Hypoglosso-facial nerve anastomosis

Abstract

The hypoglosso-facial nerve anastomosis (HFA) is a valuable surgical procedure for the treatment of certain types of facial paralysis. HFA was performed 1 to 22 months after resection of an acoustic neurinoma in 32 patients where the operation was complicated by unilateral facial palsy. 56% of these patients obtained excellent facial function, and a total of 66% were satisfied and would have repeated the operation even with their present knowledge about the disadvantages. The recovery of facial function after any nerve anastomosis or plastic procedure is never perfect but HFA usually results in symmetry of the face in response and animation of the face during conversation. HFA is most effective when used as soon as possible after facial palsy has developed, provided a sufficient time has passed for any possible spontaneous recovery. This waiting period should not exceed six months. If the operation is done promptly the results improve, probably because only slight atrophy has occurred in the facial muscles. The disadvantages of HFA are hemiatrophy of the tongue, mass movement of the face and, in some instances, hypertonia of the face. The advantages are improved facial tone with ameliorated cosmetic result, protection of the eye, intentional facial movements controlled by the tongue, and movements associated with physiological function of the tongue.

Hypoglossal-Facial Anastomosis in Complete Unilateral Facial Palsy

“…Iansek et al [7] described difficulty in moving food around the mouth and initiating swallowing in several patients. Linnet and Madsen [14] described 'speech problems' in 21 of 32 patients; however, 'nearly all' had similar difficulties before surgery.…”

Achados fonoaudiológicos em pacientes submetidos a anastomose hipoglosso facial

“…Esses achados conferem com os encontrados na literatura, que discorrem sobre os distúrbios no movimento e na execução das funções da fala, mastigação e na deglutição, presentes na hemiatrofia da língua 5 .…”

“…Uma das indicações cirúrgicas para a AHF ocorre após a exerése do Schwannoma do Nervo Vestibular (Neurinoma do VIII par) 3 , quando instalada a paralisia facial unilateral, levando à uma assimetria facial, falta dos movimentos dos músculos da face, associados a sincinesias e a espasmos 4,5 . Outras indicações seriam todos os casos onde a porção proximal do nervo facial está inviável.…”

"O uso da toxina botulínica em doentes com hipercinesia muscular facial contralateral à paralisia facial"

“…Apresenta inclusive potencial para tratar a hipertonia da face que resulta da anastomose entre os nervos facial e o hipoglosso 75 . Além disso, pode reduzir os efeitos adversos advindos do mau posicionamento de reinervações cirúrgicas 76,77 , e controlar a hiperfunção do lado contralateral e, conseqüentemente, melhorar a assimetria 43,44,45,46,47 .…”

“…A análise do resultado da reanimação facial em pacientes com paralisia facial é limitada pela dificuldade de se estabelecer métodos simples e quantitativos sobre o movimento facial 75,82,83 .…”