1
|
Zumbusch F, Schlattmann P, Guntinas-Lichius O. Facial nerve reconstruction for flaccid facial paralysis: a systematic review and meta-analysis. Front Surg 2024; 11:1440953. [PMID: 39104714 PMCID: PMC11298393 DOI: 10.3389/fsurg.2024.1440953] [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: 05/30/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives To determine the functional outcome after facial nerve reconstruction surgery in patients with flaccid facial paralysis. Methods A systematic review and meta-analysis was performed on studies reporting outcomes after direct facial nerve suture (DFS), facial nerve interpositional graft suture (FIGS), hypoglossal-facial nerve suture (HFS), masseteric-facial nerve suture (MFS), and cross-face nerve suture (CFS). These studies were identified from PubMed/MEDLINE, Embase, and Web of Science databases. Two independent reviewers performed two-stage screening and data extraction. A favorable result was defined as a final House-Brackmann grade I-III and is presented as a ratio of all patients in percentage. Pooled proportions were calculated using random-effects models. Results From 4,932 screened records, 54 studies with 1,358 patients were included. A favorable result was achieved after DFS in 42.67% of the patients [confidence interval (CI): 26.05%-61.12%], after FIGS in 66.43% (CI: 55.99%-75.47%), after HFS in 63.89% (95% CI: 54.83%-72.05%), after MFS in 63.11% (CI: 38.53%-82.37%), and after CFS in 46.67% (CI: 24.09%-70.70%). There was no statistically significant difference between the techniques (Q = 6.56, degrees of freedom = 4, p = 0.1611). Conclusions The established facial nerve reconstruction techniques including the single nerve cross-transfer techniques produce satisfactory results in most of the patients with permanent flaccid facial paralysis. An international consensus on standardized outcome measures would improve the comparability of facial reanimation techniques.
Collapse
Affiliation(s)
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Üstün GG, Açil MF, Sert G, Menkü Özdemir FD, Uzun H. Primary Neurorraphy of the Frontotemporal Branch of the Facial Nerve in Pediatric Patients. J Craniofac Surg 2023:00001665-990000000-01228. [PMID: 37983076 DOI: 10.1097/scs.0000000000009881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
LEVEL OF EVIDENCE Level III-case-control study.
Collapse
Affiliation(s)
- G Gencay Üstün
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | | | | | | | | |
Collapse
|
4
|
Park H, Kim DJ, Chung JH, Yoon ES, Park SH. Quantitative analysis of facial symmetry and animation following intraoral orthodromic temporalis transfer in facial paralysis. J Craniomaxillofac Surg 2023:S1010-5182(23)00097-5. [PMID: 37353402 DOI: 10.1016/j.jcms.2023.05.016] [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: 04/10/2023] [Accepted: 05/23/2023] [Indexed: 06/25/2023] Open
Abstract
This study aimed to quantitatively analyze the degree and vector of commissure excursion following intraoral orthodromic temporalis transfer. Patients with unilateral facial paralysis who underwent intraoral temporalis transfer were included. Intra-oral coronoidectomy was followed by submucosa tunneling through two vertical intraoral incisions to fixate the temporalis tendon to the perioral location. Oral commissure excursion, upper lip and commissure height differences, and smile angle were measured. Postoperatively, the symmetry of commissure excursion improved in repose (affected side: 114.6 ± 7.0 mm, non-affected side: 115.2 ± 4.9 mm, p = 0.134), while asymmetry arose in smiling (affected side: 30.7 ± 3.4 mm, non-affected side: 34.5 ± 4.4 mm, p = 0.001). Furthermore, the postoperative smile angle demonstrated insufficient vertical movement on the affected side during smiling (affected side: 115.6 ± 5.8°, non-affected side: 118.4 ± 4.9°, p = 0.002) but no significant difference in repose (p = 0.134). Within the limitations of the study it seems that intraoral orthodromic temporalis transfer yields excellent resting symmetry, but smile asymmetry may occur owing to insufficient oral commissure excursion. Nevertheless, as a minimally invasive surgery, this technique can obviate visible scars and benefit patients wishing for the same and can have excellent resting symmetry.
Collapse
Affiliation(s)
- Hojin Park
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Dong Jin Kim
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jae-Ho Chung
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Eul-Sik Yoon
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung Ha Park
- Department of Plastic Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Vejbrink Kildal V, Tee R, Reissig L, Weninger WJ, Tzou CHJ, Rodriguez-Lorenzo A. Selective ansa cervicalis nerve transfer to the marginal mandibular nerve for lower lip reanimation: An anatomical study in cadavers and a case report. Microsurgery 2023; 43:142-150. [PMID: 36511397 PMCID: PMC10108162 DOI: 10.1002/micr.30992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/24/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Donor nerve options for lower lip reanimation are limited in patients undergoing oncological resection of the facial nerve. The ansa cervicalis nerve (ACN) is an advantageously situated donor with great potential but has not been examined in detail. In the current study, the anatomical technical feasibility of selective ACN to marginal mandibular nerve (MMN) transfer for restoration of lower lip tone and symmetry was explored. A clinical case is presented. METHODS Dissections were conducted in 21 hemifaces in non-embalmed human cadavers. The maximal harvestable length of ACN was measured and transfer to MMN was simulated. A 28-year-old male underwent ACN-MMN transfer after parotidectomy (carcinoma) and was evaluated 12 months post-operatively (modified Terzis' Lower Lip Grading Scale [25 observers] and photogrammetry). RESULTS The harvestable length of ACN was 100 ± 12 mm. A clinically significant anatomical variant ("short ansa") was present in 33% of cases (length: 37 ± 12 mm). Tensionless coaptation was possible in all cases only when using a modification of the surgical technique in "short ansa" cases (using an infrahyoid muscle nerve branch as an extension). The post-operative course of the clinical case was uneventful without complications, with improvement in tone, symmetry, and function at the lower lip at 12-month post-operative follow-up. CONCLUSIONS Selective ACN-MMN nerve transfer is anatomically feasible in facial paralysis following oncological ablative procedures. It allows direct nerve coaptation without significant donor site morbidity. The clinical case showed good outcomes 12 months post-operatively. A strategy when encountering the "short ansa" anatomical variant in clinical cases is proposed.
Collapse
Affiliation(s)
- Villiam Vejbrink Kildal
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Richard Tee
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Lukas Reissig
- Division of Anatomy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang J Weninger
- Division of Anatomy, Medical University of Vienna, Vienna, Austria.,BioImaging Austria (CMI), Vienna, Austria
| | - Chieh-Han John Tzou
- Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior (Krankenhaus Goettlicher Heiland), Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria.,Facial Palsy Center, TZOU Medical, Vienna, Austria
| | - Andrés Rodriguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
6
|
Zhang J, Tao J, Cheng H, Liu H, Wu W, Dong Y, Liu X, Gou M, Yang S, Xu J. Nerve transfer with 3D-printed branch nerve conduits. BURNS & TRAUMA 2022; 10:tkac010. [PMID: 35441080 PMCID: PMC9012979 DOI: 10.1093/burnst/tkac010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/15/2022] [Accepted: 02/27/2022] [Indexed: 02/05/2023]
Abstract
Background Nerve transfer is an important clinical surgical procedure for nerve repair by the coaptation of a healthy donor nerve to an injured nerve. Usually, nerve transfer is performed in an end-to-end manner, which will lead to functional loss of the donor nerve. In this study, we aimed to evaluate the efficacy of 3D-printed branch nerve conduits in nerve transfer. Methods Customized branch conduits were constructed using gelatine-methacryloyl by 3D printing. The nerve conduits were characterized both in vitro and in vivo. The efficacy of 3D-printed branch nerve conduits in nerve transfer was evaluated in rats through electrophysiology testing and histological evaluation. Results The results obtained showed that a single nerve stump could form a complex nerve network in the 3D-printed multibranch conduit. A two-branch conduit was 3D printed for transferring the tibial nerve to the peroneal nerve in rats. In this process, the two branches were connected to the distal tibial nerve and peroneal nerve. It was found that the two nerves were successfully repaired with functional recovery. Conclusions It is implied that the two-branch conduit could not only repair the peroneal nerve but also preserve partial function of the donor tibial nerve. This work demonstrated that 3D-printed branch nerve conduits provide a potential method for nerve transfer.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Neurosurgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Jie Tao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Hao Cheng
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Haofan Liu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Wenbi Wu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Yinchu Dong
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Xuesong Liu
- Department of Neurosurgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Maling Gou
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Siming Yang
- Key Laboratory of Wound Repair and Regeneration of PLA, Chinese PLA General Hospital, Medical College of PLA, Beijing 100853, P.R. China
| | - Jianguo Xu
- Department of Neurosurgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| |
Collapse
|
7
|
Seminal Studies in Facial Reanimation Surgery: Consensus and Controversies in the Top 50 Most Cited Articles. J Craniofac Surg 2021; 33:1507-1513. [PMID: 34930875 DOI: 10.1097/scs.0000000000008436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Facial paralysis can impair one's ability to form facial expressions that are congruent with internal emotion. This hinders communication and the cognitive processing of emotional experience. Facial reanimation surgery, which aims to restore full facial expressivity is a relatively recent undertaking which is still evolving. Due in large part to published techniques, refinements, and clinical outcomes in the scientific literature, consensus on best practice is gradually emerging, whereas controversies still exist.Taking stock of how the discipline reached its current state can help delineate areas of agreement and debate, and more clearly reveal a path forward. To do this, the authors have analyzed the 50 seminal publications pertaining to facial reanimation surgery. In longstanding cases, the free gracilis transfer emerges as a clear muscle of choice but the nerve selection remains controversial with prevailing philosophies advocating cross facial nerve grafts (with or without the support of an ipsilateral motor donor) or an ipsilateral motor donor only, of which the hypoglossal and nerve to masseter predominate. The alternative orthodoxy has refined the approach popularized by Gillies in 1934 and does not require the deployment of microsurgical principles. Although this citation analysis does not tell the whole story, surgeons with an interest in facial reanimation will find that this is a good place to start.
Collapse
|
8
|
David AP, Seth R, Knott PD. Facial Reanimation and Reconstruction of the Radical Parotidectomy. Facial Plast Surg Clin North Am 2021; 29:405-414. [PMID: 34217443 DOI: 10.1016/j.fsc.2021.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radical parotidectomy may result from treating advanced parotid malignancies invading the facial nerve. Survival is often enhanced with multimodality treatment protocols, including postoperative radiation therapy. In addition to the reconstructive challenge of restoring facial nerve function, patients may be left with a significant cervicofacial concavity and inadequate skin coverage. This should be addressed with stable vascularized tissue that is resistant to radiation-induced atrophy. This article describes a comprehensive strategy, includes the use of the anterolateral thigh free flap, the temporalis regional muscle transfer, motor nerve to vastus lateralis grafts, nerve to masseter transfer, and fascia lata grafts for static suspension.
Collapse
Affiliation(s)
- Abel P David
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA 94115, USA
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA 94115, USA
| | - Philip Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA 94115, USA.
| |
Collapse
|
9
|
Jose A, Nagori SA, Rawat A, Singh S, Roychoudhury A. Facial Reanimation by Modified Intraoral Temporalis Tendon Transfer With Ancillary Procedures. J Craniofac Surg 2021; 32:626-628. [PMID: 33704996 DOI: 10.1097/scs.0000000000006971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Facial nerve palsy is an exceedingly debilitating condition, incapacitating functional and aesthetic facets of the face. Orthodromic transfer of temporalis muscle is an easy and predictable technique which offers early animation of oral commissure and lower face. A retrospective chart review of 6 patients of facial palsy treated with orthodromic temporalis tendon transfer for facial reanimation is presented. The technique consisted of intra-oral coronoidectomy followed by attachment of fascia lata grafts from the coronoid to the commissure, the upper and lower lips via small cutaneous incisions. Contraction of the temporalis, pulls the fascia lata extensions thereby reanimating the lower face. 4 male and 2 female patients with an age range of 25 to 49 years were treated. Simultaneous fat grafting (2 patients), depressor labi inferioris muscle resection (2 patients) and wedge excision of nasolabial fold (2 patients) was done as ancillary procedures. Post-operative smile evaluation was carried out using the Terzis and Noah facial grading system. Patients were asked to smile with and without biting, and photographs and video were taken. The results were graded from 1 to 5 based on a 5-point scale (ie, poor, fair, moderate, good, and excellent) by an independent observer. The results were excellent in 1 patient (Terzis grading 5/5) and good in the remaining 5 patients (Terzis grading 4/5). Excursion of the oral commissure ranged from 6 to 10 mm. Our experience indicates that temporalis tendon transfer for facial reanimation has a short learning curve and provides early predictable outcome without significant complications. This single-stage, day-care procedure can be easily incorporated by maxillofacial surgeons to expand their surgical spectrum.
Collapse
Affiliation(s)
- Anson Jose
- Division of Oral and Maxillofacial Surgery, Army Dental Center, Research and Referral, New Delhi
| | | | - Aditi Rawat
- Division of Oral and Maxillofacial Surgery, Army Dental Center, Research and Referral, New Delhi
| | - Shagun Singh
- Division of Oral and Maxillofacial Surgery, Army Dental Center, Research and Referral, New Delhi
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
10
|
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: 11] [Impact Index Per Article: 3.7] [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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
|
12
|
Prasetyo E, Oley MC, Faruk M. Split hypoglossal facial anastomosis for facial nerve palsy due to skull base fractures: A case report. Ann Med Surg (Lond) 2020; 59:5-9. [PMID: 32983440 PMCID: PMC7494824 DOI: 10.1016/j.amsu.2020.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Traumatic brain injury (TBI) is the most prevalent causes of morbidity and mortality worldwide. The biomechanics of primary TBI involve a direct impact, practically extended to the base of the skull, and most of the skull base fractures (SBF) are identified in anterior and medial cranial fossa. Furthermore, those predicted in the medial area are related to fissures from temporal bones. Presentation of case We report two cases of right facial nerve palsy initiated by SBF's, which were diagnosed and treated at our institution. The 3D CT evaluation in our first case showed a longitudinal fracture of the right petrosal bone, which was longitudinal and transverse for the second case. Two cases of facial nerve palsy were managed with split hypoglossal facial anastomosis to restore functional reanimation. All patients were adequately achieved after the procedure, and the hypoglossal nerve function was preserved. Conclusion Split hypoglossal facial anastomosis technique was used to treat patients with facial nerve paralysis resulting from SBF's. This was to achieve good recovery outcome, in terms of facial reanimation and preservation of tongue function. A skull base fracture (SBF) is about 4% of all cases Traumatic brain injury (TBI). SBF which frequently occurs in the petrous part of the temporal bone, is implicated in facial nerve palsy. Split hypoglossal facial anastomosis technique showed good recovery of facial reanimation with HB scale assessment.
Collapse
Affiliation(s)
- Eko Prasetyo
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University Sam Ratulangi, Manado, Indonesia.,Division of Neurosurgery, Department of Surgery, R. D. Kandou Hospital, Manado, Indonesia
| | - Maximillian Christian Oley
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University Sam Ratulangi, Manado, Indonesia.,Division of Neurosurgery, Department of Surgery, R. D. Kandou Hospital, Manado, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| |
Collapse
|
13
|
Tayebi Meybodi A, Moreira LB, Zhao X, Belykh E, Lawton MT, Eschbacher JM, Preul MC. Using the Post-Descendens Hypoglossal Nerve in Hypoglossal-Facial Anastomosis: An Anatomic and Histologic Feasibility Study. Oper Neurosurg (Hagerstown) 2020; 19:436-443. [PMID: 31943073 DOI: 10.1093/ons/opz408] [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: 07/18/2019] [Accepted: 11/11/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypoglossal-facial anastomosis (HFA) is a popular facial reanimation technique. Mobilizing the intratemporal segment of the facial nerve and using the post-descendens hypoglossal nerve (ie, the segment distal to the take-off of descendens hypoglossi) have been proposed to improve results. However, no anatomic study has verified the feasibility of this technique. OBJECTIVE To assess the anatomic feasibility of HFA and the structural compatibility between the 2 nerves when the intratemporal facial and post-descendens hypoglossal nerves are used. METHODS The facial and hypoglossal nerves were exposed bilaterally in 10 sides of 5 cadaveric heads. The feasibility of a side-to-end (ie, partial end-to-end) HFA with partial sectioning of the post-descendens hypoglossal nerve and the mobilized intratemporal facial nerve was assessed. The axonal count and cross-sectional area of the facial and hypoglossal nerves at the point of anastomosis were assessed. RESULTS The HFA was feasible in all specimens with a mean (standard deviation) 9.3 (5.5) mm of extra length on the facial nerve. The axonal counts and cross-sectional areas of the hypoglossal and facial nerves matched well. Considering the reduction in the facial nerve cross-sectional area after paralysis, the post-descendens hypoglossal nerve can provide adequate axonal count and area to accommodate the facial nerve stump. CONCLUSION Using the post-descendens hypoglossal nerve for side-to-end anastomosis with the mobilized intratemporal facial nerve is anatomically feasible and provides adequate axonal count for facial reanimation. When compared with use of the pre-descendens hypoglossal nerve, this technique preserves C1 fibers and has a potential to reduce glottic complications.
Collapse
Affiliation(s)
- Ali Tayebi Meybodi
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Leandro Borba Moreira
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Xiaochun Zhao
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Evgenii Belykh
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Lawton
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jennifer M Eschbacher
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
14
|
Amer TA, El Kholy MS, Khalaf AA, Rifky AM. Amer's classification of territories of facial nerve injury in early cases and strategies for the management of different territories. J Plast Reconstr Aesthet Surg 2020; 74:160-167. [PMID: 32631719 DOI: 10.1016/j.bjps.2020.05.100] [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: 01/23/2020] [Revised: 03/31/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
Early cases of facial nerve injury are best treated by restoring the neural pathway to the same existing facial muscles. Knowledge of the exact territory of facial nerve injury is required to design a plane for the reconstruction of these injuries and to compare results. The current study aims to design a classification system for territories of facial nerve injury based on the location of nearest healthy fascicles to the site of injury both proximally and distally. Two hundred-one patients with early facial nerve injury were assessed for treatment. According to the results of the exploration, 13 territories of injury were identified. The management strategy was planned according to the territory of injury. The current classification system is a simple, easy and effective method for the classification of territories of facial nerve injury. The classification system accurately describes the nearest possible healthy proximal and distal fascicles and can be employed to easily report cases and implement a management plan. This classification scheme also allows us to more effectively compare results.
Collapse
Affiliation(s)
- Tarek A Amer
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt.
| | - Mohamed S El Kholy
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
| | - Amr Adel Khalaf
- Department of Plastic Surgery, Nasser Institute for Research and Treatment, Egypt
| | - Amr M Rifky
- Department of Plastic Surgery, Faculty of Medicine, Cairo University, Egypt
| |
Collapse
|
15
|
Assessment of axonal sprouting and motor performance after hypoglossal-facial end-to-side nerve repair: experimental study in rats. Exp Brain Res 2020; 238:1563-1576. [PMID: 32488325 DOI: 10.1007/s00221-020-05835-6] [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: 10/09/2019] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
Hypoglossal-facial nerve anastomosis (HFA) aims to reanimate denervated mimic muscles with hypoglossal axons when the transected facial nerve is not accessible. The aim of this study was to evaluate the recovery of HFA using a "Y" tube in two variants: (1) the proximal stump of the hypoglossal nerve was entubulated to the "Y" tube (classic "Y" tube HFA) and (2) the "Y" tube was sutured to an epineurial window of a slightly damaged hypoglossal nerve (end-to-side "Y" tube HFA). A total of 48 adult female rats were divided into four groups: intact controls (group 1), sham operated (group 2), classic "Y" tube HFA (group 3) and end-to-side "Y" tube HFA (group 4). The abdominal aorta with both common iliac arteries of isogeneic male rats served as the Y-tube conduit. Animals from group 4 recovered better than those from group 3: the degree of collateral axonal branching (3 ± 1%) was significantly lower than that determined in group 3 (13 ± 1%). The mean deviation of the tongue from the midline was significantly smaller in group 4 (6 ± 4°) than that measured in animals from group 3 (41 ± 6°). In the determination of vibrissal motor function in group 3 and group 4, a decrease in amplitude was found to be - 66% and - 92%, respectively. No differences in the reinnervation pattern of the target muscles were detected. As a result, these surgical models were not determined to be able to improve vibrissal movements. It was concluded that performance of end-to-side "Y" tube HFA diminishes collateral axonal branching at the lesion site, which in turn, promotes better recovery of tongue- and vibrissal-motor performance.
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Ricciardi L, Stifano V, Pucci R, Stumpo V, Montano N, Della Monaca M, Lauretti L, Olivi A, Valentini V, Sturiale CL. Comparison between VII-to-VII and XII-to-VII coaptation techniques for early facial nerve reanimation after surgical intra-cranial injuries: a systematic review and pooled analysis of the functional outcomes. Neurosurg Rev 2020; 44:153-161. [PMID: 31912333 DOI: 10.1007/s10143-019-01231-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/05/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The surgical injury of the intracranial portion of the facial nerve (FN) is a severe complication of many skull base procedures, and it represents a relevant issue in terms of patients' discomfort, social interactions, risk for depression, and social costs. The aim of this study was to investigate the surgical and functional outcomes of the most common facial nerve rehabilitation techniques. The present study is a systematic review of the pertinent literature, according to the PRISMA guidelines. Two different online medical databases (PubMed, Scopus) were screened for studies reporting the functional outcome, measured by the House-Brackman (HB) scale, and complications, in FN early reanimation, following surgical injuries on its intracranial portion. Data on the VII-to-VII and XII-to-VII coaptation, the surgical technique, the use of a nerve graft, the duration of the deficit, and complications were collected and pooled. The XII-to-VII end-to-side coaptation seems to provide higher chances for functional restoration (HB 1-3) than the VII-to-VII (68.8% vs 60.6%), regardless of the duration of the palsy deficit, the use or not of a nerve graft, and the use of stitches or glues. However, its complication rate was as high as 28.6%, and a second procedure is then often needed. The XII-to-VII side-to-end coaptation is the most effective in providing a functional outcome (HB 1-3), even though it is associated to a higher complication rate. Further trials are needed to better investigate this relevant topic, in terms of health-related social costs and patients' quality of life.
Collapse
Affiliation(s)
- Luca Ricciardi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy.
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Resi Pucci
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Vittorio Stumpo
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Della Monaca
- Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, Università La Sapienza, Rome, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentino Valentini
- Dipartimento di Scienze Odontostomatologiche e Chirurgia Maxillo-Facciale, Università La Sapienza, Rome, Italy
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
18
|
Significance of the Marginal Mandibular Branch in Relation to Facial Palsy Reconstruction: Assessment of Microanatomy and Macroanatomy Including Axonal Load in 96 Facial Halves. Ann Plast Surg 2019; 83:e43-e49. [PMID: 31567417 DOI: 10.1097/sap.0000000000002038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The marginal mandibular branch (MMB) of the facial nerve provides lower lip symmetry apparent during human smile or crying and is mandatory for vocal phonation. In treating facial palsy patients, so far, little attention is directed at the MMB in facial reanimation surgery. However, isolated paralysis may occur congenital, in Bell's palsy or iatrogenic during surgery, prone to its anatomical course. A variety of therapies address symmetry with either weakening of the functional side or reconstruction of the paralyzed side. To further clarify the histoanatomic basis of facial reanimation procedures using nerve transfers, we conducted a human cadaver study examining macroanatomical and microanatomical features of the MMB including its axonal capacity. METHODS Nerve biopsies of the MMB were available from 96 facial halves. Histological processing, digitalization, nerve morphometry investigation, and semiautomated axonal quantification were performed. Statistical analysis was conducted with P < 0.05 as level of significance. RESULTS The main branch of 96 specimens contained an average of 3.72 fascicles 1 to 12, and the axonal capacity was 1603 ± 849 (398-5110, n = 85). Differences were found for sex (P = 0.018), not for facial sides (P = 0.687). Diameters were measured with 1130 ± 327 μm (643-2139, n = 79). A significant difference was noted between sexes (P = 0.029), not for facial sides (P = 0.512.) One millimeter in diameter corresponded to 1480 ± 630 axons (n = 71). A number of 900 axons was correlated with 0.97 mm (specificity, 90%; sensitivity, 72%). CONCLUSIONS Our morphometric results for the MMB provide basic information for further investigations, among dealing with functional reconstructive procedures such as nerve transfers, nerve grafting for direct neurotization or babysitter procedures, and neurectomies to provide ideal power and authenticity.
Collapse
|
19
|
Abstract
BACKGROUND The facial nerve and its branches are at risk of injury during dermatologic surgery. Few publications in the dermatologic literature discuss facial nerve injury and management. OBJECTIVE To review facial nerve injury and management, including static and dynamic repair techniques, and to review outcomes in facial nerve reconstruction. METHODS Two detailed literature reviews were performed using PubMed. First, articles reporting facial nerve injury and/or management in the dermatologic literature were identified. In addition, articles pertaining to outcomes in facial nerve reconstruction with a minimum of 20 patients were included. RESULTS Fifty-three articles reporting outcomes in facial nerve reconstruction were identified and consist of retrospective reviews and case series. Most patients achieve improvement in facial symmetry and movement with nerve repair. CONCLUSION Timing of facial nerve repair is an important consideration in management of facial nerve injury, with earlier repairs achieving better outcomes. Facial nerve repair does not result in normal facial movement, and improvements may require a year or more to be realized. Many options exist for facial nerve reconstruction, and patients with long-standing facial nerve injuries may still benefit from treatment.
Collapse
|
20
|
Joseph AW, Kim JC. Management of Flaccid Facial Paralysis of Less Than Two Years’ Duration. Otolaryngol Clin North Am 2018; 51:1093-1105. [DOI: 10.1016/j.otc.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
21
|
A comparative retrospective study: hypoglossofacial versus masseterofacial nerve anastomosis using Sunnybrook facial grading system. Eur Arch Otorhinolaryngol 2018; 276:209-216. [PMID: 30377760 DOI: 10.1007/s00405-018-5186-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/25/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of our study is to compare the functional results between two surgical techniques for reanimation of facial paralysis: hypoglossal-to-facial versus masseteric-to-facial nerve anastomosis. METHODS This is a retrospective study of 13 patients treated for complete facial paralysis in two medical tertiary centers. The patients were classified into two groups. First group: masseteric-to-facial nerve anastomosis. Second group: hypoglossofacial nerve anastomosis. Sunnybrook facial grading system was used to evaluate the functional results. The mean scores were compared using Mann-Whitney test. The correlation between the age at surgery, the delay in time from the onset of the facial paralysis to the time of surgery and the results of Sunnybrook scores was studied using correlation and linear regression. RESULTS No significant statistical difference was found between the mean of total score of the two groups (first group = 38 ± 4.898, second group = 37.83 ± 4.956). All the patients treated by hypoglossofacial nerve anastomosis presented with hemiglossal atrophy. We found slight superiority for the masseterofacial nerve anastomosis in dynamic movements, whereas at rest the hypoglossofacial anastomosis is slightly better. All the differences were not statistically significant. No correlation was found between the age at surgery (age range included 32-73 years) and post-operative results. No correlation was found between the delays up to 24 months from the onset of the facial paralysis and post-operative results. CONCLUSION Our study showed that both types of anastomosis are effective with comparable results. The masseterofacial nerve anastomosis is preferred when possible to avoid the hemiglossal atrophy and its complications.
Collapse
|
22
|
Kehrer A, Engelmann S, Ruewe M, Geis S, Taeger C, Kehrer M, Tamm ER, Bleys RLAW, Prantl L, Mandlik V. Perfusion maintains functional potential in denervated mimic muscles in early persistent facial paralysis which requires early microsurgical treatment - the histoanatomic basis of the extratemporal facial nerve trunk assessing axonal load in the context of possible nerve transfers. Clin Hemorheol Microcirc 2018; 70:1-13. [PMID: 30010114 DOI: 10.3233/ch-189905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Early persistent facial paralysis is characterized by intact muscles of facial expression through maintained perfusion but lacking nerve supply. In facial reanimation procedures aiming at restoration of facial tone and dynamics, neurotization through a donor nerve is performed. Critical for reanimating target muscles is axonal capacity of both donor and recipient nerves. In cases of complete paralysis, the proximal stump of the extratemporal facial nerve trunk may be selected as a recipient site for coaptation. To further clarify the histological basis of this facial reanimation procedure we conducted a human cadaver study examining macro and micro anatomical features of the facial nerve trunk including its axonal capacity in human cadavers. Axonal loads, morphology and morbidity of different donor nerves are discussed reviewing literature in context of nerve transfers. METHODS From 6/2015 to 9/2016 in a group of 53 fresh frozen cadavers a total of 106 facial halves were dissected. Biopsies of the extratemporal facial nerve trunk (FN) were obtained at 1 cm distal to the stylomastoid foramen. After histological processing and digitalization of 99 specimens available, 97 were selected eligible for fascicle counts and 87 fulfilled quality criteria for a semi-automated computer-based axon quantification software using ImageJ/Fiji. RESULTS An average of 3.82 fascicles (range, 1 to 9) were noted (n = 97). 6684±1884 axons (range, 2655- 12457) were counted for the entire group (n = 87). Right facial halves showed 6364±1904 axons (n = 43). Left facial halves demonstrated 6996±1833 axons (n = 44) with no significant difference (p = 0.73). Female cadavers featured 6247±2230 (n = 22), male showed 6769±1809 axons (n = 40). No statistical difference was seen between genders (p = 0.59). A comparison with different studies in literature is made. The nerve diameter in 82 of our specimens could be measured at 1933±424 μm (range, 975 to 3012). CONCLUSIONS No donor nerve has been described to match axonal load or fascicle number of the extratemporal facial nerve main trunk. However, the masseteric nerve may be coapted for neurotization of facial muscles with a low complication rate and good clinical outcomes. Nerve transfer is indicated from 6 months after onset of facial paralysis if no recovery of facial nerve function is seen.
Collapse
Affiliation(s)
- A Kehrer
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Engelmann
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Ruewe
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Geis
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C Taeger
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Kehrer
- Department of Trauma Surgery, University Hospital Bonn, Germany
| | - E R Tamm
- Institute of Human Anatomy, University of Regensburg, Germany
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, The Netherlands
| | - L Prantl
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| | - V Mandlik
- Department of Plastic, Reconstructive and Hand Surgery, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
23
|
Dziedzic TA, Kunert P, Marchel A. Hemihypoglossal-Facial Nerve Anastomosis for Facial Nerve Reanimation: Case Series and Technical Note. World Neurosurg 2018; 118:e460-e467. [PMID: 30257299 DOI: 10.1016/j.wneu.2018.06.217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/23/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hypoglossal nerve injury may result in swallowing and speech problems. To reduce this morbidity and allow the performance of the hypoglossal-facial nerve anastomosis bilaterally, a technique that includes partial splitting of the hypoglossal nerve and skeletonization of the facial nerve within the mastoid process has been applied. The aim of this study is to present clinical results regarding the facial and hypoglossal nerves after the procedure. METHODS Prospectively collected data from 56 consecutive patients who underwent hemihypoglossal-facial nerve anastomosis (HHFA) were analyzed. The outcome was correlated with epidemiologic data, initial disease, the presence of neurofibromatosis type 2, previous radiosurgery, and the time between nerve injury and reconstructive surgery. RESULTS Forty-eight (84%) patients achieved satisfactory outcomes; 8 of them (14%) showed some improvement, and in 1 patient (2%) there was no improvement during long-term observation. The result at follow-up was not related to the time interval between the 2 procedures. However, recovery times for facial tonicity were statistically significantly longer if the procedure was performed after 12 months (P = 0.044). There was no statistically significant association between patient age (P = 0.96) or sex (P = 0.13) and facial nerve function. HHFA resulted in no or minimal tongue atrophy without deviation in 53 patients (93%), and the remainder had mild hemiatrophy with tongue deviation <30 degrees. CONCLUSIONS HHFA is an effective technique for facial nerve reanimation with acceptable morbidity related to tongue function. Patients with a longer duration of facial palsy still have a good chance for restoration of facial movement but require longer recovery periods.
Collapse
Affiliation(s)
| | | | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Poland
| |
Collapse
|
24
|
Amer TA, El Kholy MS. The split hypoglossal nerve versus the cross-face nerve graft to supply the free functional muscle transfer for facial reanimation: A comparative study. J Plast Reconstr Aesthet Surg 2018; 71:750-757. [DOI: 10.1016/j.bjps.2018.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/13/2017] [Accepted: 01/21/2018] [Indexed: 11/24/2022]
|
25
|
Abstract
BACKGROUND Treatment of facial paralysis in the older population is often relegated to static rather than dynamic reanimation for fear of poor outcomes. This pervasive approach lacks physiologic foundation and is not evidence based. Thus, the authors present an extensive literature review demonstrating weak evidence supporting this misguided concept, followed by detailed outcomes from three centers of the largest reported series to date of patients older than 60 years after reanimation performed using three techniques-lengthening temporalis myoplasty, free functional muscle, and nerve transfers. METHODS A PubMed search spanning over 40 years identified all reports on reanimation in patients older than 60 years. In addition, detailed demographics, surgical techniques, and outcomes of 30 patients older than 60 years were analyzed. RESULTS Of 629 articles, only 45 patients were identified, described in case reports or small series, lacking details or consistent long-term follow-up. In the clinical series, average age, preoperative House-Brackmann score, and comorbidities were similar among the groups. Highest excursion was observed in the free functional muscle group, followed by nerve transfer and temporalis myoplasty, averaging 10.4, 6.8, and 3.1 mm, respectively. The most notable philtral deviation correction was in the lengthening temporalis myoplasty group, followed by the free muscle and nerve transfer groups, averaging 5.6, 2.2, and 1.13 mm, respectively. Complication rates were highest in the free functional muscle group. CONCLUSIONS Facial palsy patients should not be denied dynamic restoration based on age alone. Although surgical technique may vary based on duration of palsy, surgeon experience, and preference, with each presenting advantages and disadvantages, dynamic restoration is feasible regardless of age. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
Collapse
|
26
|
Weis E, Rubinov A, Al-Ghoul AR, Yau FMK. Sural nerve graft for neurotrophic keratitis: early results. Can J Ophthalmol 2018; 53:24-29. [DOI: 10.1016/j.jcjo.2017.10.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 11/15/2022]
|
27
|
Guzzo M, Ferraro L, Ibba T, Quattrone P, Bianchi R, Rezzonico S, Scaramellini G. Schwannoma in the Parotid Gland. Experience at Our Institute and Review of the Literature. TUMORI JOURNAL 2018; 95:846-51. [DOI: 10.1177/030089160909500636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Schwannoma of the parotid gland is an uncommon tumor. When the facial nerve is involved by the tumor at the time of the operation, the surgical approach requires careful evaluation. The purpose of this study is to provide indications which can support the decision, taking into account the different clinical presentations of parotid schwannoma. In a retrospective study, eight cases of parotid schwannoma were collected between 1975 and 2006. In three cases the tumor affected the facial nerve itself and in the remaining ones it originated from intraparotid nonfacial peripheral nerves. When the facial nerve is involved by the tumor a conservative approach should always be considered. The indication for a surgical procedure should be discussed with the patient. If a conservative strategy is chosen, yearly follow-up by means of MRI and clinical observation should be planned.
Collapse
Affiliation(s)
- Marco Guzzo
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Letizia Ferraro
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tullio Ibba
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pasquale Quattrone
- Pathology and Cytology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Bianchi
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Rezzonico
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Scaramellini
- Otorhinolaryngology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
28
|
Okochi M, Okochi H, Asai E, Sakaba T, Ueda K. Eyelid reanimation using crossface nerve graft: Relationship between surgical outcome and preoperative paralysis duration. Microsurgery 2017; 38:375-380. [PMID: 29125661 DOI: 10.1002/micr.30264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 09/07/2017] [Accepted: 10/20/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND To reanimate the mimetic muscles, crossface nerve graft (CFNG) is an effective surgical option. However, muscle atrophy after facial paralysis may influence the surgical result. We analyzed the relationship between surgical result and preoperative paralysis duration. METHODS We performed CFNG on 15 patients. The sural nerve was transferred between the affected and nonaffected sides of the zygomatic branch. Eyelid function and eyelid lid were evaluated using the modified House-Brackmann scale. The effects of age, sex, cause of facial paralysis, graft nerve length, and preoperative paralysis duration were evaluated. RESULTS The mean follow up period was 9.3 ± 3.3 (range 4-14) years. Eyelid closure was excellent in four patients, good in six, fair in one, and poor in four. Statistically, no significant difference was observed between those patients with excellent or good outcomes and fair or poor outcomes regarding age (40.9 ± 11.0 years vs. 22.6 ± 20.8; P = .067), sex (male/female = 2/8 vs. 3/2; P = .250), cause (tumor/trauma = 10/0 vs. 3/2; P = .095), and length of nerve graft (14.4 ± 0.8 cm vs. 13.8 ± 1.6 cm; P = .375). The average preoperative paralysis duration in the excellent/good patients was significantly shorter than that in the fair/poor patients (P = .005). All eight cases with preoperative paralysis of less than 6 months showed a marked excellent/good result. Two of the seven patients with preoperative paralysis was 6 months or longer marked fair/poor result. (P = .007). CONCLUSIONS To achieve successful results with CFNG, surgery should be performed within 6 months of the onset of paralysis.
Collapse
Affiliation(s)
- Masayuki Okochi
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1247, Japan
| | - Hiromi Okochi
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1247, Japan
| | - Emiko Asai
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1247, Japan
| | - Takao Sakaba
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1247, Japan
| | - Kazuki Ueda
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1247, Japan
| |
Collapse
|
29
|
van Veen MM, Dijkstra PU, Werker PM. A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal–facial nerve jump graft in facial palsy treatment. J Plast Reconstr Aesthet Surg 2017; 70:1666-1674. [DOI: 10.1016/j.bjps.2017.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
|
30
|
Flasar J, Volk GF, Granitzka T, Geißler K, Irintchev A, Lehmann T, Guntinas-Lichius O. Quantitative facial electromyography monitoring after hypoglossal-facial jump nerve suture. Laryngoscope Investig Otolaryngol 2017; 2:325-330. [PMID: 29094077 PMCID: PMC5655551 DOI: 10.1002/lio2.95] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 07/27/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives/Hypothesis The time course of the reinnervation of the paralyzed face after hypoglossal‐facial jump nerve suture using electromyography (EMG) was assessed. The relation to the clinical outcome was analyzed. Study Design Retrospective single‐center cohort study Methods Reestablishment of motor units was studied by quantitative EMG and motor unit potential (MUP) analysis in 11 patients after hypoglossal‐facial jump nerve suture. Functional recovery was evaluated using the Stennert index (0 = normal; 10 = maximal palsy). Results Clinically, first movements were seen between 6 and >10 months after surgery in individual patients. Maximal improvement was achieved at 18 months. The Stennert index decreased from 7.9 ± 2.0 preoperatively to a final postoperative score of 5.8 ± 2.4. EMG monitoring performed for 2.8 to 60 months after surgery revealed that pathological spontaneous activity disappeared within 2 weeks. MUPs were first recorded after the 2nd month and present in all 11 patients 8–10 months post‐surgery. Polyphasic regeneration potentials first appeared at 4–10 months post‐surgery. The MUP amplitudes increased between the 3rd and 15th months after surgery to values of control muscles. The MUP duration was significantly increased above normal values between the 3rd and 24th months after surgery. Conclusion Reinnervation can be detected at least 2 months earlier by EMG than by clinical evaluation. Changes should be followed for at least 18 months to assess outcome. EMG changes reflected the remodeling of motor units due to axonal regeneration and collateral sprouting by hypoglossal nerve fibers into the reinnervated facial muscle fibers. Level of Evidence 3b.
Collapse
Affiliation(s)
- Jan Flasar
- Department of Otorhinolaryngology Jena University Hospital Jena Germany.,Facial Nerve Center Jena Jena University Hospital Jena Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology Jena University Hospital Jena Germany.,Facial Nerve Center Jena Jena University Hospital Jena Germany
| | - Thordis Granitzka
- 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
| | - Andrey Irintchev
- Department of Otorhinolaryngology Jena University Hospital Jena Germany
| | - Thomas Lehmann
- Department of Medical Statistics 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
| |
Collapse
|
31
|
Kochhar A, Albathi M, Sharon JD, Ishii LE, Byrne P, Boahene KD. Transposition of the Intratemporal Facial to Hypoglossal Nerve for Reanimation of the Paralyzed Face: The VII to XII TranspositionTechnique. JAMA FACIAL PLAST SU 2017; 18:370-8. [PMID: 27348018 DOI: 10.1001/jamafacial.2016.0514] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The hypoglossal nerve has long been an axonal source for reinnervation of the paralyzed face. In this study, we report our experience with transposition of the intratemporal facial nerve to the hypoglossal nerve for facial reanimation. OBJECTIVES To determine the feasibility and outcomes of the transposition of the infratemeporal facial nerve for end-to-side coaptation to the hypoglossal nerve for facial reanimation. DESIGN, SETTINGS, AND PARTICIPANTS A case series of 20 patients with facial paralysis who underwent mobilization and transposition of the intratemporal segment of the facial nerve for an end-to-side coaptation to the hypoglossal nerve (the VII to XII technique). Participants were treated between January 2007 and December 2014 at a tertiary care center. MAIN OUTCOMES AND MEASURES Outcome measures include paralysis duration, facial tone, facial symmetry at rest, and with smile, oral commissure excursion, post-reanimation volitional smile, and synkinesis. METHODS Demographic data, the effects of this technique on facial tone, symmetry, oral commissure excursion and smile recovery were evaluated. Preoperative and postoperative photography and videography were reviewed. Facial symmetry was assessed with a facial asymmetry index. Smile outcomes were evaluated with a visual smile recovery scale, and lip excursion was assessed with the MEEI-SMILE system. RESULTS All 20 patients had adequate length of facial nerve mobilized for direct end-to-side coaptation to the hypoglossal nerve. The median duration of facial paralysis prior to treatment was 11.4 months. Median follow-up time was 29 months. Three patients were excluded from functional analysis due to lack of follow-up. Facial symmetry at rest and during animation improved in 16 of 17 patients. The median (range) time for return of facial muscle tone was 7.3 (2.0-12.0) months. A significant reduction in facial asymmetry index occurred at rest and with movement. The MEEI FACE-gram software detected a significant increase in horizontal, vertical, overall lip excursion and smile angle. No patient developed significant tongue atrophy, impaired tongue mobility, or speech or swallow dysfunction. CONCLUSIONS AND RELEVENCE Mobilization of the intratemporal segment of the facial nerve provides adequate length for direct end-to-end coaptation to the hypoglossal nerve and is effective in restoring facial tone and symmetry after facial paralysis. The resulting smile is symmetric or nearly symmetric in the majority of patients with varying degree of dental show. The additional length provided by utilizing the intratemporal segment of the facial nerve reduces the deficits associated with complete hypoglossal division/splitting, and avoids the need for interposition grafts and multiple coaptation sites. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Amit Kochhar
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles
| | - Monirah Albathi
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa E Ishii
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick Byrne
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi D Boahene
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
32
|
The Spinal Accessory Nerve for Functional Muscle Innervation in Facial Reanimation Surgery: An Anatomical and Histomorphometric Study. Ann Plast Surg 2016; 77:640-644. [PMID: 27740958 DOI: 10.1097/sap.0000000000000891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Facial reanimation surgery is performed in severe cases of facial palsy to restore facial function. In a 1-stage procedure, the spinal accessory nerve can be used as a donor nerve to power a free gracilis muscle transplant for the reanimation of the mouth. The aim of this study was to describe the surgical anatomy of the spinal accessory nerve, provide a guide for reliable donor nerve dissection, and analyze the available donor axon counts. METHODS Dissections were performed on 10 nonembalmed cadavers (measurements of 20 nerves). Surgical anatomy of the spinal accessory nerve was described and distances to important landmarks were measured. Nerve biopsies were obtained of the main nerve trunk distal to the skull base, caudoposterior to the sternocleidomastoid muscle, proximal to the trapezius muscle and at the level of donor nerve harvest to analyze the myelinated axon count throughout the course of the spinal accessory nerve. The donor nerve length and available donor nerve axon count were the primary outcome parameters in this study. RESULTS The mean donor nerve length was 11.6 cm. The spinal accessory nerve was transferred to the mandibular angle without tension for ideal coaptation to the free muscle transplant. After retraction of the trapezius muscle, a small distal nerve branch that leaves the main nerve trunk at a 90-degree angle medially was used as a landmark to indicate the level of donor nerve transection. On average, 1400 myelinated donor axons were available for innervation of the gracilis muscle transplant. CONCLUSIONS This study gives a practical guide for spinal accessory nerve dissection for its application in facial reanimation as a motor source for the innervation of a free muscle transplant.
Collapse
|
33
|
Abstract
Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. 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. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.
Collapse
Affiliation(s)
- Sertac Yetiser
- Department of Otorhinolaryngology-Head and Neck Surgery, Gulhane Medical School, Etlik-Ankara, Turkey
| | | |
Collapse
|
34
|
Müller B, Volk GF, Guntinas-Lichius O. [Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma]. HNO 2016; 65:724-734. [PMID: 27072637 DOI: 10.1007/s00106-016-0125-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients' quality of life. OBJECTIVE This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo. METHODS The present review describes a PubMed-based search of the literature of the past 10 years. RESULTS There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control. CONCLUSION There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.
Collapse
Affiliation(s)
- B Müller
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland
| | - G F Volk
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland
| | - O Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Lessingstraße 2, 07740, Jena, Deutschland.
| |
Collapse
|
35
|
Mohamed A, Omi E, Honda K, Suzuki S, Ishikawa K. Outcome of different facial nerve reconstruction techniques. Braz J Otorhinolaryngol 2016; 82:702-709. [PMID: 27222117 PMCID: PMC9444788 DOI: 10.1016/j.bjorl.2015.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/24/2015] [Accepted: 12/15/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. Objective To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Methods Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. Results For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Conclusion Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.
Collapse
Affiliation(s)
- Aboshanif Mohamed
- Akita Graduate School of Medicine, Head and Neck Surgery, Department of Otorhinolaryngology, Akita, Japan
| | - Eigo Omi
- Akita Graduate School of Medicine, Head and Neck Surgery, Department of Otorhinolaryngology, Akita, Japan
| | - Kohei Honda
- Akita Graduate School of Medicine, Head and Neck Surgery, Department of Otorhinolaryngology, Akita, Japan
| | - Shinsuke Suzuki
- Akita Graduate School of Medicine, Head and Neck Surgery, Department of Otorhinolaryngology, Akita, Japan
| | - Kazuo Ishikawa
- Akita Graduate School of Medicine, Head and Neck Surgery, Department of Otorhinolaryngology, Akita, Japan.
| |
Collapse
|
36
|
Okochi M, Ueda K, Okochi H, Asai E, Sakaba T, Kajikawa A. Facial reanimation using hypoglossal-facial neurorrhaphy with end-to-side coaptation between the jump interpositional nerve graft and hypoglossal nerve: Outcome and duration of preoperative paralysis. Microsurgery 2015; 36:460-6. [DOI: 10.1002/micr.22393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 02/06/2015] [Accepted: 02/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Masayuki Okochi
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Kazuki Ueda
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Hiromi Okochi
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Emiko Asai
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Takao Sakaba
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| | - Akiyoshi Kajikawa
- Department of Plastic and Reconstructive Surgery; Fukushima Medical University; Fukushima City Fukushima 960-1295 Japan
| |
Collapse
|
37
|
Li D, Wan H, Feng J, Wang S, Su D, Hao S, Schumacher M, Liu S. Comparison of hemihypoglossal- and accessory-facial neurorrhaphy for treating facial paralysis in rats. J Neurol Sci 2014; 347:235-41. [DOI: 10.1016/j.jns.2014.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/01/2014] [Accepted: 10/06/2014] [Indexed: 12/18/2022]
|
38
|
Ozsoy U, Demirel BM, Hizay A, Ozsoy O, Ankerne J, Angelova S, Sarikcioglu L, Ucar Y, Turhan M, Dunlop S, Angelov DN. Manual stimulation of the whisker pad after hypoglossal–facial anastomosis (HFA) using a Y-tube conduit does not improve recovery of whisking function. Exp Brain Res 2014; 232:2021-33. [DOI: 10.1007/s00221-014-3892-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 02/24/2014] [Indexed: 12/19/2022]
|
39
|
Wan H, Zhang L, Li D, Hao S, Feng J, Oudinet JP, Schumacher M, Liu S. Hypoglossal-facial nerve “side”-to-side neurorrhaphy for persistent incomplete facial palsy. J Neurosurg 2014; 120:263-72. [PMID: 24205907 DOI: 10.3171/2013.9.jns13664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Hypoglossal-facial nerve neurorrhaphy is a widely used method for treating complete facial palsy. However, the classic surgical procedure using a “side”-to-end neurorrhaphy is not suitable for incomplete facial palsy (IFP), because sectioning of the facial nerve for neurorrhaphy compromises remnant axons and potential spontaneous reinnervation. For the treatment of persistent IFP, the authors investigated in rats a modified method using hypoglossal-facial nerve “side”-to-side neurorrhaphy.
Methods
An IFP model was created by crushing the facial nerve and then ligating the injury site to limit axonal regeneration. After 9 weeks, rats with IFP were submitted to hypoglossal-facial nerve “side”-to-side neurorrhaphy: The gap between the 2 nerves was bridged with a predegenerated peroneal nerve graft, which was sutured to only one-half of the hypoglossal nerve and to the remnant facial nerve through a small window created by removing the epineurium, thus preserving regenerating facial axons.
Results
Four months after repair surgery, double innervation of the target whisker pad by hypoglossal and facial motor neurons was supported by the recording of muscle action potentials and their retrograde labeling. Regenerated hypoglossal and facial motor neurons effectively participated in the reinnervation of the whisker pad, significantly improving facial symmetry without evident synkinesis, compared with rats that underwent IFP without hypoglossal-facial nerve neurorrhaphy.
Conclusions
This study demonstrates that hypoglossal-facial nerve “side”-to-side neurorrhaphy with a predegenerated nerve graft can lead to rapid functional benefits for persistent IFP without compromising the remnants of facial axons, thus providing a proof-of-feasibility for further studies in humans.
Collapse
Affiliation(s)
- Hong Wan
- 1Beijing Neurosurgical Institute
| | - Liwei Zhang
- 2Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China; and
| | - Dezhi Li
- 2Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China; and
| | - Shuyu Hao
- 2Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China; and
| | - Jie Feng
- 1Beijing Neurosurgical Institute
| | - Jean Paul Oudinet
- 3UMR 788, INSERM et Université Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - Song Liu
- 1Beijing Neurosurgical Institute
- 2Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China; and
- 3UMR 788, INSERM et Université Paris-Sud, Le Kremlin-Bicêtre, France
| |
Collapse
|
40
|
Wan H, Zhang L, Blanchard S, Bigou S, Bohl D, Wang C, Liu S. Combination of hypoglossal-facial nerve surgical reconstruction and neurotrophin-3 gene therapy for facial palsy. J Neurosurg 2013; 119:739-50. [DOI: 10.3171/2013.1.jns121176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Facial nerve injury results in facial palsy that has great impact on the psychosocial conditions of affected patients. Reconstruction of the facial nerve to restore facial symmetry and expression is still a significant surgical challenge. In this study, the authors assessed a hypoglossal-facial nerve anastomosis method combined with neurotrophic factor gene therapy to treat facial palsy in adult rats after facial nerve injury.
Methods
Surgery consisted of the interposition of a predegenerated nerve graft (PNG) that was anastomosed with the hypoglossal and facial nerves at each of its extremities. The hypoglossal nerve was cut approximately 50% for this anastomosis to conserve partial hypoglossal function. Before their transplantation, the PNGs were genetically engineered using lentiviral vectors to induce overexpression of the neurotrophic factor neurotrophin-3 (NT-3) to improve axonal regrowth in the reconstructed nerve pathway. Reconstruction was performed after facial nerve injury, either immediately or after a delay of 9 weeks. The rats were followed up for 4 months postoperatively, and treatment outcomes were then assessed.
Results
Compared with the functional innervation in control rats that underwent facial nerve injury without subsequent treatment, functional innervation of the paralyzed whisker pad by hypoglossal motoneurons in rats treated 4 months after nerve reconstruction was evidenced by the retrograde transport of neuronal tracers, the recording of muscle action potentials conducted by the PNG, and the recovery of facial symmetry. Although a better outcome was observed when reconstruction was performed immediately after facial nerve injury, reconstruction with NT3-treated PNGs significantly improved functional reinnervation of the paralyzed whisker pad even when implantation occurred 9 weeks posttrauma.
Conclusions
Results demonstrated that hypoglossal-facial nerve anastomosis facilitates innervation of paralyzed facial muscle via hypoglossal motoneurons without sacrificing ipsilateral hemitongue function. Neurotrophin-3 treatment through gene therapy could effectively improve such innervation, even after delayed reconstruction. These findings suggest that the combination of surgical reconstruction and NT-3 gene therapy is promising for its potential application in treating facial palsy in humans.
Collapse
Affiliation(s)
- Hong Wan
- 1Beijing Neurosurgical Institute
| | - Liwei Zhang
- 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; and
| | - Stephane Blanchard
- 3Unité Rétrovirus et Transfert Génétique, Institut National de la Santé et de la Recherche Médicale U622, Department of Neuroscience, Institut Pasteur, Paris, France
| | - Stephanie Bigou
- 3Unité Rétrovirus et Transfert Génétique, Institut National de la Santé et de la Recherche Médicale U622, Department of Neuroscience, Institut Pasteur, Paris, France
| | - Delphine Bohl
- 3Unité Rétrovirus et Transfert Génétique, Institut National de la Santé et de la Recherche Médicale U622, Department of Neuroscience, Institut Pasteur, Paris, France
| | | | - Song Liu
- 1Beijing Neurosurgical Institute
- 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; and
- 3Unité Rétrovirus et Transfert Génétique, Institut National de la Santé et de la Recherche Médicale U622, Department of Neuroscience, Institut Pasteur, Paris, France
| |
Collapse
|
41
|
Kovačič U, Zele T, Tomšič M, Sketelj J, Bajrović FF. Influence of breaching the connective sheaths of the donor nerve on its myelinated sensory axons and on their sprouting into the end-to-side coapted nerve in the rat. J Neurotrauma 2012; 29:2805-15. [PMID: 22873667 DOI: 10.1089/neu.2011.2298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The influence of breaching the connective sheaths of the donor sural nerve on axonal sprouting into the end-to-side coapted peroneal nerve was examined in the rat. In parallel, the effect of these procedures on the donor nerve was assessed. The sheaths of the donor nerve at the coaptation site were either left completely intact (group A) or they were breached by epineurial sutures (group B), an epineurial window (group C), or a perineurial window (group D). In group A, the compound action potential (CAP) of sensory axons was detected in ~10% and 40% of the recipient nerves at 4 and 8 weeks, respectively, which was significantly less frequently than in group D at both recovery periods. In addition, the number of myelinated axons in the recipient nerve was significantly larger in group D than in other groups at 4 weeks. At 8 weeks, the number of axons in group A was only ~15% of the axon numbers in other groups (p<0.05). Focal subepineurial degenerative changes in the donor nerves were only seen after 4 weeks, but not later. The average CAP area and the total number of myelinated axons in the donor nerves were not different among the experimental groups. In conclusion, myelinated sensory axons are able to penetrate the epiperineurium of donor nerves after end-to-side nerve coaption; however, their ingrowth into recipient nerves is significantly enhanced by breaching the epiperineurial sheets at the coaptation site. Breaching does not cause permanent injury to the donor nerve.
Collapse
Affiliation(s)
- Uroš Kovačič
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Slovenia.
| | | | | | | | | |
Collapse
|
42
|
Comparison of Hemihypoglossal Nerve versus Masseteric Nerve Transpositions in the Rehabilitation of Short-Term Facial Paralysis Using the Facial Clima Evaluating System. Plast Reconstr Surg 2012; 130:662e-672e. [DOI: 10.1097/prs.0b013e318267d5e8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Penna V, Bjoern Stark G, Leibig N, Boyle V, Sakalidou M. Rho-inhibition by local application of c3-toxin for enhancement of axonal sprouting in a rat end-to-side nerve repair model. Microsurgery 2012; 32:207-12. [DOI: 10.1002/micr.20978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/21/2011] [Indexed: 01/15/2023]
|
44
|
Sakalidou M, Leibig N, Boyle V, Koulaxouzidis G, Penna V. Interleukin-10 and regeneration in an end-to-side nerve repair model of the rat. J Peripher Nerv Syst 2011; 16:334-40. [DOI: 10.1111/j.1529-8027.2011.00368.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
45
|
Shipchandler TZ, Seth R, Alam DS. Split hypoglossal-facial nerve neurorrhaphy for treatment of the paralyzed face. Am J Otolaryngol 2011; 32:511-6. [PMID: 21093962 DOI: 10.1016/j.amjoto.2010.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 09/12/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Several methods of neural rehabilitation for facial paralysis using 12-7 transfers have been described. The purpose of this study is to report on a series for dynamic reinnervation of the paralyzed face by using a split 12-7 nerve transposition. The goals of this procedure are to minimize tongue morbidity and to provide good facial reinnervation. METHODS Prospective case series. Melolabial crease discursion, overall facial movement, and degree of tongue atrophy and mobility were recorded. RESULTS Thirteen patients underwent facial reanimation using a split hypoglossal-facial nerve transfer with postoperative follow-up to 58 months (range, 6-58 months). All patients achieved excellent rest symmetry and facial tone. Of 13 patients, 10 had measurable coordinated movement and discursion of their melolabial crease. Of 13 patients, 12 had mild to moderate ipsilateral tongue atrophy. The mean time to onset of visible reinnervation was 3 months. CONCLUSION Split hypoglossal-facial nerve transposition provides good rehabilitation of facial nerve paralysis with reduced lingual morbidity. Long-term rest symmetry and potential learned movement can be achieved. This technique may provide a favorable alternative to the traditional method of complete hypoglossal sacrifice or jump grafting.
Collapse
|
46
|
Volk GF, Pantel M, Streppel M, Guntinas-Lichius O. Reconstruction of complex peripheral facial nerve defects by a combined approach using facial nerve interpositional graft and hypoglossal-facial jump nerve suture. Laryngoscope 2011; 121:2402-5. [DOI: 10.1002/lary.22357] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
47
|
Ozsoy U, Hizay A, Demirel BM, Ozsoy O, Bilmen Sarikcioglu S, Turhan M, Sarikcioglu L. The hypoglossal–facial nerve repair as a method to improve recovery of motor function after facial nerve injury. Ann Anat 2011; 193:304-13. [PMID: 21458251 DOI: 10.1016/j.aanat.2011.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/03/2011] [Accepted: 01/05/2011] [Indexed: 12/16/2022]
|
48
|
Smile Reconstruction Through Bilateral Muscular Transplants Neurotized by Hypoglossal Nerves. J Craniofac Surg 2011; 22:845-7. [DOI: 10.1097/scs.0b013e31820f7d50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
49
|
Venail F, Sabatier P, Mondain M, Segniarbieux F, Leipp C, Uziel A. Outcomes and complications of direct end-to-side facial-hypoglossal nerve anastomosis according to the modified May technique. J Neurosurg 2009; 110:786-91. [PMID: 19119877 DOI: 10.3171/2008.9.jns08769] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to address the efficiency and safety of direct end-to-side facial-hypoglossal nerve anastomosis for facial palsy rehabilitation. METHODS The authors conducted a retrospective study of 12 consecutive procedures performed between December 2000 and February 2006. Facial palsies were caused by the surgical removal of tumors in the brainstem, cerebellopontine angle, or mastoid process. Direct end-to-side facial-hypoglossal anastomosis was performed in each case. Facial function (evaluated using the overall percentage of facial function and House-Brackmann scale grades), as well as tongue trophicity and mobility, were assessed at 6, 12, and 24 months after surgery. Postoperative early and late complications were systematically reviewed. RESULTS The mean delay between tumoral and reparative surgery was 15.9 +/- 4 months (median 11 months). Preoperatively, the mean percentage facial function score was 11.6 +/- 1.7% (45% of patients with House-Brackmann Grade 5 facial palsy and 55% of patients with House-Brackmann Grade 6). Mean facial function scores increased to 19.3, 32.2, and 43.8% at 6, 12, and 24 months after surgery, respectively. Twenty-four months after surgery, 50% of cases had House-Brackmann Grade 3 facial palsy and 50% had Grade 4. A significantly better recovery at 24 months was observed postoperatively for neural lesions occurring in the mastoid or the brainstem compared with those in the cerebellopontine angle. Tongue hemiparesis was observed in 5 patients (41.7%), 2 of whom had tongue hypotrophy (16.7%). No patient complained of swallowing or speech disturbance. Facial synkinesis was noted in 1 patient (8.3%). CONCLUSIONS Facial recovery after direct end-to-side facial-hypoglossal nerve anastomosis is similar to results observed with end-to-end or end-to-side facial-hypoglossal nerve anastomosis with an interpositional graft. Tongue hypotrophy and palsy were observed in a small number of cases. This procedure allows one to minimize, although not fully prevent, facial synkinesis. The site of the neural lesion appears to be an important factor in the prognosis of recovery.
Collapse
Affiliation(s)
- Frederic Venail
- Ear, Nose, and Throat, University Hospital Gui de Chauliac, France.
| | | | | | | | | | | |
Collapse
|
50
|
The "babysitter" procedure: minihypoglossal to facial nerve transfer and cross-facial nerve grafting. Plast Reconstr Surg 2009; 123:865-876. [PMID: 19319050 DOI: 10.1097/prs.0b013e31819ba4bb] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 1984, Terzis introduced the "babysitter" procedure, a new concept in facial reanimation. It involves two stages, with coaptation of ipsilateral 40 percent hypoglossal to facial nerve on the affected side, performed concomitantly with cross-facial nerve grafting and secondary microcoaptations 8 to 15 months later. This article presents the senior author's (J.K.T.) experience with the original procedure. METHODS Of 75 patients who had minihypoglossal nerve transfer, 20 fulfilled the selection criteria for the original babysitter procedure. All patients' records, photographs, videotapes, and needle electromyography studies were reviewed. The clinical results were scored using Terzis' Grading Scale. Eye closure, smile, and lower lip depression were each assessed separately. Functional and aesthetic outcomes and preoperative and postoperative electromyography results were analyzed. RESULTS Seventy-five percent of patients achieved excellent and good results, 15 percent had moderate results, and 10 percent had fair results. The difference between preoperative and postoperative eye closure was statistically significant (t test, p < 0.001). Symmetrical smile and full contraction (excellent result) was achieved in two patients (10 percent), 13 patients (65 percent) had nearly symmetrical smile (good result), and five patients (25 percent) had a moderate result. Two patients (10 percent) had full lower lip depression (excellent result) and 15 (75 percent) had good results. In three patients (15 percent), subsequent digastric or platysma muscle transfer was performed because of inadequate depression and symmetry (moderate result). A statistically significant difference was observed between preoperative and postoperative electromyography results, in eye closure, smile, and lower lip depression. CONCLUSIONS The original babysitter procedure offers significant improvement in selected patients with facial paralysis. Symmetry and coordinated movements can be restored, with satisfying aesthetic and functional outcomes.
Collapse
|