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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Chang and Shen showed that the proximity between the cortical area of the hypoglossal and facial nerves favors anasgomosis after surgery. Patients who have undergone XIIVII anastomosis are not considered to be capable of regaining control of their emotive facial expressions, the smile in particular, since this control is regulated by the extrapyramidal system Rinn et al.

We thank Charlotte Buckmaster for her linguistic expertise. The meta-analysis conducted by Yetiser and Karapinarbased on data of patients derived from 23 studies, reported a median improvement of two levels on the HB grading system in patients who underwent hyppoglossal alone.

May M, Schaitkin BM, editors. During the rehabilitation period, 29 patients showed clinical improvement as revealed by the HB grading system. 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.

Ensuring accuracy of this maneuver is of paramount importance to avoid tension at the level of the suture. In a meta-analysis, Yetiser and Karapinar reported a median improvement of two levels on the House-Brackmann HB grading system in patients who underwent surgery alone.

Long-term facial nerve function following facial reanimation after translabyrinthine vestibular achwannoma surgery: Results An accurate evaluation of the results is hindered by two important factors. Eur J Phys Rehabil Med. Two young women 31 and 34 years old each underwent removal of a large 4-cm vestibular schwannoma via the suboccipital retrosigmoid approach. All post-hoc comparisons showed a significant anatsomosis in scores test for trend: Our study demonstrates that patients undergoing XII-VII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement.


The HB grading system House and Fcial, 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. Hypoglossal-facial nerve XII-VII anstomosis 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.

If there was more than 1 article by the same author sonly the most recent article and those that did not overlap and that matched the above criteria were accepted. Second, and much more importantly, the House 7 grading system can only be perfectly adapted for facial nerve recovery when a lesion in continuity is present Bell or delayed posttraumatic palsy or a nerve-to-nerve repair is performed, Additional problems are encountered when the results are evaluated in light of a repair with a different nerve.

A stay suture mobilizes the hypoglossal nerve upward and laterally. Rehabilitation of facial nerve palsy after surgery for acoustic neuroma. Our study did not reveal either of these correlations, which may be due to the fact that our patients were operated on by different surgeons.

To prevent eye complications related to incomplete eyelid closure, eight patients had gold weight implants and six patients had undergone tarsorrhaphy.

The hypoglossal nerve is prepared in the retromandibular space distal to the origin of the descending ansa, to enhance the naastomosis of recruiting powerful motor axons Fig. Our study is the first to report results obtained by combining XII-VII anastomosis with a prolonged systematic rehabilitation program in a large clinical series.

Good and fair results occurred with higher frequency in younger patients who were operated on within shorter intervals, although these relationships were not statistically significant. The aim of this study was to assess the 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. The average age of the patients was The data were hhypoglossal from existing literature written in English or French.

Cortical representation sites of mimic movements after facial nerve reconstruction: The recovery continues for at least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable.


The study was approved by the institutional ethics committee and the patients gave their written consent to participate in the research study. The disadvantage is that it was difficult ahastomosis quantify patient compliance with the rehabilitation. The same process is then used to learn other voluntary movements such as snarling and lip puckering. For post-hoc comparisons, the exact McNemar test was used, as well as a test for linear trend of the log-relative risk to exploit the ordinal nature of the score.

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

Our study used a long-term follow-up period to confirm that XII-VII anastomosis combined with targeted rehabilitation produces a good functional recovery Brudny et al. Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy. Acoustic Neuroma and Skull Base Fcaial. Support Center Support Center. Journal List Funct Neurol v. At this point the patients are taught to use mirror visual feedback to dose the strength of tongue thrust necessary to achieve symmetry of muscle contraction between the reinnervated and the healthy side and to prevent the onset of synkinesis.

Anqstomosis severity of facial nerve paralysis does not have a negative effect on prognosis. These factors have hypog,ossal us to develop an alternative method of facial nerve reanimation, although similar procedures have been previously reported by Darrouzet, et al.

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

Four patients had dysphagia, 11 complained of lachrymation disorders, and nine had ataxia. At first, they need to use a strong tongue thrust to achieve static and dynamic facial symmetry. 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.

Modification of the anastomosis technique seems to resolve this problem.