European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 1, pp 209–216 | Cite as

A comparative retrospective study: hypoglossofacial versus masseterofacial nerve anastomosis using Sunnybrook facial grading system

  • Nasser M. Altamami
  • Sandra Zaouche
  • Delphine Vertu-CiolinoEmail author
Head & Neck



The aim of our study is to compare the functional results between two surgical techniques for reanimation of facial paralysis: hypoglossal-to-facial versus masseteric-to-facial nerve anastomosis.


This is a retrospective study of 13 patients treated for complete facial paralysis in two medical tertiary centers. The patients were classified into two groups. First group: masseteric-to-facial nerve anastomosis. Second group: hypoglossofacial nerve anastomosis. Sunnybrook facial grading system was used to evaluate the functional results. The mean scores were compared using Mann–Whitney test. The correlation between the age at surgery, the delay in time from the onset of the facial paralysis to the time of surgery and the results of Sunnybrook scores was studied using correlation and linear regression.


No significant statistical difference was found between the mean of total score of the two groups (first group = 38 ± 4.898, second group = 37.83 ± 4.956). All the patients treated by hypoglossofacial nerve anastomosis presented with hemiglossal atrophy. We found slight superiority for the masseterofacial nerve anastomosis in dynamic movements, whereas at rest the hypoglossofacial anastomosis is slightly better. All the differences were not statistically significant. No correlation was found between the age at surgery (age range included 32–73 years) and post-operative results. No correlation was found between the delays up to 24 months from the onset of the facial paralysis and post-operative results.


Our study showed that both types of anastomosis are effective with comparable results. The masseterofacial nerve anastomosis is preferred when possible to avoid the hemiglossal atrophy and its complications.


Facial paralysis reanimation Hypoglossofacial nerve anastomosis Masseterofacial nerve anastomosis 



The authors declare that no funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors (Nasser Al Tamami, Sandra Zaouche, and Delphine Vertu-Ciolino) have no conflict of interest.


  1. 1.
    Leckenby J, Grobbelaar A (2013) Smile Restoration for Permanent Facial Paralysis. Arch Plastic Surg 40(5):633CrossRefGoogle Scholar
  2. 2.
    Glicenstein J (2015) Histoire de la paralysie faciale. Annales de Chirurgie Plastique Esthétique 60(5):347–362CrossRefGoogle Scholar
  3. 3.
    Hammerschlag P (1999) Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: Evolution in management of facial paralysis. Laryngoscope 109(S90):1–23CrossRefGoogle Scholar
  4. 4.
    McLaughlin CR (1953) Surgical support in permanent facial paralysis. Plast Reconstr Surg 11(4):302–314CrossRefGoogle Scholar
  5. 5.
    Love JG (1951) Nerve anastomosis in the treatment of facial paralysis: Special consideration of the etiologic role of total removal of tumors of the acoustic nere. AMA Arch Surg 62(3):379–390CrossRefGoogle Scholar
  6. 6.
    Hirsh L, Murtagh F (1978) Spinofacial anastomosis. Acta Neurochir 40(3–4):285–297CrossRefGoogle Scholar
  7. 7.
    Fernandez E, Doglietto F, Ciampini A, Lauretti L (2007) Hypoglossal-facial anastomosis. J Neurosurg 107(1):244–245CrossRefGoogle Scholar
  8. 8.
    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(2):203–206CrossRefGoogle Scholar
  9. 9.
    Manni J, Beurskens C, van de Velde C, Stokroos R (2001) Reanimation of the paralyzed face by indirect hypoglossal-facial nerve anastomosis. Am J Surg 182(3):268–273CrossRefGoogle Scholar
  10. 10.
    Atlas M, Lowinger D (1997) A new technique for hypoglossal-facial nerve repair. Laryngoscope 107(7):984–991CrossRefGoogle Scholar
  11. 11.
    Yetiser S, Karapinar U (2007) Hypoglossal-facial nerve anastomosis: a meta-analytic study. Ann Otol Rhinol Laryngol 116(7):542–549CrossRefGoogle Scholar
  12. 12.
    Sleilati F, Nasr M, Stephan H, Asmar Z, Hokayem N (2010) Treating facial nerve palsy by true termino-lateral hypoglossal–facial nerve anastomosis. J Plastic Reconstr Aesth Surg 63(11):1807–1812CrossRefGoogle Scholar
  13. 13.
    Klebuc M (2011) Facial reanimation using the masseter-to-facial nerve transfer. Plast Reconstr Surg 127(5):1909–1915CrossRefGoogle Scholar
  14. 14.
    Wang W, Yang C, Li Q, Li W, Yang X, Zhang Y (2014) Masseter-to-facial nerve transfer: a highly effective technique for facial reanimation after acoustic neuroma resection. Ann Plast Surg 73:S63–S69CrossRefGoogle Scholar
  15. 15.
    Hardy R, Perret G, Meyers R (1957) Phrenicofacial nerve anastomosis for facial paralysis. J Neurosurg 14(4):400–404CrossRefGoogle Scholar
  16. 16.
    Perret G (1967) Results of phrenicofacial nerve anastomosis for facial paralysis. Arch Surg 94(4):505–508CrossRefGoogle Scholar
  17. 17.
    Körte W, Bernhardt M (1903) Ein Fall von Nervenpfropfung: Des Nervus facialis auf den Nervus hypoglossus. DMW 29(17):293–295CrossRefGoogle Scholar
  18. 18.
    May M (2000) Nerve substitution techniques: XII-VII hook-up, XII-VII jump graft, and cross-face graft. The facial nerve. 2nd ed. New York: Thieme, pp 611–634Google Scholar
  19. 19.
    Okochi M, Ueda K, Okochi H, Asai E, Sakaba T, Kajikawa A (2015) Facial reanimation using hypoglossal-facial neurorrhaphy with end-to-side coaptation between the jump interpositional nerve graft and hypoglossal nerve: outcome and duration of preoperative paralysis. Microsurgery 36(6):460–466CrossRefGoogle Scholar
  20. 20.
    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(4):786–791CrossRefGoogle Scholar
  21. 21.
    Sood S, Anthony R, Homer J, Van Hille P, Fenwick J (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(3):219–226CrossRefGoogle Scholar
  22. 22.
    Biglioli F, Colombo V, Rabbiosi D et al (2017) Masseteric–facial nerve neurorrhaphy: Results of a case series. J Neurosurg 126(1):312–318CrossRefGoogle Scholar
  23. 23.
    Klebuc M (2015) The evolving role of the masseter-to-facial (V–VII) nerve transfer for rehabilitation of the paralyzed face. Annales de Chirurgie Plastique Esthétique 60(5):436–441CrossRefGoogle Scholar
  24. 24.
    Fournier H, Denis F, Papon X, Hentati N, Mercier P (1997) An anatomical study of the motor distribution of the mandibular nerve for a masseteric-facial anastomosis to restore facial function. Surg Radiol Anat 19(4):241–244CrossRefGoogle Scholar
  25. 25.
    Brenner E, Schoeller T (1998) Masseteric nerve: a possible donor for facial nerve anastomosis? Clin Anat 11(6):396–400CrossRefGoogle Scholar
  26. 26.
    Bermudez L, Nieto L (2004) Masseteric-facial nerve anastomosis: case report. J Reconstr Microsurg 21(01):25–30CrossRefGoogle Scholar
  27. 27.
    Biglioli F, Frigerio A, Colombo V et al (2012) Masseteric–facial nerve anastomosis for early facial reanimation. J Cranio-Maxillofac Surg 40(2):149–155CrossRefGoogle Scholar
  28. 28.
    Sforza C, Frigerio A, Mapelli A et al (2012) Facial movement before and after masseteric-facial nerves anastomosis: a three-dimensional optoelectronic pilot study. J Cranio-Maxillofac Surg 40(5):473–479CrossRefGoogle Scholar
  29. 29.
    Bianchi B, Ferri A, Ferrari S, Copelli C, Salvagni L, Sesenna E (2014) The masseteric nerve: a versatile power source in facial animation techniques. Br J Oral Maxillofac Surg 52(3):264–269CrossRefGoogle Scholar
  30. 30.
    Brener MJ, Neely JG (2004) Approaches to grading facial nerve function. Semin Plastic Surg 18(1):13–21CrossRefGoogle Scholar
  31. 31.
    House JW (1983) Facial nerve grading systems. Laryngoscope 93(8):1056–1069CrossRefGoogle Scholar
  32. 32.
    Brackmann D, Barrs D (1984) Assessing recovery of facial function following acoustic neuroma surgery. Otolaryngol Head Neck Surg 92(1):88–93CrossRefGoogle Scholar
  33. 33.
    House J, Brackmann D (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93(2):146–147CrossRefGoogle Scholar
  34. 34.
    Ross B, Fradet G, Nedzelski J (1996) Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg 114(3):380–386CrossRefGoogle Scholar
  35. 35.
    Neely J, Cherian N, Dickerson C, Nedzelski J (2010) Sunnybrook facial grading system: reliability and criteria for grading. Laryngoscope 120(5):1038–1045Google Scholar
  36. 36.
    Wei-Li H, Ross B, Nedzelski J (2001) Reliability of the Sunnybrook facial grading system by novice users. The J Otolaryngol 30(04):208CrossRefGoogle Scholar
  37. 37.
    Kanerva M, Poussa T, Pitkäranta A (2006) Sunnybrook and House-Brackmann facial grading systems: intrarater repeatability and interrater agreement. Otolaryngol Head Neck Surg 135(6):865–871CrossRefGoogle Scholar
  38. 38.
    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(5):662e–672eCrossRefGoogle Scholar
  39. 39.
    Socolovsky M, Martins R, di Masi G, Bonilla G, Siqueira M (2016) Treatment of complete facial palsy in adults: Comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihypoglossal-facial neurorrhaphy with grafts, and masseter to facial nerve transfer. Acta Neurochir 158(5):945–957CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Otolaryngology, Facial Plastic and Cervicofacial SurgeryEdouard Herriot HospitalLyon Cedex 03France
  2. 2.Department of Otolaryngology, and OtoneurosurgerySouth of Lyon Hospital CenterLyonFrance

Personalised recommendations