Hypoglossal-Facial Anastomosis for Facial Nerve Reconstruction: Outcomes using the Side-to-End Surgical Technique

Abstract

Introduction The side-to-end hypoglossal-facial anastomosis (HFA) technique is an excellent alternative technique to the classic end-terminal anastomosis, because it may decrease the symptoms resulting from hypoglossal-nerve transection. Methods Patients with facial nerve palsy (House-Brackmann [HB] grade VI) requiring facial reconstruction from 2014 to 2017were retrospectively included in the study. Results In total, 12 cases were identified, with a mean follow-up of 3 years. The causes of facial paralysis were due to resection of posterior-fossa tumors and trauma. There was improvement in 91.6% of the patients (11/12) after the HFA. The rate of improvement according to the HB grade was as follows: HB III - 58.3%; HB IV - 16.6%; and HB II - 16.6%. The first signs of improvement were observed in the patients with the shortest time between the paralysis and the anastomosis surgery (3.5 months versus 8.5 months; p = 0.011). The patients with HB II and III had a shorter time between the diagnosis and the anastomosis surgery (mean: 5.22 months), while the patients with HB IV and VI had a longer time of paresis (mean: 9.5 months; p = 0.099). We did not observe lingual atrophy or changes in swallowing. Discussion and Conclusion Hypoglossal-facial anastomosis with the terminolateral technique has good results and low morbidity in relation to tongue motility and swallowing problems. The HB grade and recovery appear to be better in patients operated on with a shorter paralysis time.

Feasibility of an endoscope-dominated side-to-end hypoglossal-facial anastomosis: an anatomical study

“…A retroauricular-arch incision was made, exposing the mastoid process and extending caudally along the anterior border of the sternocleidomastoid muscle until just above the angle of the mandible ( Figure 1A ) ( 12 ). Attention was given to avoid injury to the greater auricular nerve ( Figure 1B ).…”

“…In microscopic surgery, the styloid process ( Figures 2B,C ) is traditionally used as a landmark for localizing the stylomastoid foramen and the main trunk of the facial nerve ( 12 , 13 ). Using an endoscope, we found that the facial nerve and its branches were located more superficially than the styloid process ( Figures 2B,C ), and we could easily identify them without using the styloid process as a landmark, both in the stylomastoid foramen area ( Figure 2C ) and within the parotid gland ( Figure 2E ).…”

“…The structures exposed in classic mastoidectomy are shown in Figure 4 ( 12 , 13 ). We performed a simulated endoscope-dominated transaditus hypoglossal-facial nerve anastomosis surgery with some modifications, exploiting the advantages of the endoscope, including the broad surgical fields, multiple surgical views, and ability to quickly switch among different surgical fields.…”

“…Under endoscopy, the facial nerve was skeletonized from the second (external) genu ( 12 , 13 ) to the stylomastoid foramen ( Figure 6K ), leaving behind only a thin layer of bone over the facial nerve, which was removed later with a microdissector ( Figure 6L ). The soft tissues, including the vessels in the facial canal and the nerve sheath, were left intact to preserve the vascular supply to the facial nerve ( Figure 6L ).…”

Effectiveness of Hypoglossal-Facial Anastomosis in the Rehabilitation of Facial Paralysis Following Vestibular Schwannoma Surgery: A Systematic Review

“…Ruschel et al (2020) analyzed the 'side-to-end' HFA technique to assess seven patients with FP secondary to VS resection [ 7 ]. All patients initiated with grade VI on the HB scale, and all exhibited positive outcomes.…”