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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La terapia occupazionale nella paralisi periferica del nervo faciale. Results An accurate evaluation of the results is hindered by two important factors. This use of the new motor circuit is accompanied by a reorganization of brain activation patterns: Table I Correlations of the House-Brackmann score at 36 months.

Hypoglossal-facial nerve anastomosis: a meta-analytic study.

Depending on its condition, a ruptured proximal stump might not always be considered the best choice for reinnervation. Surgical Technique Via a transmastoid fossa approach, the intratemporal facial nerve is exposed from the vertical third portion up to the external genu. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy.

The advantage of mirror visual feedback, the rehabilitation hypogloossal reported in our study, is that it does not require special equipment and can be performed at home, unlike the electromyographic biofeedback technique described by Brudny et al.

Hypoglossal-facial nerve anastomosis: a meta-analytic study.

The recovery continues for at least three years after the faciaal, meaning that prolonged follow-up of these patients is advisable. Support Center Support Center. Given the speedy results the technique could be applied in cases referred late, probably even 2 years after nerve damage.

The objectives of rehabilitation are i for the patient to become aware of being able to perform new faciall, 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.

In accordance with other studies, we found better motor recovery in the lower hemiface than in the frontalis muscle Magliulo et al. 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. This may be due to an unrecognized injury to the hypoglossal donor nerve following the brain hemorrhage that damaged the sixth and seventh cranial nerves.

A comparison of surgical techniques used in dynamic reanimation of the paralyzed face. All post-hoc comparisons showed a significant reduction in scores test for trend: The fallopian canal is then carefully opened using a diamond bur under continuous suction and irrigation, and the distal facial nerve is extracted and rerouted outside the stylomastoid foramen. The aim of this study was to assess dacial grade and timing of recovery in patients with complete facial palsy treated with XII-VII anastomosis followed by a home rehabilitation program involving mirror visual feedback.


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After surgery, the facial muscles are reinnervated by the twelfth hjpoglossal nerve, therefore patients have to learn how to control facial motility through the use of voluntary tongue movements Rinn, Summary Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis House-Brackmann grade VI treated with hypoglossal-facial nerve XII-VII anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle facixl mediated by tongue movement and synkinesis control with mirror feedback.

Both these rehabilitation techniques have been demonstrated to produce equivalent results in patients with idiopathic and post-surgical long-term paralysis Ross et al.

Two young women 31 and 34 years old each underwent removal of a large 4-cm vestibular schwannoma via the suboccipital retrosigmoid approach. The study was approved by the institutional ethics committee and the patients gave their written consent to participate in the research study.

Elena Dalla Toffola, E-mail: Drawing illustrating the surgical procedure. Clinical Material and Methods Patient Population Two young women 31 and 34 years old each underwent removal of a large 4-cm vestibular schwannoma via the suboccipital retrosigmoid approach.

First, regardless of the scale used, data somehow depend on the personal evaluation of the surgeon or the team. 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. If eye-mouth synkinesis occurs, patients are told to reduce the strength of their tongue thrust. A limitation of the jump graft technique is the necessity of a graft together with its obvious double line of suture to be crossed by the regenerating axons as well as the resultant scarring and morbidity at the donor site usually the sural nerve or, more rarely, the great auricular nerve.

In reporting the results of an extrafacial neurotization technique, one inevitably underestimates the quality of even the best results: The ability to mimic such voluntary and involuntary movements is highly dependent on prolonged exercise at the mirror. Once patients have mastered static symmetry, they need to improve dynamic symmetry. At 1 year postresection, electromyography and clinical examination results showed evidence of irreversible damage and surgery was undertaken.


The published results of hypoglossal-facial nerve anastomosis have been variable, and there are still questions about the indications, timing, and surgical techniques for this procedure. At first, they need to use a strong tongue thrust to achieve static and dynamic facial symmetry.

End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face

Acta Neurochir Wien ; National Center for Biotechnology InformationU. Both the jump graft technique and the intratemporal hemihypoglossal—facial attachment described by other authors Table 2 entail the interruption of approximately one half of the hypoglossal nerve to attach the recipient facial nerve.

A very important issue is still to be ascertained: In the two patients treated, the gold weight in the upper eyelid was removed without consequence. Twenty patients had an acoustic neuroma average size 3.

If there was more than 1 article by hypoglossaal same author sonly the most recent article and those that did not overlap and that matched the above criteria were accepted. The first rehabilitation assessment took place on average 5. 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 anstomosis disability and improve their social participation Coulter and May, ; Dalla Toffola et al.

Patients who met the following inclusion criteria were included in the present study:. At approximately 7 to 8 months postoperatively the upper orbicularis oculi muscle is also functioning, and a good symmetric blinking reflex is present.

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When the patient is emotionally upset sudden burst of crying or laughingthe responses are uncoordinated and the sequelae of the palsy are clearly visible. Reinnervation started at 2 months postoperatively and constantly improves during the 1st year. Numerous authors of surgical studies have pointed out that XII-VII anastomosis patients can hypoglossa, from a long-term rehabilitation program, yet without describing such programs Magliulo et al.

Introduction Hypoglossal-facial nerve XII-VII anastomosis is a surgical procedure that has long been used to restore movement to the facial muscles in cases of paralysis of the seventh cranial nerve Ozsoy et al.