, Volume 36, Issue 3, pp 155-164
Date: 15 Nov 2012

The split hypoglossal nerve to supply the free functional muscle transfer in facial reanimation

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The introduction of the concept of free muscle transfer ushered a new era in the management of facial paralysis. Several nerves were used to supply the newly introduced muscle. The current work studies the possibility of using the split hypoglossal nerve in supplying the functional muscle transfer.


Twenty-five patients with long-standing facial nerve paralysis were treated by the author using 26 free muscle transfers and the split hypoglossal nerve. The distance and the angle of commissure excursion were measured pre- and postoperatively, and results were statistically analyzed. Only results from 24 patients were analyzed after exclusion of one patient with Mobius syndrome treated with two free flaps.


The first contraction observed after muscle transfer occurred 3 to 6 months postoperatively (mean 4.6 months). Postoperatively, the gained excursion using the free latissmus dorsi flap and split lypoglossal nerve ranged between 9 and 29 mm (mean 17.75 ± 6.14) and the difference in angle ranged between 0° and 19° (mean 6.88 ± 5.83). None of our patients complained of mastication or speech problems.


Within the limitations of the present study, the split hypoglossal nerve is probably a possible alternative donor nerve to supply the free functional muscle transfer in long-standing facial nerve paralysis.

Level of Evidence: Level IV, therapeutic study.