The Surgical and Mechanical Treatment of Peripheral Nerves

Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: Evolution in management of facial paralysis

“…Mass movements of the face reanimated by HFA were noted in all clinical reports 16,17,22–30,32–35 . Lipschitz, 63 as cited by Ford and Woodhall, 64 in 1906 postulated that misdirected regenerating nerve fibers that grew into all parts of the degenerated facial nerve trunk produced a diffuse spread of stimuli.…”

“…Evans thought pre‐existing difficulty with manipulating food was the primary contraindication to HFA and advocated an alternative cranial nerve motor source, that is, spinal accessory, with sparing the trapezius muscle. He quoted Stookey's conclusions 25 about the differing suitability of these two reinnervating crossover nerves: “In a singer the spinal accessory should be used for crossing. A hod carrier could better sacrifice his hypoglossal.”…”

“…Loss of vision from neuroparalytic keratopathy is most likely in those with the dry eye, poor Bell's phenomena, and corneal anesthesia from loss of trigeminal function 72 . While some series cited were notable for absence of problems due to lagophthalmos, 16,23–28,33–35 21% of respondents to a follow‐up questionnaire encountered ophthalmologic deficiencies including dryness (29%), irritation (17%), visual impairment (11%), ocular pain (9%), and epiphora (4%). Others were bothered by corneal abrasion, neurotrophic keratitis, and problems with lateral tarsorraphy 29 …”

“…Early advocates of HFA commented on the closer anatomic relationship between facial motor cortex and hypoglossal motor cortex when compared with other cranial nerves (i.e., the spinal accessory or glossopharyngeal), which might suggest closer temporal and functional similarity from a potential association at the cortical level. Others have observed that involuntary intraoral lingual movements concomitant with emotional liability might effect “appropriate” facial movements following HFA 25,80,81 . While Shroder 82 and others 83 have commented on direct ipsilateral projections from spinal trigeminal nucleus (STN) to the hypoglossal nucleus (HN) in cat and rat, there is still a paucity of information about the neuroanatomy and regulation of emotional expression.…”

“…Although reinnervation of the distal facial nerve was initially performed with crossover nerve from the spinal accessory, the majority of the literature, especially in the United States, then advocated the hypoglossal nerve as the new motor nerve of choice 17,25,27 . The reasons for this are manifold: closer temporal and functional similarity between chewing, talking, and swallowing in conjunction with facial movement; closer cortical anatomic proximity; minimally visible intraoral dysfunction; avoidance of painful shoulder drop and voluntary facial movement with gross shoulder movement; and embarrassing facial movement with shoulder activity.…”