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Treatment of complete facial palsy in adults: comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihipoglossal-facial neurorrhaphy with grafts, and masseter to facial nerve transfer

  • Clinical Article - Neurosurgical Techniques
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Abstract

Background

The hypoglossal (with or without grafts) and masseter nerves are frequently used as axon donors for facial reinnervation when no proximal stump of the facial nerve is available. We report our experience treating facial nerve palsies via hemihypoglossal-to-facial nerve transfers either with (HFG) or without grafts (HFD), comparing these outcomes against those of masseteric-to-facial nerve transfers (MF).

Method

A total of 77 patients were analyzed retrospectively, including 51 HFD, 11 HFG, and 15 MF nerve transfer patients. Both the House-Brackmann (HB) scale and our own, newly-designed scale to rate facial reanimation post nerve transfer (quantifying symmetry at rest and when smiling, eye occlusion, and eye and mouth synkinesis when speaking) were used to enumerate the extent of recovery.

Results

With both the HB and our own facial reanimation scale, the HFD and MF procedures yielded better outcome scores than HFG, though only the HGD was statistically superior. HGD produced slightly better scores than MF for everything but eye synkinesis, but these differences were generally not statistically significant. Delaying surgery beyond 2 years since injury was associated with appreciably worse outcomes when measured with our own but not the HB scale. The only predictors of outcome were the surgical technique employed and the duration of time between the initial injury and surgery.

Conclusions

HFD appears to produce the most satisfactory facial reanimation results, with MF providing lesser but still satisfactory outcomes. Using interposed grafts while performing hemihypoglossal-to-facial nerve transfers should likely be avoided, whenever possible.

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References

  1. Angelov DN, Gunkel A, Stennert E, Neiss WF (1993) Recovery of original nerve supply after hypoglossal facial anastomosis causes permanent motor hyperinnervation of the whisker-pad muscles in the rat. J Comp Neurol 338:214–224

    Article  CAS  PubMed  Google Scholar 

  2. Arai H, Sato K, Yanai A (1995) Hemihypoglossal-facial nerve anastomosis in treating unilateral facial palsy after acoustic neuroma resection. J Neurosurg 82:51–54

    Article  CAS  PubMed  Google Scholar 

  3. Asaoka K, Sawamura Y, Nagashima M, Fukushima T (1999) Surgical anatomy for direct hypoglossal-facial nerve side-to-end “anastomosis”. J Neurosurg 91:268–275

    Article  CAS  PubMed  Google Scholar 

  4. Atlas MD, Lowinger DSG (1997) A new technique for hypoglossal-facial nerve repair. Laryngoscope 107:984–991

    Article  CAS  PubMed  Google Scholar 

  5. Bae Y, Zuker RM, Manktelow RT, Wade S (2006) A comparison of commissure excursion following gracilis muscle transplantation for facial paralysis using a cross-face nerve graft versus the motor nerve to the masseter nerve. Plast Reconstr Surg 118:885–899

    Article  Google Scholar 

  6. Bernat I, Vitte E (2006) Related timing for peripheral and central plasticity in hypoglossal-facial nerve anastomosis. Muscle Nerve 33:334–341

    Article  PubMed  Google Scholar 

  7. Borschel GH, Kawamura DH, Kasukurthi R, Hunter DA, Zuker RM, Woo AS (2012) The motor nerve to the masseter muscle: an anatomic and histomorphometric study to facilitate its use in facial reanimation. J Plast Reconstr Aesthet Surg 65:363–366

    Article  PubMed  Google Scholar 

  8. Brenner E, Schoeller T (1998) Masseteric nerve: a possible donor for facial nerve anastomosis? Clin Anat 11(6):396–400

    Article  CAS  PubMed  Google Scholar 

  9. Campero A, Ajler P, Socolovsky M, Martins C, Rhoton A (2012) Facial nerve reanimation by partial section of the hypoglossal nerve and mini mastoidectomy [in Spanish]. Surg Neurol Int 3(Suppl 6):S400–S404

    PubMed  PubMed Central  Google Scholar 

  10. Campero A, Socolovsky M (2007) Facial reanimation by means of the hypoglossal nerve: anatomic comparison of different techniques. Neurosurgery 61:41–49

    PubMed  Google Scholar 

  11. Chang CGS, Shen AL (1984) Hypoglossal anastomosis after resection of acoustic neuroma. Surg Neurol 21:282–286

    Article  CAS  PubMed  Google Scholar 

  12. Chen YS, Yanagihara N, Murakami S (1994) Regeneration of facial nerve after hypoglossal facial anastomosis: an animal study. Otolaryngol Head Neck Surg 111:710–716

    Article  CAS  PubMed  Google Scholar 

  13. Collar RM, Byrne PJ, Boahene KDO (2013) The subzygomatic triangle: rapid, minimally invasive identification of the masseteric nerve for facial reanimation. Plast Reconstr Surg 132:183–188

    Article  CAS  PubMed  Google Scholar 

  14. Conley J, Baker DC (1979) Hypoglossal-facial nerve anastomosis for innervation of the paralysed face. Plast Reconstr Surg 63:63–72

    Article  CAS  PubMed  Google Scholar 

  15. Constantinidis J, Akbarian A, Steinhart H, Iro H, Mautes A (2003) Effects of immediate and delayed facial-facial nerve suture on rat facial muscle. Acta Otolaryngol 123:998–1003

    Article  PubMed  Google Scholar 

  16. Coombs CJ, Ek EW, Wu T, Cleland H, Leung MK (2009) Masseteric-facial nerve coaptation—an alternative technique for facial nerve reinnervation. J Plast Reconstr Aesthet Surg 62(12):1580–1588

    Article  CAS  PubMed  Google Scholar 

  17. Cotrufo S, Hart A, Payne AP, Sjogren A, Lorenzo A, Morley S (2011) Topographic anatomy of the nerve to masseter: an anatomical and clinical study. J Plast Reconstr Aesthet Surg 64:1424–1429

    Article  PubMed  Google Scholar 

  18. Cusimano MD, Sekhar L (1994) Partial hypoglossal to facial nerve anastomosis for reinnervation of the paralyzed face in patients with lower cranial nerve palsies: technical note. Neurosurgery 35:532–534

    Article  CAS  PubMed  Google Scholar 

  19. Danner CJ (2008) Facial nerve paralysis. Otolaryngol Clin N Am 41(3):619–632

    Article  Google Scholar 

  20. Darrouzet V, Dutkiewicz J, Chambrin A, Stoll D, Bebear JP (1997) L’anastomose hypoglosso-faciale: resultats et evolution technique vers l’anastomose latero-terminale avec deroutment du nerf facial intra-temporal (technique de May modifiée) [in French]. Rev Laryngol Otol Rhinol 118:203–210

    CAS  Google Scholar 

  21. Darrouzet V, Guerin J, Bébéar J (1999) New technique of side-to-end hypoglossal-facial nerve attachment with translocation of the infratemporal facial nerve. J Neurosurg 90:27–34

    Article  CAS  PubMed  Google Scholar 

  22. Escat E, Vie A (1925) Manuel operatoire de l’anastomose du nerf facial avec le nerf masserterin [in French]. Ann Mal Oreille Larynx 77:1149–1159

    Google Scholar 

  23. Faria JCM, Scopel GP, Ferreira MC (2010) Facial reanimation with masseteric nerve: babysitter or permanent procedure? Preliminary results. Ann Plast Surg 64:31–34

    Article  CAS  PubMed  Google Scholar 

  24. Ferraresi S, Garozzo D, Migliorini V, Buffatti P (2006) End-to side intrapetrous hypoglossal-facial anastomosis for reanimation of the face. J Neurosurg 104:457–460

    Article  PubMed  Google Scholar 

  25. Fisher MD, Zhang Y, Erdmann D, Marcus J (2013) Dissection of the masseter branch of the trigeminal nerve for facial reanimation. Plast Reconstr Surg 131:1065–1067

    Article  CAS  PubMed  Google Scholar 

  26. Flores LP (2007) Surgical results of the hypoglossal-facial nerve jump graft technique. Acta Neurochir (Wien) 149:1205–1210

    Article  CAS  Google Scholar 

  27. Gavron JP, Clemis JD (1984) Hypoglossal-facial nerve anastomosis: a review of forty cases caused by facial nerve injuries in the posterior fossa. Laryngoscope 94:1447–1450

    Article  CAS  PubMed  Google Scholar 

  28. Godefroy WP, Malessy MJA, Tromp AAM, Van Der Mey AGL (2007) Intratemporal facial nerve transfer with direct coaptation to the hypoglossal nerve. Otol Neurotol 28:546–550

    Article  PubMed  Google Scholar 

  29. Guntinas-Lichius O, Angelov D (1997) Delayed hypoglossal-facial nerve suture after predegeneration of the peripheral facial nerve stump improves the innervation of mimetic musculature by hypoglossal motoneurons. J Comp Neurol 387:234–242

    Article  CAS  PubMed  Google Scholar 

  30. Guntinas-Lichius O, Streppel M, Stennert E (2006) Postoperative functional evaluation of different reanimation techniques for facial nerve repair. Am J Surg 191:61–67

    Article  PubMed  Google Scholar 

  31. Hammerschlag PE (1999) Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: evolution in management of facial paralysis. Laryngoscope 109:1–23

    Article  CAS  PubMed  Google Scholar 

  32. Hayashi A, Nishida M, Seno H, Inoue M, Iwata H, Shirasawa T, Arai H, Kayamori R, Komuro Y, Yanai A (2013) Hemihypoglossal nerve transfer for acute facial paralysis. J Neurosurg 118(1):160–166

    Article  PubMed  Google Scholar 

  33. Hontanilla B, Marre D, Cabello A (2014) Masseteric nerve for reanimation of the smile in short-term facial paralysis. Brit J Oral Max Surg 52:118–123

    Article  Google Scholar 

  34. Hontanilla B, Marre D, Cabello A (2013) Facial reanimation with gracilis muscle transfer neurotized to cross-facial nerve graft versus masseteric nerve: a comparative study using the FACIAL CLIMA evaluating system. Plast Reconstr Surg 131:1241–1252

    Article  CAS  PubMed  Google Scholar 

  35. Hontanilla B, Marré D (2012) Comparison of hemihypoglossal nerve versus masseteric nerve transpositions in the rehabilitation of short-term facial paralysis using the Facial Clima evaluating system. Plast Reconstr Surg 130:662–672

    Article  Google Scholar 

  36. House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147

    PubMed  Google Scholar 

  37. Hwang K, Kim SG, Kim DJ (2006) Facial-hypoglossal nerve anastomosis using laser nerve welding. J Craniofac Surg 17:687–691

    Article  PubMed  Google Scholar 

  38. Klebuc MJA (2011) Facial reanimation using the masseter-to-facial nerve transfer. Plast Reconstr Surg 127:1909–1915

    Article  CAS  PubMed  Google Scholar 

  39. Korte W (1903) Ein fall von nervenpfropfung: des nervus facialis auf den nervus hypoglossus. Deutsche Med Wihnschr 17:293–295

    Article  Google Scholar 

  40. Krishnan KG, Schackert G, Seifert V (2010) Outcomes of microneurovascular facial reanimation using masseteric innervation in patients with long-standing facial palsy resulting from cured brainstem lesions. Neurosurgery 67:663–674

    Article  PubMed  Google Scholar 

  41. Kunihiro T, Kanzaki J, Yoshihara S, Satoh Y, Satoh A (1996) Hypoglossal-facial nerve anastomosis after acoustic neuroma resection: influence of the time anastomosis on recovery of facial movement. J Otorhinolaryngol Relat Spec 58:32–5

    Article  CAS  Google Scholar 

  42. Lamas G, Lannadère E, Tankéré F, Truong Tan T, Bernat I, Gatignol P (2010) Termino-terminal hypoglossofacial anastomosis, indications, results [in French]. Rev Laryngol Otol Rhinol (Bord) 131:97–102

    CAS  Google Scholar 

  43. Le Clerc N, Herman P, Kania R, Tran H, Altabaa K, Tran Ba Huy P, Sauvaget E (2013) Comparison of 3 procedures for hypoglossal-facial anastomosis. Otol Neurotol 34:1483–1488

    Article  PubMed  Google Scholar 

  44. Mackinnon SE, Dellon AL (1995) Fascicular patterns of the hypoglossal nerve. J Reconstr Microsurg 11:195–198

    Article  CAS  PubMed  Google Scholar 

  45. Magliulo G, D’Amico R, Forino M (2001) Results and complications of facial reanimation following cerebellopontine angle surgery. Eur Arch Otorhinolaryngol 258:45–48

    Article  CAS  PubMed  Google Scholar 

  46. Malik TH, Kelly G, Ahmed A, Saeed SR, Ramsden RT (2005) A comparison of surgical techniques used in dynamic reanimation of the paralyzed face. Otol Neurotol 26:284–291

    Article  PubMed  Google Scholar 

  47. Manktelow RT, Tomat LR, Zuker RM, Chang M (2009) Smile reconstruction in adults with free muscle transfer innervated by the masseter motor nerve: effectiveness and cerebral adaptation. J Plast Reconstr Aesth Surg 62:1580–1588

    Article  Google Scholar 

  48. Martins RS, Socolovsky M, Siqueira MG, Campero A (2008) Hemihypoglossal-facial neurorrhaphy after mastoid dissection of the facial nerve: results in 24 patients and comparison with the classic technique. Neurosurgery 63:310–316

    Article  PubMed  Google Scholar 

  49. May M, Sobol SM, Mester SJ (1991) Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy. Otolaryngol Head Neck Surg 104:818–825

    Article  CAS  PubMed  Google Scholar 

  50. Myckatyn T, Mackinnon S (2003) The surgical management of facial nerve injury. Clin Plast Surg 30:307–318

    Article  PubMed  Google Scholar 

  51. Pitty LF, Tator CH (1992) Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors. J Neurosurg 77:724–731

    Article  CAS  PubMed  Google Scholar 

  52. Pons Y, Gauthier J, Dagain A, Conessa C, Clement P, Desgeorges M, Poncet JL (2009) Long-term results of facial palsy’s rehabilitation by end-to-end hypoglossal-facial anastomosis [in French]. Rev Laryngol Otol Rhinol (Bord) 130:169–174

    CAS  Google Scholar 

  53. Rebol J, Milojkovic V, Didanovic V (2006) Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve. Acta Neurochir (Wien) 148:653–657

    Article  CAS  Google Scholar 

  54. Roland JT, Lin K, Klausner LM, Miller PJ (2006) Direct facial-to-hypoglossal neurorrhaphy with parotid release. Skull Base 16:101–107

    Article  PubMed  Google Scholar 

  55. Rochkind S, Shafi M, Alon M, Salame K, Fliss DM (2008) Facial nerve reconstruction using a split hypoglossal nerve with preservation of tongue function. J Reconstr Microsurg 24:469–474

    Article  PubMed  Google Scholar 

  56. Samii M, Alimohamadi M, Khouzani RK, Rashid MR, Gerganov V (2015) Comparison of direct side-to-end and end-to-end hypoglossal-facial anastomosis for facial nerve repair. World Neurosurg 84(2):368–375

    Article  PubMed  Google Scholar 

  57. Samii M, Matthies C (1994) Indication, technique and results of facial nerve reconstruction. Acta Neurochir (Wien) 130:125–139

    Article  CAS  Google Scholar 

  58. Sawamura Y, Abe H (1997) Hypoglossal–facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique. J Neurosurg 86:203–206

    Article  CAS  PubMed  Google Scholar 

  59. Sforza C, Tarabbia F, Mapelli A, Colombo V, Sidequersky FV, Rabbiosi D, Annoni I, Biglioli F (2014) Facial reanimation with masseteric to facial nerve transfer: a three-dimensional longitudinal quantitative evaluation. J Plast Reconstr Aesthet Surg 67:1378–1386

    Article  PubMed  Google Scholar 

  60. Slattery WH 3rd, Cassis AM, Wilkinson EP, Santos F, Berliner K (2014) Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve. Otol Neurotol 35:509–513

    Article  PubMed  Google Scholar 

  61. Snyder-Warwick AK, Fattah AY, Zive L, Halliday W, Borschel GH, Zuker RM (2015) The degree of facial movement following microvascular muscle transfer in pediatric facial reanimation depends on donor motor nerve axonal density. Plast Reconstr Surg 135:370–379

    Article  Google Scholar 

  62. Sood S, Anthony R, Homer JJ, Van Hille P, Fenwick JD (2000) Hypoglossal-facial nerve anastomosis: assessment of clinical results and patient benefit for facial nerve palsy following acoustic neuroma excision. Clin Otolaryngol Allied Sci 25:219–226

    Article  CAS  PubMed  Google Scholar 

  63. Spira M (1978) Anastomosis of masseteric nerve to lower division of facial nerve for correction of lower facial paralysis. Plast Reconstr Surg 61:330–334

    Article  CAS  PubMed  Google Scholar 

  64. Thurner KH, Egg G, Spoendlin H, Schrott-Fischer A (1993) A quantitative study of nerve fibers in the human facial nerve. Eur Arch Otorhinolaryngol 250:161–167

    Article  CAS  PubMed  Google Scholar 

  65. Vacher C, Dauge MC (2004) Morphometric study of the cervical course of the hypoglossal nerve and its application to hypoglossal facial anastomosis. Surg Radiol Anat 26:86–90

    Article  CAS  PubMed  Google Scholar 

  66. Venail F, Sabatier P, Mondain M, Segniarbieux F, Leipp C, Uziel A (2009) Outcomes and complications of direct end-to-side facial-hypoglossal nerve anastomosis according to the modified May technique. J Neurosurg 110:786–791

    Article  PubMed  Google Scholar 

  67. Wang W, Yang C, Li Q, Li W, Yang X, Zhang YX (2014) Masseter-to-facial nerve transfer: a highly effective technique for facial reanimation after acoustic neuroma resection. Ann Plast Surg 73(Suppl 1):S63–S69

    Article  CAS  PubMed  Google Scholar 

  68. Zuker RM, Manktelow RT (1989) A smile for the Mobius’ syndrome patient. Ann Plast Surg 22:188–194

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, Buenos Aires, 1428, Argentina

    Mariano Socolovsky, Gilda di Masi & Gonzalo Bonilla

  2. Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil

    Roberto S. Martins & Mario Siqueira

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  1. Mariano Socolovsky
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  2. Roberto S. Martins
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  3. Gilda di Masi
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  4. Gonzalo Bonilla
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  5. Mario Siqueira
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Correspondence to Mariano Socolovsky.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Being this a retrospective study, formal consent is not required.

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Informed consent was obtained from all individual participants included in the study. When identifying information about participants is available in the article, additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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The authors report no conflicts of interests concerning the materials or methods used in this study or the findings specified in this paper. No funding or financial support was received upon confection of the present paper by the authors

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Comment

A well done study that confirms that facial reanimation, as assessed by either a standard (House-Brackmann) or newly developed as yet unverified grading system by the authors, gets better results when either a direct hemihypoglossal-to-facial nerve or masseter-to-facial nerve transfer is performed compared to the former combined with a nerve graft. In addition, the results are better when the nerve repair procedure is done within 2 years of the initial injury. Although these results are neither new or surprising, the data is believable and well presented.

Michel Kliot

Illinois, USA

This original material has never been presented or published previously

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Socolovsky, M., Martins, R.S., di Masi, G. et al. Treatment of complete facial palsy in adults: comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihipoglossal-facial neurorrhaphy with grafts, and masseter to facial nerve transfer. Acta Neurochir 158, 945–957 (2016). https://doi.org/10.1007/s00701-016-2767-7

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