with complete facial palsy due to facial nerve transection during surgery for acoustic neuroma removal followed by a hypoglossal-facial nerve anastomosis. This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of. This procedure allows a straight end-to-side hypoglossal–facial anastomosis without interruption of the 12th cranial nerve or the need for graft interposition.
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Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy.
End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face
Support Center Support Center. The average age of the patients was May M, Schaitkin BM, editors. The results are unquestionably dependent on the precision of the suture, and therefore microsurgical skill in nerve repair is obviously welcome.
Rehabilitation of facial nerve palsy after surgery for acoustic neuroma.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
During the rehabilitation period, 29 patients showed clinical improvement as revealed by the HB grading system. Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded articles. Twenty patients had an acoustic neuroma average size 3. The HB grading system House and Brackmann, was used to evaluate the severity of paralysis before the anastomosis, at the first rehabilitation assessment and at follow-up sessions 12, 18 and 36 months after surgery.
Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis.
Follow-up evaluations were performed between 18 and 24 months posttreatment. Enhancing facial appearance with cosmetic camouflage. The average interval from tumor surgery to hypoglossal-facial nerve anastomosis was 6.
At each clinical assessment patients were taught to perform specific exercises, according to their clinical status, and were then instructed to repeat them daily at home. All post-hoc comparisons showed a significant reduction in scores test for trend: At approximately 7 to 8 months postoperatively the upper orbicularis oculi muscle is also functioning, and a good symmetric blinking reflex is present.
The main trunk of the nerve is progressively gently pulled using multiple epineurial stay sutures and is anchored to the surrounding connective tissue in an upward and lateral position Fig.
The importance of sparing part of the hypoglossal nerve was originally emphasized by Zehm and Hartenau 12 inbut in May, et al. Facial reanimation with end-to-end hypoglossofacial anastomosis: The ability to mimic such voluntary and involuntary movements is highly dependent on prolonged exercise at the mirror. Epiendoneurial opening—note the herniating fascicles still in continuity. The hypoglossal nerve is prepared in the retromandibular space distal to the origin of the descending ansa, to enhance the possibility of recruiting powerful motor axons Fig.
Global assessment of outcomes after varying reinnervation techniques for patients with facial paralysis subsequent to acoustic neuroma excision. Rehabilitation treatment The objectives of rehabilitation are i for the patient to become anastomosix of being able to perform new movements, ii for the patient then to learn the tongue movements that produce facial muscle contractions, and iii to render the newly acquired movements automatic Dalla Toffola and Petrucci, ; Ross et al.
Patients who met the following inclusion criteria were included in the present study: Only one patient did not show signs of reinnervation after surgery. Good and fair results occurred with higher frequency in younger patients annastomosis were operated on within shorter intervals, although these relationships were not statistically significant.
Eighteen patients had hypoacusis, due to the removal of a neuroma of the eighth cranial nerve in 16 patients, and to an expansive lesion in two. As originally demonstrated by Oberlin and colleagues, 10 and confirmed by our recent experience 4 in microsurgical repair of peripheral nerves, a perfectly functioning secondary nerve has extraordinary power of regeneration, sometimes preferable to a damaged proximal stump of the proper nerve.
End-to-side interposed donor grafting as a facial nerve reinforcement technique after vestibular schwannoma surgery. Good or fair results were achieved in 17 At very high magnification, through a small epineurial window, the endoneuria of two descending fascicles are opened Fig.
Many surgical series show a significant correlation between early surgery and outcome Yetiser and Karapinar, ; Celis-Aguilar et al. During the next phase, at the first signs of reinnervation, patients, using mirror feedback, need to learn which tongue positions thrust against teeth or palate produce the desired facial expressions.
Chang and Shen showed that the proximity between the cortical area of the hypoglossal and facial nerves favors rehabilitation after surgery.
This interruption is proven by the observation that either the graft or the facial nerve stump has a square section, which is exactly one half of the hypoglossal nerve. First, regardless of the scale used, data somehow depend on the personal evaluation of the surgeon or the team. Approccio clinico e riabilitativo alla paralisi del VII nervo cranico. We thank Charlotte Buckmaster for her linguistic expertise.
Our study used a long-term follow-up period to confirm that XII-VII anastomosis combined with targeted rehabilitation produces yypoglossal good functional recovery Brudny et al.
Long-term facial nerve function following facial reanimation after translabyrinthine vestibular achwannoma surgery: In addition, patients are taught compensatory techniques to help them in their activities of daily living and esthetic camouflage in an attempt to both reduce their disability and improve their social participation Coulter and May, ; Dalla Toffola et al.