with complete facial palsy due to facial nerve transection during surgery for acoustic neuroma removal followed by a hypoglossal-facial nerve anastomosis. This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of. This procedure allows a straight end-to-side hypoglossal–facial anastomosis without interruption of the 12th cranial nerve or the need for graft interposition.

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Larger randomized clinical trials should be considered in order to provide more conclusive evidence. For the first four to five months after surgery, before the first signs of reinnervation gypoglossal, patients who have undergone this procedure have complete facial paralysis. Acoustic Neuroma and Skull Base Surgery. Argomenti di Terapia Occupazionale.

Percent distribution of HB grades at surgery 0at first rehabilitation assessment 1and at 12, 18 and 36 months after the anastomosis.

A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. To help them memorize the correct position and strength of tongue thrust, they are told to repeat the movement several times a day.

Patients who met the following inclusion criteria were included in the present study: Articles that reported facial nerve function after surgery and timing of repair were included.

The main trunk of the nerve is progressively gently pulled using multiple epineurial stay sutures and is anchored to the surrounding connective tissue in an upward and lateral position Fig. The results are unquestionably dependent on the precision of the suture, and therefore microsurgical skill in nerve repair is obviously welcome. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. These factors have prompted us to develop an alternative method of facial nerve reanimation, although similar procedures have been previously reported by Darrouzet, et al.


A reduced rate of synkinesis after a true end-to-side coaptation has also hypoglossql confirmed by the observations of Yoleri, et al. The severity of facial nerve paralysis does not have a negative effect on prognosis. Elena Dalla Toffola, E-mail: The facial nerve is extracted from the fallopian canal, rerouted, and neurotized end to side to the hypoglossal nerve distal to the descending ansa.

Analysis of the reports indicates that hypoylossal repair, before 12 months, provides a better outcome. Ensuring accuracy of this maneuver is of paramount importance to avoid tension at the level of the suture.

End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face

The average age of the patients was hypoglsosal Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis House-Brackmann grade VI treated with hypoglossal-facial nerve XII-VII anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback.

Compared with other previously described techniques, we used a true end-to-side suture in that no nerve fascicle was interrupted.

Hypoglossal-facial nerve anastomosis is an effective and hypoglossall technique that gives consistent and satisfying results. This procedure involves the use of only a portion of the hypoglossal nerve and has the enormous advantage of avoiding the tongue dysfunction that results from resection of the entire hypoglossal nerve.

Otolaryngol Head Neck Surg. Depending on its condition, a ruptured proximal stump might not always be considered the best choice for reinnervation. Four patients had dysphagia, 11 complained of lachrymation disorders, and nine had ataxia.

Good and fair results occurred with higher frequency in younger patients who were operated on within shorter intervals, although these relationships were not statistically significant. Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy. Hypoglossal-facial nerve XII-VII anastomosis is a surgical procedure that has long been used to restore movement to the facial muscles in cases facjal paralysis of the seventh cranial nerve Ozsoy et al.


Hypoglossal-facial nerve anastomosis: a meta-analytic study.

The objectives of rehabilitation are i for the patient to become aware of being able to perform new movements, ii for the patient then to learn the tongue movements that produce facial muscle contractions, and iii to render the newly acquired movements automatic Dalla Toffola and Petrucci, ; Ross et al. Discussion Based on our experience, this procedure is quick and reliable, and recovery has an overall better quality than that with the anastlmosis cranial nerve jump graft 26 cases in our previous series, unpublished data.

Based on our experience, this procedure is quick and reliable, and recovery has an overall better quality than that with the seventh—12th cranial nerve jump graft 26 cases in our previous series, unpublished data. A limitation of the jump graft technique is the necessity of a graft together with its obvious double line of suture to be crossed by the regenerating axons as well as the resultant scarring and morbidity at the donor site usually the sural nerve or, more rarely, the great auricular nerve.

Hypoglossal-facial nerve anastomosis: a meta-analytic study.

Many surgical series show a significant correlation between early surgery and outcome Yetiser and Karapinar, ; Celis-Aguilar et al. Patients who met the following inclusion criteria were included in the present study:. In a meta-analysis, Yetiser and Karapinar reported a median improvement of two levels on the House-Brackmann HB grading system in anwstomosis who underwent surgery alone.

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