Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis

Urban, Matthew J.; Eggerstedt, Michael; Varelas, Eleni A; Epsten, Madeline; Beer, Adam; Smith, Ryan M.; Revenaugh, Peter C.

doi:10.1089/fpsam.2020.0523

Cited by 11 publications

(13 citation statements)

References 86 publications

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“…Faster time to movement with NTM transfers when compared with a hypoglossal nerve transfer has been confirmed in studies by Hontanilla et al 19 . (2 months versus 4.5 months) and Albathi 20 (5.6 months versus 10.8 months) and in recent systematic reviews 7,17 . Our mean time to movement of 5.4 months was in line with these studies.…”

Section: Discussionsupporting

confidence: 89%

“…5,6 The partial hypoglossal donor nerve, however, tends to be more effective in restoring the facial resting tone, compared to the NTM. 7 Branches of the contralateral facial nerve are an alternative donor source of axons for reinnervating the musculature of the affected side via a cross-facial nerve graft (CFNG). They allow for the possibility of synchronous and spontaneous movement.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of immediate facial nerve reanimation with nerve transfer for facial nerve neoplasm‐induced paralysis: a retrospective review

Shein

Lee

Coulson

et al. 2023

ANZ Journal of Surgery

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Background: The purpose of this study was to evaluate the outcomes of our polyneural, zone-based reanimation approach for patients with neoplasm-induced facial paralysis. Methods: A retrospective review of consecutive patients who underwent facial reanimation surgery using multiple donor nerve transfers was undertaken. In each case, the selection of donor nerves was based on the availability of donor nerve and the viability of the motor endplate on the affected side. Sources of the neural inputs utilized included the remnant facial nerve stump, masseteric nerve, partial hypoglossal nerve, and branches of the contralateral facial nerve. Clinical outcomes were scored by expert raters. Ratings were undertaken using the modified House-Brackmann, eFACE and MEEI FACEgram scoring systems. Results: Between 2017 and 2020, 12 patients were included in the study (mean age 60 years; range 26-81 years). Eight patients (67%) achieved a grade III outcome on the modified House-Brackmann grading scale. Mean eFACE static and dynamic scores were 76 and 57 respectively, reflecting a high degree of symmetry at rest and moderate restoration of dynamic movement. Mean time to movement was 5.4 months (SD 1.9). Objective FACE-gram measurements confirmed restoration of midface movement with an average improvement in smile excursion and mouth angle excursion of 3.19 mm (SD 3.18) and 4.81 (SD 2.90) respectively. Conclusion: Facial reanimation using multiple nerve transfers is effective in achieving improvements in facial function and symmetry.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Outcomes of immediate facial nerve reanimation with nerve transfer for facial nerve neoplasm‐induced paralysis: a retrospective review

Shein

Lee

Coulson

et al. 2023

ANZ Journal of Surgery

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“…Historically, the House-Brackmann (H-B) score is the most well-known and widely used grading system to score facial nerve function, using both characteristics in rest and in motion 16 . Although originally not developed to score facial function after reconstruction and despite its shortcomings, the H-B grading system is also frequently used in studies reporting on outcome of the N7-N12 transfer, namely in around 70% 17 .…”

Section: Introductionmentioning

confidence: 99%

Reestablishment of the Smile after Hypoglossal–Facial Nerve Transfer: What Can We Learn?

Kleijwegt

Wever²,

Hensen³

et al. 2023

J Neurol Surg B Skull Base

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Objective: To assess the ability to smile following hypoglossal-facial nerve transfer (N12-N7). Design: Retrospective chart review. Setting: National tertiary referral center for skull base pathology. Participants: Seventeen patients Main outcome measures: The ability to smile following N12-N7 transfer was assessed by five medical doctors on photos of the whole face and frontal, orbital and oral segments. The (segmented) photos were scored: symmetrical, asymmetrical, correct or incorrect assessment of affected side. Results: Seventeen patients were analysed by 5 assessors providing 85 assessments. The whole face in rest was judged symmetrical in 26% of the cases, and mildly asymmetrical in 56%. Frontal, orbital, and oral segments were symmetrical in 63, 20 and 35% respectively. The affected side was correctly identified in 76%. When smiling, the whole face was symmetrical in 6% and mildly asymmetric in 59%. The affected side was correctly identified in 94%. The frontal, orbital, and oral segments during smiling were symmetrical in 67, 15 and 6%, respectively. The affected side of the frontal, orbital and buccal facial segments during smiling was correctly identified in 89, 89 and 96%, respectively. Interobserver variability with Fleiss Kappa analysis showed that the strength of agreement during smile of the total face was good (0.771) Conclusions: Following N12-N7 transfer a good facial symmetry in rest can be achieved. During smiling, almost all patients showed asymmetry of the face which was predominantly determined by orbital and oral segments. To improve the ability to smile after N12-N7 transfer additional procedures are needed.

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“…When the proximal end of the facial nerve is unusable for grafting, but the distal nerve branches and mimetic muscles are still viable, nerve transfers are usually performed to reanimate the paralyzed face. The most common donor nerves are the masseter and the hypoglossal, both being powerful motor sources 1,2 . A neurorrhaphy from the masseter nerve to a zygomatic or buccal facial branch usually provides the patient a good smile and an early recovery of facial motor function 3 with minimal donor site morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…The most common donor nerves are the masseter and the hypoglossal, both being powerful motor sources. 1,2 A neurorrhaphy from the masseter nerve to a zygomatic or buccal facial branch usually provides the patient a good smile and an early recovery of facial motor function 3 with minimal donor site morbidity. However, many patients undergoing a masseter-to-facial transfer (MFT) exhibit poor static tone at rest or speaking, as resting tone is much better achieved with hypoglossal-to-facial transfer (HFT).…”

mentioning

confidence: 99%

Contribution and safety of the side‐to‐end hypoglossal‐to‐facial transfer in multidisciplinary facial reanimation

et al. 2022

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Background This study evaluates facial and tongue function in patients undergoing side‐to‐end hypoglossal‐to‐facial transfer (HFT) with additional techniques. Methods Thirty‐seven patients underwent a side‐to‐end HFT. Twelve had additional cross‐face grafts, and 9 had an additional masseter‐to‐facial transfer. Facial was assessed with House–Brackmann (HB), Sunnybrook Facial Grading Scale (SFGS), and eFACE. Martins scale and the Oral‐Pharyngeal Disability Index (OPDI) were used to assess tongue function. Results Ninety‐four percent of cases reached HB grades III–IV. Mean total SFGS score improved from 16 ± 15 to 59 ± 11, while total eFACE score from 52 ± 13 to 80 ± 5. Dual nerve transfers were a predictor for a better eFACE total score p = 0.034, β = 2.350 [95% CI, 0.184–4.516]), as well as for a higher SFGS total score (p = 0.036, β = 5.412 [95% CI, 0.375–10.449]). All patients had Martin's grade I. Mean postoperative OPDI scores were 84 ± 17 (local physical), 69 ± 16 (simple and sensory motor components), 82 ± 14 (complex functions), and 73 ± 22 (psychosocial). Conclusions The side‐to‐end HFT offers predictable facial function outcome and preserves tongue function in nearly all cases. Dual nerve transfers appear to improve the final outcome.

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Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis

Cited by 11 publications

References 86 publications

Outcomes of immediate facial nerve reanimation with nerve transfer for facial nerve neoplasm‐induced paralysis: a retrospective review

Outcomes of immediate facial nerve reanimation with nerve transfer for facial nerve neoplasm‐induced paralysis: a retrospective review

Reestablishment of the Smile after Hypoglossal–Facial Nerve Transfer: What Can We Learn?

Contribution and safety of the side‐to‐end hypoglossal‐to‐facial transfer in multidisciplinary facial reanimation

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