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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Only one patient, whose palsy was caused by a brain hemorrhage, did not show signs of reinnervation after the surgery. Faciwl main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis.
At 1 year postresection, electromyography and clinical examination results showed evidence of irreversible damage and surgery was undertaken. Both these rehabilitation techniques have been demonstrated to produce equivalent results in patients with idiopathic and post-surgical long-term paralysis Ross et al. Note, however, that this nerve suture must be considered an end-to-end type of union, although it may macroscopically appear as an anastmoosis type.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
For the same reason, during this procedure we do not voluntarily interrupt the distal tiny lower branches extending from the facial nerve, as described by Darrouzet, et al. 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. 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.
Three years after the anastomosis, Through repetition of these exercises the movements become automatic, i. Articles that reported facial nerve function after surgery and timing of repair were included. The hypoglossal nerve is prepared in the retromandibular space distal to the origin of hypogllossal descending ansa, to enhance the possibility of recruiting powerful motor axons Fig. Good and fair results occurred with higher frequency in younger patients who were operated hypogloxsal within shorter intervals, although these relationships were not statistically significant.
Closure of the eye generally requires separate treatment involving the insertion of either a gold weight or a fascial sling in the upper eyelid. 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.
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.
The nerve is traced medially into the facial recess and cut. The fallopian canal is then dacial opened using a diamond bur under continuous suction and irrigation, and the distal facial nerve is extracted and rerouted outside the stylomastoid foramen.
End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face
Nuovo Trattato di Medicina Fisica e Riabilitazione. Many surgical series show a significant correlation between early surgery and outcome Yetiser and Karapinar, ; Celis-Aguilar et al.
The tongue was normal at this time. Surgical results of the hypoglossal-facial nerve jump graft technique. There were no surgical complications. The same process is then used to learn other voluntary movements such as snarling and lip puckering.
The advantage of mirror visual feedback, the rehabilitation technique 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.
First, regardless of the scale used, data somehow depend on the personal evaluation of the surgeon or the team. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy.
The ability to mimic such voluntary and involuntary movements is highly dependent on prolonged exercise at the mirror. Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. Only one patient did not show signs of reinnervation after surgery. J Plast Reconstr Aesthet Anastomozis.
In the two patients treated, the gold weight in the upper eyelid was removed without consequence. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. The average age of the patients was Discussion Our study demonstrates that patients treated with XII-VII anastomosis followed by a rehabilitation program show a progressive improvement of facial function: Our results support this assumption: Other authors identify age as a prognostic factor for outcome Malik et al.
When the patient is emotionally upset sudden burst of crying or laughingthe responses are uncoordinated and the sequelae of the palsy are clearly visible. 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. Otolaryngol Head Neck Surg.
These factors have prompted us to develop an alternative method of facial nerve reanimation, although similar procedures have been previously reported by Darrouzet, et al. Photographs depicting the procedure. An accurate evaluation of the results is hindered by two important factors.
The severity of facial nerve paralysis does not have a negative effect on prognosis.
In light of the results obtained and the absolute lack of any morbidity associated with our procedure, one wonders whether the technique may be even better than a direct intracranial repair of the seventh cranial nerve when a wear-and-tear interruption of faciql proximal facial hy;oglossal occurs, as might happen in the course of removing large acoustic tumors.
Preliminary studies suggest a favorable effect of electromyographic biofeedback rehabilitation Brudny et al.
Enhancing facial appearance with cosmetic camouflage. The use of home rather than hospital-based rehabilitation offered certain advantages: