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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Reinnervation occurred in 29 patients, on average at 5. Synkinesis is barely noticeable, and contracture or spasm is totally absent. Argomenti di Terapia Occupazionale. 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. Note, however, that this nerve suture must be considered an end-to-end type of union, although it may macroscopically appear as an end-to-side type.
Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy. Surgical Technique Via a transmastoid fossa approach, the intratemporal facial nerve is exposed from the vertical third portion up to the external genu. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis.
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 activation mediated by tongue movement and synkinesis control with mirror feedback.
At each clinical assessment patients were taught to perform gypoglossal exercises, according to their clinical status, and were then instructed to repeat them daily at home.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
An accurate evaluation of the results is hindered by two important factors. Facial nerve grading system. Treating facial nerve palsy by true termino-lateral hypoglossal-facial nerve anastomosis. Depending on its condition, a ruptured proximal stump might not always be considered the best choice for reinnervation.
May M, Schaitkin BM, editors. Photographs depicting the procedure. Dalla Toffola E, Petrucci L.
This use of the new motor circuit is accompanied by a reorganization of brain activation patterns: Enhancing facial appearance with cosmetic camouflage. To do this they must anastomosus how to produce a voluntary smile; again they need to use a mirror, dosing the strength of their tongue thrust and repeating the movement several times a day. Of particular interest are the normalization of the sagging face as early as 2 months after nerve repair and the definitive resolution of the eye problem.
The average interval from tumor surgery to hypoglossal-facial nerve anastomosis was 6. National Center for Biotechnology InformationU. A comparison of surgical techniques used in dynamic reanimation of the paralyzed face.
Our patients demonstrated good synkinesis control, which can be strongly influenced by the rehabilitation process, as suggested by Brudny et al. Conclusions In light of the results obtained and the absolute lack of any morbidity associated with our procedure, one wonders whether hpoglossal technique may anasttomosis even better than a direct intracranial repair of the seventh cranial nerve when a wear-and-tear interruption of the faciql facial nerve occurs, as might happen in the course of removing large acoustic tumors.
At the end of the follow-up period, three patients presented dysphagia and four patients had mild post-surgery hemitongue atrophy without difficulty in moving their tongue.
Rehabilitation treatment The objectives of rehabilitation are i for the patient to become aware 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.
Cortical representation sites of mimic movements after facial nerve reconstruction: It is technically safe, and the results are consistent and durable. Use of this procedure gains an additional length of 3.
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. Patients who met the following inclusion criteria were included in the present study:. All of our patients were sent to us by different centers, so there is also a potential recruitment bias linked to both the selection of patients with fewer signs of recovery and the geographical origins of the patients.
Hypoglossal-facial nerve anastomosis: a meta-analytic study.
Very soon the lower part of the muscle is perfectly active and lagophthalmos anastomossis no longer visible. The nerve is traced medially into the facial recess and cut. Only one patient did not show signs of reinnervation after surgery. A stay suture mobilizes the hypoglossal nerve upward and laterally. Clinical Material and Methods Patient Population Two young women 31 and hhpoglossal years old each underwent removal of a large 4-cm vestibular schwannoma via the suboccipital retrosigmoid approach.
Many surgical series show a significant correlation between early surgery and outcome Yetiser and Karapinar, ; Celis-Aguilar et al. Approccio clinico e riabilitativo alla paralisi del VII nervo cranico.
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. Hypoglossal-facial nerve anastomosis is one of the procedures frequently performed to restore function after facial palsy secondary to surgery for removal of cerebellopontine angle tumors.
Modification of the anastomosis technique seems to resolve this problem. 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 activation mediated by tongue movement and synkinesis control with mirror feedback.
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.
End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face
Two young women 31 and 34 years old each underwent removal of a large 4-cm vestibular schwannoma via the suboccipital retrosigmoid approach. Surgical results of the hypoglossal-facial nerve jump graft technique.
Facial nerve function had to be reported according to the House-Brackmann scale. Thirty patients were included in the study. For the first four to five months after surgery, before the first signs of reinnervation appear, patients who have undergone this procedure have complete facial paralysis.