Cross-face facial nerve anastomosis: historical notes.
The anastomosis between the two facial nerves for the treatment of facial paralysis, in which the proximal stump of the severed facial nerve is not accessible, was utilized in eleven patients. The palsy was secondary to resection of an acoustic tumor in nine patients, sarcoma of the petrous bone was the cause in one and an automobile accident in the other. The original concept of anastomosing a branch of the normal pes anserinus to the trunk of the paralyzed facial nerve, as first presented by the author at the Second International Symposium on Facial Nerve Surgery held in Japan in September, 1970, has been modified. The technique of anastomosing the cervico-facial division of the normal facial nerve, and directing it to the temporo-facial division of the paralyzed facial nerve via a sural autograft 20-22 cm long, was combined with the utilization of the ipsilateral descendens cervicalis (hypoglossi). This nerve was anastomosed to the cervico-facial division of the paralyzed facial nerve and utilized in four patients. The technique is illustrated in detail.