Cross-Facial Nerve Grafting as an Adjunct to Hypoglossal-Facial Nerve Crossover in Reanimation of Early Facial Paralysis: Clinical and Electrophysiological Evaluation

Abstract

Reanimation of a spontaneous and synchronous smile, and sufficient depressor mechanism of the lower lip presents a surgical challenge in facial paralysis. Hypoglossal-facial nerve crossover and cross-facial nerve grafting are the best options if the mimetic muscles around the mouth are still viable in patients in whom the facial nerve was sacrificed at the brainstem. Although good muscle tone and facial motion have been obtained by hypoglossal-facial nerve crossover, smile is dependent on conscious tongue movement. Cross-facial nerve grafting provides a voluntary and emotion-driven smile, but requires two coaptation sites, which leads to substantial axonal loss and a long regeneration time. This method was not successful in activating the depressor mechanism. The first stage is the classic "baby-sitting" procedure, in which the bulk of the mimetic muscles was maintained by the rapid reinnervation of the hypoglossal-facial nerve crossover during the regeneration period of the cross-facial nerve graft, and temporalis muscle transfer to the eyelids is performed. During the second stage, the cross-facial nerve graft that used the thickest zygomaticobuccal branch on the healthy side was coapted with the corresponding branches on the paralyzed side. The hypoglossal-facial nerve crossover continued to innervate the depressor muscles. Good spontaneous smile and sufficient depressor mechanism were achieved by cross-facial nerve grafting and hypoglossal-facial nerve crossover respectively, and these techniques are demonstrated by the authors clinically and electrophysiologically.

Surgical management of facial nerve paralysis in the pediatric population

“…Dynamic facial reanimation may be achieved by either the use of a muscle free flap or a local rotational muscle flap [54][55][56]. When free flaps are used, the flap must be innervated by one of many potential donor nerves including branches of ipsilateral/contralateral facial nerve, masseteric branch of the trigeminal nerve, and as others [32,50,[57][58][59][60][61][62][63] (Fig. 3).…”

Facial nerve damage following surgery for cerebellopontine angle tumours. Prevention and comprehensive treatment

“…An interesting concept is the 'baby-sitter' technique, based on combining hypoglossal-facial anastomosis with facial-facial anastomosis. The idea is to use the high efficiency of hypoglossal-facial anastomosis in reinnervation of facial muscles and, at the same time, to offer a chance of recovering emotional function [67,68]. With a technique sparing a part of the hypoglossal nerve, satisfactory reanimation of facial muscles may be achieved with minimum damage to function of the tongue and the non-affected side of the face.…”

Management of Traumatic Facial Nerve Injuries

“…34 As the sole method of reanimation, pure cross-face nerve grafts do not have great results, but when combined with the babysitter procedure or single-stage free tissue transfer (e.g., gracilis, latissimus dorsi), symmetric and coordinated movements with satisfying aesthetic outcomes can be achieved. 35,36…”