chewing. No patient had worsened chewing or swallowing. Patients have not yet recovered significant resting tone. All patients achieved smile activity when biting down with a median (interquartile range) oral commissure excursion of 7.57 mm (5.19-9.94 mm), starting 3 to 5 months after transfer. CONCLUSIONS End-to-trunk masseteric to facial nerve transfer is a safe and effective procedure. Patients had rapid reinnervation with good excursion and achieved a natural appearing smile. The rehabilitated smile appears better than that achieved with hypoglossal-facial nerve transfer. The procedure can be performed coincident with cross-facial nerve grafting, and in some cases may produce dynamic facial movement that obviates the need for free muscle transfer.
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Ferraresi S, Basso E, Maistrello L, Di Pasquale P. The Masseteric-Facial Anastomosis With Intratemporal Translocation of the Facial Nerve: Step-by-Step Technique and Results. Oper Neurosurg (Hagerstown) 2021; 21:360-370. [PMID: 34424333 DOI: 10.1093/ons/opab286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the absence of a viable proximal nerve stump, damaged after surgical procedures around the skull base, numerous techniques for facial reanimation have been developed over time, aiming to restore baseline symmetry and active mimicry. OBJECTIVE To report experience using the masseteric nerve as a direct transfer to the facial nerve rerouted after intratemporal translocation. This paper illustrates the main steps of the technique and the quality of results. METHODS Eleven patients were treated with a masseteric direct transfer to the facial nerve. Its extratemporal rerouting toward the zygoma allowed tension-free coaptation between donor and recipient nerves. RESULTS Of the 11 patients, 8 had a good to excellent recovery, showing different patterns of time and scores, according to age, surgical timing, and masseteric nerve function quality. The return of activity in the frontalis muscle, never obtained after reinnervation via the hypoglossal nerve, is of particular interest. The quality of the smile can be improved with re-education and practice but remains under volitional control. A true emotional response is still lacking. CONCLUSION The masseteric nerve is an excellent alternative to the hypoglossal nerve and can reinnervate the whole territory of the facial nerve rerouted after intratemporal translocation. The overall results are remarkable, but the low quality of the trigeminal nerve, eventually affected by the first surgery, may be an important limitation. Even if the patients appear more at ease in re-education than with other techniques, a fully natural facial expression remains impossible to obtain.
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Affiliation(s)
- Stefano Ferraresi
- Department of Neurosurgery, Ospedale S. Maria della Misericordia, Rovigo, Italy
| | - Elisabetta Basso
- Department of Neurosurgery, Ospedale S. Maria della Misericordia, Rovigo, Italy
| | - Lorenzo Maistrello
- Department of Neurosurgery, Ospedale S. Maria della Misericordia, Rovigo, Italy
| | - Piero Di Pasquale
- Neuroanesthesiology Unit, Department of Neurosurgery, Ospedale S. Maria della Misericordia, Rovigo, Italy
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Abstract
This article describes a method of performing a dual nerve transfer procedure and provides illustrative cases for analysis and discussion. Clinical indications, technical pearls, and pitfalls are discussed. Dual nerve transfer for facial reanimation efficiently combines the strengths of the hypoglossal and masseteric nerve transfers and builds on existing nerve transfer techniques.
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Affiliation(s)
- Tyler S Okland
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jon-Paul Pepper
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Stanford Facial Nerve Center, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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12
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Funk EK, Greene JJ. Advances in Facial Reanimation: Management of the Facial Nerve in the Setting of Vestibular Schwannoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Negley KJ, Rasool A, Byrne PJ. Motor Relearning After Hypoglossal-Facial Nerve Anastomosis. Am J Phys Med Rehabil 2021; 100:e85-e88. [PMID: 32796157 DOI: 10.1097/phm.0000000000001562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Facial paralysis is a clinical condition associated with significant functional and psychosocial morbidity (Facial Plast Surg FPS. 2011;27(4):346-57). The management paradigm for this condition continues to evolve with the use of both surgical and nonsurgical strategies (Facial Plast Surg FPS. 2011;27(4):346-57). Hypoglossal-facial nerve anastomosis is a surgical technique whereby the hypoglossal nerve acts as a donor motor nerve to restore facial muscle reinnervation via movements of the tongue (Plast Reconstr Surg. 1979;63(1):63-72). This case describes a 33-yr-old woman with unilateral facial paralysis who underwent hypoglossal-facial nerve anastomosis and 14 wks of postoperative rehabilitation. This report highlights the details of her rehabilitation regimen including the specific techniques used to enhance motor relearning of facial expression through movement of the tongue.
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Affiliation(s)
- Kelly J Negley
- From the Department of Physical Therapy, Marymount University, Arlington, Virginia (KJN); Medstar National Rehabilitation Hospital, Washington, DC (KJN); Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Alberta, Canada (AR); and Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Department of Dermatology, Department of Biomedical Engineering, The Johns Hopkins School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland (PJB)
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The Experience of a Facial Nerve Unit in the Treatment of Patients With Facial Paralysis Following Skull Base Surgery. Otol Neurotol 2021; 41:e1340-e1349. [PMID: 33492811 DOI: 10.1097/mao.0000000000002902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
: The management of facial paralysis following skull base surgery is complex and requires multidisciplinary intervention. This review shows the experience of a facial nerve (FN) unit in a tertiary university referral center. A multidisciplinary approach has led to the breaking of some old treatment paradigms. An overview of five FN scenarios is presented. For each setting a contemporary approach is proposed in contrast to the established approach. 1) For patients with an anatomically preserved FN with no electrical response at the end of surgery for vestibular schwannoma, watchful waiting is usually advocated. In these cases, reinforcement with an interposed nerve graft is recommended. 2) In cases of epineural FN repair, with or without grafting, and a poor expected prognosis, an additional masseter-to-facial transfer is recommended. 3) FN transfer, mainly hypoglossal-to-facial and masseter-to facial, are usually chosen based on the surgeons' preference. The choice should be based on clinical factors. A combination of techniques improves the outcome in selected patients. 4) FN reconstruction following malignant tumors requires a combination of parotid and temporal bone surgery, involving different specialists. This collaboration is not always consistent. Exposure of the mastoid FN is recommended for lesions involving the stylomastoid foramen, as well as intraoperative FN reconstruction. 5) In patients with incomplete facial paralysis and a skull base tumor requiring additional surgery, consider an alternative reinnervation procedure, "take the FN out of the equation" before tumor resection. In summary, to achieve the best results in complex cases of facial paralysis, a multidisciplinary approach is recommended.
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15
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Urban MJ, Eggerstedt M, Varelas E, Epsten MJ, Beer AJ, Smith RM, Revenaugh PC. Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis. Facial Plast Surg Aesthet Med 2021; 24:10-17. [PMID: 33635144 DOI: 10.1089/fpsam.2020.0523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Hypoglossal and masseteric nerve transfer are currently the most popular cranial nerve transfer techniques for patients with facial paralysis. The authors performed a systematic review and meta-analysis to compare functional outcomes and adverse effects of these procedures. Methods: A review of online databases was performed to include studies with four or more patients undergoing hypoglossal or masseter nerve transfer without muscle transfer or other cranial nerve transposition. Facial nerve outcomes, time to reinnervation, and adverse events were pooled and studied. Results: A total of 71 studies were included: 15 studies included 220 masseteric-facial transfers, and 60 studies included 1312 hypoglossal-facial transfers. Oral commissure symmetry at rest was better for hypoglossal transfer (2.22 ± 1.6 mm vs. 3.62 ± 2.7 mm, p = 0.047). The composite Sunnybrook Facial Nerve Grading Scale was better for masseteric transfer (47.7 ± 7.4 vs. 33.0 ± 6.4, p < 0.001). Time to first movement (in months) was significantly faster in masseteric transfer (4.6 ± 2.6 vs. 6.3 ± 1.3, p < 0.001). Adverse effects were rare (<5%) for both procedures. Conclusions: Both nerve transfer techniques are effective for facial reanimation, and the surgeon should consider the nuanced differences in selecting the correct procedure for each patient.
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Affiliation(s)
- Matthew J Urban
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Eggerstedt
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eleni Varelas
- Rush University Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Madeline J Epsten
- Rush University Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam J Beer
- Rush University Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan M Smith
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter C Revenaugh
- Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Abstract
Facial nerve injury often results in facial paralysis, which seriously affects the patients both aesthetically and functionally. Facial nerve reinnervation methods, including direct anastomosis, nerve graft, nerve transposition, cross-facial nerve graft, and combined surgeries, have recently become a hot topic with many new procedures being explored. This study summarizes the relevant literatures and discusses the scope of application, advantages, and disadvantages of the different methods. The treatment options or combined surgeries for facial nerve reinnervation should be individualized for specific patients to achieve the best reanimation outcome with good static symmetry, facial tone, and spontaneous, natural, symmetrical, and strong facial movements.
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17
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Wehrle CJ, Sinkler MA, Brown JJ, Ritter EF. Facial nerve transfer for facial reanimation with parotidoplasty approach. Microsurgery 2020; 40:868-873. [PMID: 33085134 DOI: 10.1002/micr.30674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/17/2020] [Accepted: 10/09/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Facial paralysis has a profound impact on quality of life in affected individuals, primarily through loss of verbal and nonverbal communication. Common facial nerve reanimation techniques include coaptation to the masseteric or hypoglossal nerve. Most techniques require nerve grafts to achieve a tension-free neurorrhaphy. Our report aims to show a surgical adaption to current facial reanimation procedures using a partial parotidoplasty approach in order to avoid challenges caused by interpositional nerve grafts through primary neurorrhaphy. PATIENTS AND METHODS The modified surgical approach was performed on four patients, aged 30-67. Length of paralysis ranged from 6 to 13 months. Cause of paralysis included one patient with Bell's palsy in one patient, prior surgery in two patients, and traumatic fracture in the remaining patient. A modified Blair approach is used to expose the parotid capsule. The facial nerve is dissected proximally toward the stylomastoid foramen and distally toward the masseter. The parotid gland substance is sectioned overlying each branch of the facial nerve using ultrasonic dissection or hemostatic scalpel, allowing mobilization of the proximal segment and upper and lower divisions of the facial nerve. The superficial lobe of the parotid is preserved in most cases. The House-Brackmann (H-B) functional scale was used to assess facial nerve function pre- and post-operatively. RESULTS All patients showed H-B score V or greater prior to reanimation. Follow-up was conducted at 3-, 6-, and 12-months in all patients with resultant improvement of H-B scores of I in three patients and II in the remaining patient. Only one complication was noted, with one patient developing a right postauricular hematoma that was adequately managed without sequelae. All remaining patients experienced an uncomplicated post-operative course. CONCLUSION Our modified approach to facial nerve reanimation works well with a planned parotidoplasty allowing for successful reanimation outcomes without the need for interpositional grafting. This technique may be considered in masseteric and hemi-hypoglossal nerve transfers for the reinnervation of facial muscles.
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Affiliation(s)
| | | | - Jimmy J Brown
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Edmond F Ritter
- Department of Plastic Surgery, Medical College of Georgia, Augusta, Georgia, USA
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Krane NA, Chen JS, Hanseler H, Baghoomian W, Ng J, Wax MK, Loyo M. Early Outcomes in an Emerging Facial Nerve Center: The Oregon Health and Science University (OHSU) Experience. Ann Otol Rhinol Laryngol 2020; 130:459-466. [PMID: 32917109 DOI: 10.1177/0003489420957371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nerve transfer (NT) and free gracilis muscle transfer (FGMT) are procedures for reanimation of the paralyzed face. Assessing the surgical outcomes of these procedures is imperative when evaluating the effectiveness of these interventions, especially when establishing a new center focused on the treatment of patients with facial paralysis. We desired to discuss the factors to consider when implementing a facial nerve center and the means by which the specialist can assess and analyze outcomes. METHODS Patients with facial palsy secondary to multiple etiologies, including cerebellopontine angle tumors, head and neck carcinoma, and trauma, who underwent NT or FGMT between 2014 and 2019 were included. Primary outcomes were facial symmetry and smile excursion, calculated using FACE-gram and Emotrics software. Subjective quality of life outcomes, including the Facial Clinimetric Evaluation (FaCE) Scale and Synkinesis Assessment Questionnaire (SAQ), were also assessed. RESULTS 14/22 NT and 6/6 FGMT patients met inclusion criteria having both pre-and postoperative photo documentation. NT increased oral commissure excursion from 0.4 mm (SD 5.3) to 2.9 mm (SD 6.8) (P = 0.05), and improved symmetry of excursion (P < 0.001) and angle (P < 0.001). FGMT increased oral commissure excursion from -1.4 mm (SD 3.9) to 2.1 mm (SD 3.7), (P = 0.02), and improved symmetry of excursion (P < 0.001). FaCE scores improved in NT patients postoperatively (P < 0.001). CONCLUSIONS Measuring outcomes, critical analyses, and a multidisciplinary approach are necessary components when building a facial nerve center. At our emerging facial nerve center, we found NT and FGMT procedures improved smile excursion and symmetry, and improved QOL following NT in patients with facial palsy secondary to multiple etiologies.
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Affiliation(s)
- Natalie A Krane
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Jimmy S Chen
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Haley Hanseler
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Wenelia Baghoomian
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - John Ng
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, USA
| | - Mark K Wax
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Myriam Loyo
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA
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Yoshioka N. Hypoglossal-Facial Side-to-End Neurorrhaphy With Concomitant Masseteric-Zygomatic Nerve Branch Coaptation and Muscle Transfer for Facial Reanimation: Technique and Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E230-E235. [PMID: 32445574 DOI: 10.1093/ons/opaa128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypoglossal-facial direct side-to-end neurorrhaphy has become widely used for facial reanimation in patients with irreversible facial nerve damage. Although this procedure achieves good restoration of facial function, it has disadvantages such as mass movement and lack of spontaneity. OBJECTIVE To present a new facial reanimation technique using hypoglossal-facial direct side-to-end neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and secondary muscle transfer to reduce mass movement and achieve a spontaneous smile in patients with facial paralysis. METHODS This article describes a novel facial reanimation technique that employs hypoglossal and masseteric nerve transfer combined with secondary vascularized functional gracilis muscle transfer. RESULTS Details of the technique are reported in a patient with complete facial paralysis after brain surgery. The hypoglossal nerve was partially served and connected to the mastoid segment of the facial nerve by side-to-end anastomosis to restore facial symmetry. A nerve supplying the masseter muscle was coapted with a zygomatic branch by end-to-end anastomosis to restore voluntary movement of the oral commissure, as well as to assist with eye closure. A cross face sural nerve graft was connected to zygomatic branches on the healthy side. In the second stage, a vascularized functional gracilis muscle graft was transplanted using the cross face nerve graft as the donor nerve to restore a natural smile. CONCLUSION Hypoglossal-facial neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and muscle transfer is an alternative facial reanimation technique that reduces mass movement and achieves a natural smile.
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Affiliation(s)
- Nobutaka Yoshioka
- Department of Craniofacial Surgery and Plastic Surgery, Tominaga Hospital, Osaka, Japan
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20
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Advances in facial nerve management in the head and neck cancer patient. Curr Opin Otolaryngol Head Neck Surg 2020; 28:235-240. [PMID: 32628417 DOI: 10.1097/moo.0000000000000641] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize best practices in facial nerve management for patients with head and neck cancer. In addition, we provide a review of recent literature on novel innovations and techniques in facial reanimation surgery. RECENT FINDINGS Although recommended when tumor ablation surgery requires facial nerve sacrifice, facial reanimation procedures are not always performed. Concurrent dynamic facial reanimation with masseteric nerve transfers and cable graft repair can preserve native facial muscle function. Static suspension can provide facial support and immediate resting symmetry for patients. Eyelid weight and eye care should not be delayed, particularly in patients with trigeminal sensory deficits. Choice of neural source to innervate a gracilis-free muscle transfer for smile reanimation remains controversial; however, new techniques, such as dual innervation and multivector muscle transfer, may improve aesthetic and functional outcomes. SUMMARY Management of the facial nerve in the setting of head and neck cancer presents unique challenges. When possible, simultaneous oncologic resection and facial reanimation is ideal given the open surgical field, newly dissected and electrically stimulatable facial nerve branches, as well as minimizing postoperative healing time to prevent postsurgical treatment delays. A coordinated approach to facial nerve management with a multidisciplinary surgical team may help provide optimal, comprehensive care.
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Vila PM, Kallogjeri D, Yaeger LH, Chi JJ. Powering the Gracilis for Facial Reanimation: A Systematic Review and Meta-analysis of Outcomes Based on Donor Nerve. JAMA Otolaryngol Head Neck Surg 2020; 146:429-436. [PMID: 32215620 PMCID: PMC7099528 DOI: 10.1001/jamaoto.2020.0065] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/10/2020] [Indexed: 11/14/2022]
Abstract
Importance Free gracilis transfer for dynamic reanimation in chronic facial paralysis is the gold standard, but there remains a need to better understand outcomes with respect to the donor nerve. Objective To characterize outcomes in adults undergoing primary gracilis transfer for facial paralysis stratified by donor nerve used for neurotization. Data Sources Search strategies were used in Ovid MEDLINE (1946-2019), Embase (1947-2019), Scopus (1823-2019), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov (1997-2019). Study Selection Inclusion and exclusion criteria were designed to capture studies in adults with unilateral chronic facial paralysis undergoing single-paddle free gracilis transfer. All study types were included except case reports. Abstracts and full texts were reviewed in duplicate. Of 130 unique citations, 10 studies including 295 patients were included after applying inclusion and exclusion criteria. Data were analyzed between November 2018 and December 2019. Data Extraction and Synthesis PRISMA guidelines were followed. The Newcastle-Ottawa scale was used to assess study quality, and the Cochrane Risk of Bias tool was used to assess risk of bias. Independent extraction by 2 authors (P.M.V. and J.J.C.) was performed. Data were pooled using a random-effects model. Main Outcomes and Measures Owing to heterogeneity in reporting of facial reanimation outcomes, we first performed a systematic review, and then compiled available outcomes for meta-analysis. Outcomes studied for meta-analysis were oral commissure excursion and facial symmetry. Results Meta-analysis of masseteric nerve (MN) (n = 56) vs cross-facial nerve graft (CFNG) (n = 52) in 3 retrospective studies showed no statistical heterogeneity between these studies (I2 = 0%), and the standardized mean difference (SMD) was greater for MN (0.55; 95% CI, 0.17 to 0.94). Meta-analysis of angles of symmetry in 2 retrospective studies comparing MN (n = 51) to CFNG (n = 47) both at rest (-0.22; 95% CI, -0.63 to 0.18) and with smiling (-0.14; 95% CI, -0.73 to 0.46) were better with MN, though the difference was not statistically significant. Conclusions and Relevance Owing to heterogeneity in reported outcomes from facial reanimation, we were unable to make definitive conclusions regarding the optimal donor nerve. Establishing a reporting standard at peer-reviewed journals to improve results reporting is one method to allow for improved collaboration in the future. Standardizing follow-up times, assessing spontaneity in an objective and reproducible fashion, and use of consistent outcome measures would allow for future meta-analyses and better understanding of options for facial reanimation.
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Affiliation(s)
- Peter M. Vila
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Lauren H. Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John J. Chi
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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22
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Volk GF, Geitner M, Geißler K, Thielker J, Raslan A, Mothes O, Dobel C, Guntinas-Lichius O. Functional Outcome and Quality of Life After Hypoglossal-Facial Jump Nerve Suture. Front Surg 2020; 7:11. [PMID: 32266284 PMCID: PMC7096350 DOI: 10.3389/fsurg.2020.00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/02/2020] [Indexed: 12/22/2022] Open
Abstract
Background: To evaluate the face-specific quality of life after hypoglossal-facial jump nerve suture for patients with long-term facial paralysis. Methods: A single-center retrospective cohort study was performed. Forty-one adults (46% women; median age: 55 years) received a hypoglossal-facial jump nerve suture. Sunnybrook and eFACE grading was performed before surgery and at a median time of 42 months after surgery. The Facial Clinimetric Evaluation (FaCE) survey and the Facial Disability Index (FDI) were used to quantify face-specific quality of life after surgery. Results: Hypoglossal-facial jump nerve suture was successful in all cases without tongue dysfunction. After surgery, the median FaCE Total score was 60 and the median FDI Total score was 76.3. Most Sunnybrook and eFACE grading subscores improved significantly after surgery. Younger age was the only consistent independent predictor for better FaCE outcome. Additional upper eyelid weight loading further improved the FaCE Eye comfort subscore. Sunnybrook grading showed a better correlation to FaCE assessment than the eFACE. Neither Sunnybrook nor eFACE grading correlated to the FDI assessment. Conclusion: The hypoglossal-facial jump nerve suture is a good option for nerve transfer to reanimate the facial muscles to improve facial motor function and face-specific quality of life.
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Affiliation(s)
- Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Maren Geitner
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Ashraf Raslan
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany.,Department of Otorhinolaryngology, Assiut University Hospital, Assiut, Egypt
| | - Oliver Mothes
- Department of Computer Science, Friedrich Schiller University, Jena, Germany
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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23
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Facial reanimation: an update on nerve transfers in facial paralysis. Curr Opin Otolaryngol Head Neck Surg 2019; 27:231-236. [DOI: 10.1097/moo.0000000000000543] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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24
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Revenaugh PC, Smith RM, Plitt MA, Ishii L, Boahene K, Byrne PJ. Use of Objective Metrics in Dynamic Facial Reanimation. JAMA FACIAL PLAST SU 2018; 20:501-508. [DOI: 10.1001/jamafacial.2018.0398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter C. Revenaugh
- Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan M. Smith
- Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Max A. Plitt
- Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Lisa Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick J. Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Greene JJ, McClendon MT, Stephanopoulos N, Álvarez Z, Stupp SI, Richter CP. Electrophysiological assessment of a peptide amphiphile nanofiber nerve graft for facial nerve repair. J Tissue Eng Regen Med 2018; 12:1389-1401. [PMID: 29701919 PMCID: PMC6269104 DOI: 10.1002/term.2669] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/01/2018] [Accepted: 04/12/2018] [Indexed: 12/27/2022]
Abstract
Facial nerve injury can cause severe long-term physical and psychological morbidity. There are limited repair options for an acutely transected facial nerve not amenable to primary neurorrhaphy. We hypothesize that a peptide amphiphile nanofiber neurograft may provide the nanostructure necessary to guide organized neural regeneration. Five experimental groups were compared, animals with (1) an intact nerve, (2) following resection of a nerve segment, and following resection and immediate repair with either a (3) autograft (using the resected nerve segment), (4) neurograft, or (5) empty conduit. The buccal branch of the rat facial nerve was directly stimulated with charge balanced biphasic electrical current pulses at different current amplitudes whereas nerve compound action potentials (nCAPs) and electromygraphic responses were recorded. After 8 weeks, the proximal buccal branch was surgically reexposed and electrically evoked nCAPs were recorded for groups 1-5. As expected, the intact nerves required significantly lower current amplitudes to evoke an nCAP than those repaired with the neurograft and autograft nerves. For other electrophysiologic parameters such as latency and maximum nCAP, there was no significant difference between the intact, autograft, and neurograft groups. The resected group had variable responses to electrical stimulation, and the empty tube group was electrically silent. Immunohistochemical analysis and transmission electron microscopy confirmed myelinated neural regeneration. This study demonstrates that the neuroregenerative capability of peptide amphiphile nanofiber neurografts is similar to the current clinical gold standard method of repair and holds potential as an off-the-shelf solution for facial reanimation and potentially peripheral nerve repair.
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Affiliation(s)
- Jacqueline J Greene
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mark T. McClendon
- Simpson Querrey Institute for BioNanotechnology Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Nicholas Stephanopoulos
- Simpson Querrey Institute for BioNanotechnology Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Zaida Álvarez
- Simpson Querrey Institute for BioNanotechnology Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Samuel I. Stupp
- Simpson Querrey Institute for BioNanotechnology Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Chemistry, Northwestern University, Evanston, IL 60208, USA
- Department of Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Claus-Peter Richter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Medicine, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- The Hugh Knowles Center, Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, U.S.A
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26
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Sahovaler A, Yeh D, Yoo J. Primary facial reanimation in head and neck cancer. Oral Oncol 2017; 74:171-180. [DOI: 10.1016/j.oraloncology.2017.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/15/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
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