The Split Hypoglossal Nerve and Cross-Face Nerve Graft for Dual Innervation of the Functional Muscle Transfer in Facial Reanimation

Abstract

Facial paralysis is a disabling deformity. The affected individual is seriously affected both esthetically and functionally. Free functional muscle transfer is currently the corner stone in the management of long-standing facial nerve paralysis. Several nerve options are available to supply the free muscle transfer. These nerves can be used alone or in combination. The aim of this work is to study the possibility and results of dually innervating the free functioning muscle transfer. The dual innervation is done using the split hypoglossal nerve and crossface nerve graft (CFNG) both sutured in an end-to-end manner to the nerve to gracilis. Twenty-nine patients with unilateral long-standing facial nerve paralysis (more than 1 y) were treated using free gracilis muscle transfer dually supplied by the split hypoglossal nerve and CFNG, both sutured in an end-to-end manner. The gained excursion after the free gracilis transfer was 9 to 29 mm (mean: 17.24 mm). A statistically significant increase (P-value = 0.0001) in the distance from where the midline crosses the lower vermilion border to commissure occurred from preoperative (mean: 16.55 mm) to postoperative setting (mean: 33.79 mm). Spontaneity was achieved in 26 patients (89.6%). In conclusion, dual innervation of the free muscle transfer using both the split hypoglossal nerve and CFNG (both sutured in an end-to-end manner to the nerve to gracilis) is a good possible option to treat long-standing cases of facial nerve paralysis. It yields adequate muscle excursion with acceptable spontaneity.

Letter to “The Split Hypoglossal Nerve and Cross-Face Nerve Graft for Dual Innervation of the Functional Muscle Transfer in Facial Reanimation”

“…To the Editor: Eyeball rupture, even if rare, is one of the most serious global injuries, leading to visual loss and/or enucleation. 1 This event is most frequent in case of concomitant orbital fractures, in which most commonly the wound is located further than 5 mm over the limbus (type 3). 2 However, there are only few reports of orbital fractures associated with orbital trauma and their management.…”

“…Although we are fascinated by their work, we desire to ask a few questions about some points that caught our attention. 1 I am writing to bring attention to the differences in postoperative physiotherapy requirements for patients who have undergone facial reanimation surgery using either the masseter nerve or the hypoglossal nerve in dual innervation with a free gracilis muscle flap.…”

“…To the Editor: We have read the article “The Split Hypoglossal Nerve and Cross-Face Nerve Graft for Dual Innervation of the Functional Muscle Transfer in Facial Reanimation” and we congratulate the authors for their precious studies. Although we are fascinated by their work, we desire to ask a few questions about some points that caught our attention 1 …”