Reanimation of early facial paralysis with hypoglossal/facial end-to-side neurorrhaphy: a new approach.
The classic hypoglossal transfer to the facial nerve invariably results in profound functional deficits in speech, mastication, and swallowing, and causes synkinesis and involuntary movements in the facial muscles despite good reanimation. Techniques such as a hypoglossal/facial nerve interpositional jump graft and splitting the hypoglossal nerve cause poor functional results in facial reanimation and mild-to-moderate hemiglossal atrophy, respectively. Direct hypoglossal/facial nerve cross-over through end-to-side coaptation without tension was done in three fresh cadavers and four patients. The patients had facial paralysis for less than 7 months. Complete mobilization of the facial nerve trunk and its main branches beyond the pes anserinus from the stylomastoid foramen, division of the frontal branch, if necessary, and superior elevation of the hypoglossal nerve after dividing the descendens hypoglossi, thyrohyoidal branches, occipital artery, and retromandibular veins were performed. The end of the facial nerve was hooked up through both a quarter of a partial oblique neurotomy and a perineurial window at the side of the hypoglossal nerve. Temporalis muscle transfer to the eyelids and the first stage of cross-facial nerve transfer were performed simultaneously. None of the patients experienced hemiglossal atrophy, synkinesis, and involuntary movements of the facial muscles. Regarding facial reanimation, one patient had excellent, one patient good, and the others fair and poor results after a follow-up of at least 1 year.