Side-to-End Hypoglossal to Facial Anastomosis With Transposition of the Intratemporal Facial Nerve

Slattery, William H.; Cassis, Adam; Wilkinson, Eric P.; Santos, Felipe; Berliner, Karen I.

doi:10.1097/mao.0b013e3182936bcf

Cited by 43 publications

(26 citation statements)

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“…Gelingt bei einem Patienten mit Neurofibromatose Typ 2 operativ eine funktionelle Erhaltung des Nervus facialis nicht, dann bietet eine direkte Transplantation im gleichen Eingriff die besten Chancen für eine Regeneration. Eine Seit-zu-End-Verbindung zwischen Hypoglossus und Fazialis innerhalb des ersten Jahres nach Fazialisparalyse kann noch immer ein ebenso gutes Ergebnis bezüglich der Rehabilitation des Gesichts erbringen [100][101][102][103][104]. Bei länger bestehenden Paresen sind plastische Rekonstruktionen mit Temporaliszügeltransfer, Tarsoraphie und Lidimplantationen ("Lid loading") zu erwägen.…”

Section: Referatunclassified

Diagnostik und Therapie des Vestibularisschwannoms – eine interdisziplinäre Herausforderung

et al. 2017

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Vestibular schwannomas expand slowly in the internal auditory canal, in the cerebellopontine angle, inside the cochlear and the labyrinth. Larger tumors can displace and compress the brainstem. With an annual incidence of 1:100 000 vestibular schwannoma represent 6-7% of all intracranial tumors. In the cerebellopontine angle they are by far the most neoplasm with 90% of all lesions located in this region. Magnetic resonance imaging (MRI), audiometry, and vestibular diagnostics are the mainstays of the clinical workup for patients harboring tumors. The first part of this paper delivers an overview of tumor stages, the most common grading scales for facial nerve function and hearing as well as a short introduction to the examination of vestibular function.Upholding or improving quality of life is the central concern in counseling and treating a patient with vestibular schwannoma. Preservation of neuronal function is essential and the management options - watchful waiting, microsurgery and stereotactic radiation - should be custom-tailored to the individual situation of the patient. Continuing interdisciplinary exchange is important to monitor treatment quality and to improve treatment results. Recently, several manuscripts and reviews have been published on the topic of vestibular schwanomma. On the occasion of the 88 annual meeting of the German Society of Oto-rhino-laryngology, Head and Neck surgery a special volume of the journal "HNO" will be printed. Hence this presentation has been designed to deviate from the traditional standard which commonly consists of a pure literature review. The current paper was conceptually woven around a series of interdisciplinary cases which outlines examples for every stage of the disease that show characteristic results for management options to date. Systematic clinical decision pathways have been deduced from our experience and from results reported in the literature. These pathways are graphically outlined after the case presentations. Important criteria for decision making are size and growth rate of the tumor, hearing of the patient and the probability of total tumor resection with preservation of hearing and facial nerve function, age and co-morbidity of the patient, best possible control of vertigo and tinnitus and last but not least the patient's preference and choice. In addition to this, the experience and the results of a given center with each treatment modality will figure in the decision making process.We will discuss findings that are reported in the literature regarding facial nerve function, hearing, vertigo, tinnitus, and headache and reflect on recent studies on their influence on the patient's quality of life. Vertigo plays an essential role in this framework since it is an independent predictor of quality of life and a patient's dependence on social welfare.Pathognomonic bilateral vestibular schwannoma that occur in patients suffering from neurofibromatosis typ-2 (NF2) differ from spontaneous unilateral tumors in their biologic behavior. Treatment of neurof...

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Section: Referatunclassified

Diagnostik und Therapie des Vestibularisschwannoms – eine interdisziplinäre Herausforderung

et al. 2017

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“…Both nerves receive afferent input from the trigeminal reflex, and act synergistically in the coordination of some mimic and prandial functions; furthermore, both contain myelinated motor fibers with similar fascicular anatomy. 23,24 Reinnervation occurs in 4 to 12 months. Approximately 70% of the patients obtain good results, with the function of the facial nerve classified as "good", or as HB grade III.…”

Section: Discussionmentioning

confidence: 99%

Hypoglossal-Facial Anastomosis for Facial Nerve Reconstruction: Outcomes using the Side-to-End Surgical Technique

Ruschel¹,

Duarte

Cruz

et al. 2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Introduction The side-to-end hypoglossal-facial anastomosis (HFA) technique is an excellent alternative technique to the classic end-terminal anastomosis, because it may decrease the symptoms resulting from hypoglossal-nerve transection. Methods Patients with facial nerve palsy (House-Brackmann [HB] grade VI) requiring facial reconstruction from 2014 to 2017were retrospectively included in the study. Results In total, 12 cases were identified, with a mean follow-up of 3 years. The causes of facial paralysis were due to resection of posterior-fossa tumors and trauma. There was improvement in 91.6% of the patients (11/12) after the HFA. The rate of improvement according to the HB grade was as follows: HB III - 58.3%; HB IV - 16.6%; and HB II - 16.6%. The first signs of improvement were observed in the patients with the shortest time between the paralysis and the anastomosis surgery (3.5 months versus 8.5 months; p = 0.011). The patients with HB II and III had a shorter time between the diagnosis and the anastomosis surgery (mean: 5.22 months), while the patients with HB IV and VI had a longer time of paresis (mean: 9.5 months; p = 0.099). We did not observe lingual atrophy or changes in swallowing. Discussion and Conclusion Hypoglossal-facial anastomosis with the terminolateral technique has good results and low morbidity in relation to tongue motility and swallowing problems. The HB grade and recovery appear to be better in patients operated on with a shorter paralysis time.

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“…Modifications to the classic procedure have been proposed to improve facial function while minimizing functional deficits to the tongue. 11,12,[18][19][20][21][22][23][24][25] Several authors have reported using split hypoglossal-facial nerve techniques to reanimate the paralyzed face. 12,18 As described by Arai et al, 12 the distal hypoglossal nerve is partially divided and split longitudinally along its length to gain length for direct coaptation to the main facial nerve branch.…”

Section: Discussionmentioning

confidence: 99%

“…Several anatomic and clinic al studies have presented data on this approach 13,14,19,25,[27][28][29] Atlas and Lowinger 13 reported 3 cases of intratemporal facial nerve transposition using a similar technique, with functional recovery in all cases and a dramatic reduction in hemiglossal weakness. Recently, Slattery et al 25 described 19 patients who underwent a similar technique with 36.8% attaining House-Brackmann grade III, 47.4% a grade IV, and 15.8% a grade V result. Our experience with 20 patients using the VII to XII transposition technique shows a reliably high restoration of dynamic and static facial symmetry and excursion with minimal tongue morbidity.…”

Section: Discussionmentioning

confidence: 99%

Transposition of the Intratemporal Facial to Hypoglossal Nerve for Reanimation of the Paralyzed Face

Kochhar

Albathi²,

Sharon³

et al. 2016

JAMA Facial Plast Surg

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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.

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Side-to-End Hypoglossal to Facial Anastomosis With Transposition of the Intratemporal Facial Nerve

Abstract: The HFA swingdown technique is a safe and effective method to restore facial nerve function in patients with facial paralysis and obviates the need for an interposition jump graft.

Cited by 43 publications

References 16 publications

Diagnostik und Therapie des Vestibularisschwannoms – eine interdisziplinäre Herausforderung

Diagnostik und Therapie des Vestibularisschwannoms – eine interdisziplinäre Herausforderung

Hypoglossal-Facial Anastomosis for Facial Nerve Reconstruction: Outcomes using the Side-to-End Surgical Technique

Transposition of the Intratemporal Facial to Hypoglossal Nerve for Reanimation of the Paralyzed Face

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