Reanimation of the face after facial nerve palsy resulting from resection of a cerebellopontine angle tumour

Abstract

Twenty-three patients with facial nerve paralysis following surgery for a cerebellopontine angle tumour had a facial-hypoglossal anastomosis and simultaneous anastomosis of the cervical ansa with the distal stump of the hypoglossal nerve. In 18 patients, simultaneously with the neural anastomoses, additional transpositions of the temporalis and masseter muscles were performed. At follow-up examination 3-87 months after reconstructive surgery, eight patients had House grade II, ten grade III and five grade IV outcome. The EMG evidence of reinnervation was observed 5-11 months after anastomosis. Combination of the facial-hypoglossal anastomosis with simultaneous myoplasty and with anastomosis of the distal hypoglossal nerve stump to the ansa cervicalis provides the advantage of immediate protection against ophthalmic complications, prevents hemiatrophy of the tongue and gives good functional results when reinnervation of the facial muscles takes place.

Morphological study of the ansa cervicalis and the phrenic nerve

“…Ansa cervicalis is preferred over the traditional use of hypoglossal nerve in this procedure because it avoids late complications such as defective speech and swallowing due to scarred degeneration of the target muscles of the hypoglossal nerve (Schipper et al ., 2005). It has also been reported that such defects could be minimized by combining facial–hypoglossal anastomosis with simultaneous myoplasty and anastomosis of the distal hypoglossal stump to the ansa cervicalis (Kukwa et al ., 1994), again underlining the importance of ansa cervicalis in this type of treatment procedures.…”

Ansa Cervicalis Nerve: Review of the Topographic Anatomy and Morphology

“…Its use is not limited to laryngeal reinnervation. Kukwa et al 27 describe the use of this nerve in preventing the morbidity associated with tongue hemiatrophy after facial‐hypoglossal anastomosis. Despite the multitude of topographic and morphologic variations of the ansa cervicalis nerve formation reported in the literature, the structures of surgical interest in laryngeal reinnervation (main nerve roots and branches) are found in relatively predictable locations.…”

Long-Term Outcomes of Facial Nerve Function in Irradiated and Nonirradiated Nerve Grafts

“…17 Other authors have anastomosed the ansa cervicalis to the distal hypoglossal nerve stump during faciohypoglossal anastomosis to protect against atrophy of the tongue. 18 The best HB outcome in our experience with this procedure was HB grade IV, which was observed in 4 of 9 patients.…”