Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve

• Published in: Otology & neurotology Vol. 35; no. 3; p. 509
• Main Authors: Slattery, 3rd, William H, Cassis, Adam M, Wilkinson, Eric P, Santos, Felipe, Berliner, Karen
• Format: Journal Article
• Language: English
• Published: United States 01.03.2014
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Child; Facial Nerve - surgery; Facial Paralysis - surgery; Female; Follow-Up Studies; Humans; Hypoglossal Nerve - surgery; Male; Middle Aged; Nerve Transfer - methods; Retrospective Studies; Treatment Outcome; Young Adult
• ISSN: 1537-4505
• DOI: 10.1097/MAO.0b013e3182936bcf

To describe results in a large series of patients using a recent variation of hypoglossal-facial nerve anastomosis (HFA) in which the intratemporal facial nerve segment is used, obviating the need for a sensory nerve "jump graft." Retrospective chart review. Tertiary neurotologic referral center. Nineteen patients (12 female/7 male subjects) with facial paralysis because of posterior fossa surgery for tumor (n = 15), Bell's palsy (n = 1), facial neuroma (n = 1), hemangioma (n = 1), and trauma (n = 1) who underwent HFA from 1997 to 2011, with at least 1-year follow-up. Mean age at surgery is 47.4 years (range, 11.2-83 yr). Mean follow-up is 4.0 years. Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve (swingdown HFA). House-Brackmann (H-B) facial nerve grade. Seven patients (36.8%) achieved an H-B Grade III, 9 patients (47.4%) a grade IV, and 3 patients (15.8%) a grade V at last follow-up. No patients complained of dysphagia, dysarthria, or had evidence of oral incompetence. One patient complained of mild tongue weakness. Age at time of HFA (p ≤ 0.049, III younger than V) and time from facial nerve injury to HFA (p ≤ 0.02, III<IV and V) were significant factors for ultimate facial nerve outcome. All patients with an H-B III result had HFA within 6 months of injury. Other factors were not significant. The HFA swingdown technique is a safe and effective method to restore facial nerve function in patients with facial paralysis and obviates the need for an interposition jump graft.