The Masseteric-Facial Anastomosis With Intratemporal Translocation of the Facial Nerve: Step-by-Step Technique and Results

2021 ◽  
Author(s):  
Stefano Ferraresi ◽  
Elisabetta Basso ◽  
Lorenzo Maistrello ◽  
Piero Di Pasquale
Keyword(s):  
Facial Nerve ◽  
Emotional Response ◽  
Hypoglossal Nerve ◽  
Direct Transfer ◽  
Nerve Stump ◽  
Surgical Timing ◽  
Quality Of Results ◽  
Facial Reanimation ◽  
Masseteric Nerve

Abstract BACKGROUND In the absence of a viable proximal nerve stump, damaged after surgical procedures around the skull base, numerous techniques for facial reanimation have been developed over time, aiming to restore baseline symmetry and active mimicry. OBJECTIVE To report experience using the masseteric nerve as a direct transfer to the facial nerve rerouted after intratemporal translocation. This paper illustrates the main steps of the technique and the quality of results. METHODS Eleven patients were treated with a masseteric direct transfer to the facial nerve. Its extratemporal rerouting toward the zygoma allowed tension-free coaptation between donor and recipient nerves. RESULTS Of the 11 patients, 8 had a good to excellent recovery, showing different patterns of time and scores, according to age, surgical timing, and masseteric nerve function quality. The return of activity in the frontalis muscle, never obtained after reinnervation via the hypoglossal nerve, is of particular interest. The quality of the smile can be improved with re-education and practice but remains under volitional control. A true emotional response is still lacking. CONCLUSION The masseteric nerve is an excellent alternative to the hypoglossal nerve and can reinnervate the whole territory of the facial nerve rerouted after intratemporal translocation. The overall results are remarkable, but the low quality of the trigeminal nerve, eventually affected by the first surgery, may be an important limitation. Even if the patients appear more at ease in re-education than with other techniques, a fully natural facial expression remains impossible to obtain.

Using the Post-Descendens Hypoglossal Nerve in Hypoglossal-Facial Anastomosis: An Anatomic and Histologic Feasibility Study

2020 ◽  
Vol 19 (4) ◽  
pp. 436-443
Author(s):  
Ali Tayebi Meybodi ◽  
Leandro Borba Moreira ◽  
Xiaochun Zhao ◽  
Evgenii Belykh ◽  
Michael T Lawton ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Anatomic Study ◽  
Nerve Stump ◽  
Cross Sectional ◽  
Facial Nerves ◽  
Facial Reanimation ◽  
Structural Compatibility

Abstract BACKGROUND Hypoglossal-facial anastomosis (HFA) is a popular facial reanimation technique. Mobilizing the intratemporal segment of the facial nerve and using the post-descendens hypoglossal nerve (ie, the segment distal to the take-off of descendens hypoglossi) have been proposed to improve results. However, no anatomic study has verified the feasibility of this technique. OBJECTIVE To assess the anatomic feasibility of HFA and the structural compatibility between the 2 nerves when the intratemporal facial and post-descendens hypoglossal nerves are used. METHODS The facial and hypoglossal nerves were exposed bilaterally in 10 sides of 5 cadaveric heads. The feasibility of a side-to-end (ie, partial end-to-end) HFA with partial sectioning of the post-descendens hypoglossal nerve and the mobilized intratemporal facial nerve was assessed. The axonal count and cross-sectional area of the facial and hypoglossal nerves at the point of anastomosis were assessed. RESULTS The HFA was feasible in all specimens with a mean (standard deviation) 9.3 (5.5) mm of extra length on the facial nerve. The axonal counts and cross-sectional areas of the hypoglossal and facial nerves matched well. Considering the reduction in the facial nerve cross-sectional area after paralysis, the post-descendens hypoglossal nerve can provide adequate axonal count and area to accommodate the facial nerve stump. CONCLUSION Using the post-descendens hypoglossal nerve for side-to-end anastomosis with the mobilized intratemporal facial nerve is anatomically feasible and provides adequate axonal count for facial reanimation. When compared with use of the pre-descendens hypoglossal nerve, this technique preserves C1 fibers and has a potential to reduce glottic complications.

scholarly journals An Anatomical study for localisation of Zygomatic branch of Facial nerve and Masseteric nerve – An aid to nerve coaptation for facial reanimation surgery: A cadaver based study in Eastern India

2017 ◽  
Vol 50 (01) ◽  
pp. 074-078
Author(s):  
Ratnadeep Poddar ◽  
Alipta Bhattacharya ◽  
Iman Sinha ◽  
Asis Kumar Ghosal
Keyword(s):  
Facial Nerve ◽  
Reference Point ◽  
Copper Wire ◽  
Anatomical Study ◽  
Cross Sectional Study ◽  
Reference Points ◽  
Circular Area ◽  
Cross Sectional ◽  
Facial Reanimation ◽  
Masseteric Nerve

ABSTRACT Context: In cases of chronic facial palsy, where direct neurotisation is possible, ipsilateral masseteric nerve is a very suitable motor donor. We have tried to specifically locate the masseteric nerve for this purpose. Aims: Describing an approach of localisation and exposure of both the zygomatic branch of Facial nerve and the nerve to masseter, with respect to a soft tissue reference point over face. Settings and Design: Observational cross sectional study, conducted on 12 fresh cadavers. Subjects and Methods: A curved incision was given, passing about 0.5cms in front of the tragal cartilage. A reference point “R” was pointed out. The zygomatic branch of facial nerve and masseteric nerve were dissected out and their specific locations were recorded from fixed reference points with help of copper wire and slide callipers. Statistical Analysis Used: Central Tendency measurements and Unpaired “t” test. Results: Zygomatic branch of the Facial nerve was located within a small circular area of radius 1 cm, the centre of which lies at a distance of 1.1 cms (±0.4cm) in males and 0.2cm (±0.1cm) in females from the point, ‘R’, in a vertical (coronal) plane. The nerve to masseter was noted to lie within a circular area of 1 cm radius, the centre of which was at a distance of 2.5cms (±0.4cm) and 1.7cms (±0.2cm) from R, in male and female cadavers, respectively. Finally, Masseteric nerve's depth, from the masseteric surface was found to be 1cm (±0.1cm; male) and 0.8cm (±0.1cm; female). Conclusions: This novel approach can reduce the post operative cosmetic morbidity and per-operative complications of facial reanimation surgery.

Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Walid Ibn Essayed ◽  
Emad Aboud ◽  
Ossama Al-Mefty
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Nerve Function ◽  
Nerve Paralysis ◽  
Carotid Canal ◽  
Great Auricular Nerve ◽  
Facial Nerves ◽  
Facial Reanimation ◽  
Graft Donor ◽  
Facial Nerve Schwannoma

Abstract Facial nerve schwannomas can develop at any portion of the facial nerve.1 When arising from the mastoid portion of the facial nerve, the tumor will progressively erode the mastoid, giving the schwannoma an aggressive radiological appearance.1,2 The facial nerve is frequently already paralyzed, or no fascicles can be saved during resection. In these cases, end-to-end interposition grafting is the best option for facial reanimation.1,3-5 The healthy proximal and distal facial nerves are prepared prior to grafting. The great auricular nerve is readily available near the surgical site and represents an excellent graft donor with minimal associated morbidity.4,6 We demonstrate this technique through a case of a 48-yr-old male who presented with a complete right-sided facial nerve palsy due to a large facial schwannoma that invaded the mastoid and extended to the hypoglossal canal, causing hypoglossal nerve paralysis, and petrous carotid canal. His 4-yr follow-up showed no recurrent tumor with restored facial nerve function palsy to a House-Brackman grade III, and full recovery of his hypoglossal nerve function. The patient consented to the surgery and the publication of his image.

Regeneration of Facial Nerve after Hypoglossal Facial Anastomosis: An Animal Study

1994 ◽  
Vol 111 (6) ◽  
pp. 710-716 ◽  
Author(s):  
Yuh-Shyang Chen ◽  
Naoaki Yanagihara ◽  
Shingo Murakami
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Blink Reflex ◽  
Anastomotic Site ◽  
Orbicularis Oculi Muscle ◽  
Histologic Study ◽  
Cross Sectional ◽  
Proximal Stump ◽  
Nerve Anastomosis

Hypogiossal-facial nerve anastomosis was carried out in 20 adult guinea pigs. Electromyographic responses of orbicularis oculi muscle evoked by blink reflex were recorded 2, 4, and 6 months after surgery. Then the anastomotic site was reopened, and a segment of buccal branch and the anastomotic trunk were resected for detailed histologic study. Regenerated axons were counted, and the cross-sectional area of axons and fasciculi was measured. Data obtained from both blink reflex measurement and histologic study demonstrate a good quality of regeneration of the facial nerve from the hypoglossal nerve completed 6 months after the operation. In addition a new nerve bundle was regenerated from the proximal stump of the facial nerve connecting to the anastomotic site in 80% of the animals. Postoperative change in innervation pattern of the facial nerve was also Illustrated.

scholarly journals Hypoglossal-facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique

1996 ◽  
Vol 1 (2) ◽  
pp. E8 ◽  
Author(s):  
Yutaka Sawamura ◽  
Hiroshi Abe
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Hypoglossal Nerve ◽  
Mastoid Process ◽  
Mastoid Cavity ◽  
Distal Stump ◽  
Delayed Treatment ◽  
Stylomastoid Foramen ◽  
Facial Reanimation ◽  
Nerve Anastomosis

This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of nerve grafts or hemihypoglossal nerve splitting. Using this technique, the mastoid process is partially resected to open the stylomastoid foramen and the descending portion of the facial nerve in the mastoid cavity is exposed by drilling to the level of the external genu and then sectioning its most proximal portion. The hypoglossal nerve beneath the internal jugular vein is exposed at the level of the axis and dissected as proximally as possible. One-half of the hypoglossal nerve is transected: use of less than one-half of the hypoglossal nerve is adequate for approximation to the distal stump of the atrophic facial nerve. The nerve endings, the proximally cut end of the hypoglossal nerve, and the distal stump of the facial nerve are approximated and anastomosed without tension. This technique was used in four patients with long-standing facial paralysis (greater than 24 months), and it provided satisfactory facial reanimation, with no evidence of hemitongue atrophy or dysfunction. Because it completely preserves glossal function, the hemihypoglossal-facial nerve anastomosis described here constitutes a successful approach in patients with long-standing facial paralysis who do not wish to have tongue function compromised.

Facial Reanimation by Means of the Hypoglossal Nerve: Anatomic Comparison of Different Techniques

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-41-ONS-50 ◽  
Author(s):  
Alvaro Campero ◽  
Mariano Socolovsky
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Average Length ◽  
Average Distance ◽  
External Auditory Meatus ◽  
Nerve Transfer ◽  
Mastoid Process ◽  
Digastric Muscle ◽  
Facial Reanimation ◽  
Nerve Anastomosis

Abstract Objective: The goal of this study was to determine the various anatomical and surgical relationships between the facial and hypoglossal nerves to define the required length of each for a nerve transfer, either by means of a classical hypoglossal-facial nerve anastomosis or combined with any of its variants developed to reduce tongue morbidities. Methods: Five adult cadaver heads were bilaterally dissected in the parotid and submaxillary regions. Two clinical cases are described for illustration. Results: The prebifurcation extracranial facial nerve is found 4.82 ± 0.88 mm from the external auditory meatus, 5.31 ± 1.50 mm from the mastoid tip, 15.65 ± 0.85 mm from the lateral end of C1, 17.19 ± 1.64 mm from the border of the mandible condyle, and 4.86 ± 1.29 mm from the digastric muscle. The average lengths of the mastoid segment of the facial nerve and the prebifurcation extracranial facial nerve are 16.35 ± 1.21 mm and 18.93 ± 1.41 mm, respectively. The average distance from the bifurcation of the facial nerve to the hypoglossal nerve turn is 31.56 ± 2.53 mm. For a direct hypoglossal-facial nerve anastomosis, a length of approximately 19 mm of the hypoglossal nerve is required. For the interposition nerve graft technique, a 35 mm-long graft is required. For the technique using a longitudinally dissected hypoglossal nerve, an average length of 31.56 mm is required. Exposure of the facial nerve within the mastoid process drilling technique requires 16.35 mm of drilling. Conclusion: This study attempts to establish the exact graft, dissection within the hypoglossal nerve, and mastoid drilling requirements for hypoglossal to facial nerve transfer.

Differential Reanimation of the Midface and Lower Face Using the Masseteric and Hypoglossal Nerves for Facial Paralysis

2017 ◽  
Vol 15 (2) ◽  
pp. 174-178 ◽  
Author(s):  
Nobutaka Yoshioka
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Hypoglossal Nerve ◽  
Donor Site ◽  
Mass Movement ◽  
Nerve Transfer ◽  
Short Term ◽  
Lower Face ◽  
Masseteric Nerve

Abstract BACKGROUND Hypoglossal nerve transfer is frequently employed to reanimate the paralyzed facial muscles after irreversible proximal facial nerve injury. However, it can cause significant postoperative synkinesis because it involves the reinnervation of the whole mimetic musculature using a single motor source. OBJECTIVE To describe our experience with differential reanimation of the midface and lower face using separate motor sources in patients with short-term facial paralysis after brain surgery. METHODS Seven patients underwent combined nerve transfer (the masseteric nerve to the zygomatic branch and the hypoglossal nerve to the cervicofacial division of the facial nerve) and cross-facial nerve grafting with the aim of achieving a spontaneous smile. The median duration of paralysis before surgery was 7 mo and follow-up ranged from 7 to 31 mo (mean: 18 mo). For evaluation, both physical examination and video analysis were performed. RESULTS In all patients, reanimation of both the midface and the lower face was successful. A nearly symmetrical resting lip was achieved in all patients, and they were able to voluntarily elevate the corners of their mouths without visible synkinesis and to close their eyes while biting. No patient experienced impairment of masticatory function or tongue atrophy. CONCLUSION Differential reanimation of the midface and lower face with the masseteric and hypoglossal nerves is an alternative method that helps to minimize synkinetic mass movement and morbidity at the donor site.

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