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.

Hypoglossal-Facial Side-to-End Neurorrhaphy With Concomitant Masseteric-Zygomatic Nerve Branch Coaptation and Muscle Transfer for Facial Reanimation: Technique and Case Report

2020 ◽  
Vol 19 (3) ◽  
pp. E230-E235
Author(s):  
Nobutaka Yoshioka
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Mass Movement ◽  
Nerve Transfer ◽  
Nerve Graft ◽  
Gracilis Muscle ◽  
Muscle Transfer ◽  
Nerve Branch ◽  
Facial Reanimation ◽  
Healthy Side

Abstract BACKGROUND Hypoglossal-facial direct side-to-end neurorrhaphy has become widely used for facial reanimation in patients with irreversible facial nerve damage. Although this procedure achieves good restoration of facial function, it has disadvantages such as mass movement and lack of spontaneity. OBJECTIVE To present a new facial reanimation technique using hypoglossal-facial direct side-to-end neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and secondary muscle transfer to reduce mass movement and achieve a spontaneous smile in patients with facial paralysis. METHODS This article describes a novel facial reanimation technique that employs hypoglossal and masseteric nerve transfer combined with secondary vascularized functional gracilis muscle transfer. RESULTS Details of the technique are reported in a patient with complete facial paralysis after brain surgery. The hypoglossal nerve was partially served and connected to the mastoid segment of the facial nerve by side-to-end anastomosis to restore facial symmetry. A nerve supplying the masseter muscle was coapted with a zygomatic branch by end-to-end anastomosis to restore voluntary movement of the oral commissure, as well as to assist with eye closure. A cross face sural nerve graft was connected to zygomatic branches on the healthy side. In the second stage, a vascularized functional gracilis muscle graft was transplanted using the cross face nerve graft as the donor nerve to restore a natural smile. CONCLUSION Hypoglossal-facial neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and muscle transfer is an alternative facial reanimation technique that reduces mass movement and achieves a natural smile.

Hemihypoglossal nerve transfer for acute facial paralysis

2013 ◽  
Vol 118 (1) ◽  
pp. 160-166 ◽  
Author(s):  
Ayato Hayashi ◽  
Masanobu Nishida ◽  
Hisakazu Seno ◽  
Masahiro Inoue ◽  
Hiroshi Iwata ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Hypoglossal Nerve ◽  
Severe Infection ◽  
Nerve Transfer ◽  
Average Period ◽  
Success Rates ◽  
Functional Deficits ◽  
Facial Reanimation ◽  
Nerve Anastomosis

Object The authors have developed a technique for the treatment of facial paralysis that utilizes anastomosis of the split hypoglossal and facial nerve. Here, they document improvements in the procedure and experimental evidence supporting the approach. Methods They analyzed outcomes in 36 patients who underwent the procedure, all of whom had suffered from facial paralysis following the removal of large vestibular schwannomas. The average period of paralysis was 6.2 months. The authors used 5 different variations of a procedure for selecting the split nerve, including evaluation of the split nerve using recordings of evoked potentials in the tongue. Results Successful facial reanimation was achieved in 16 of 17 patients using the cephalad side of the split hypoglossal nerve and in 15 of 15 patients using the caudal side. The single unsuccessful case using the cephalad side of the split nerve resulted from severe infection of the cheek. Procedures using the ansa cervicalis branch yielded poor success rates (2 of 4 cases). Some tongue atrophy was observed in all variants of the procedure, with 17 cases of minimal atrophy and 14 cases of moderate atrophy. No procedure led to severe atrophy causing functional deficits of the tongue. Conclusions The split hypoglossal-facial nerve anastomosis procedure consistently leads to good facial reanimation, and the use of either half of the split hypoglossal nerve results in facial reanimation and moderate tongue atrophy.

The kite flap for reconstructing tumour excision wounds in the middle and lower face: a retrospective study

2020 ◽  
Vol 29 (10) ◽  
pp. 562-566
Author(s):  
Ma Yan ◽  
Zhou Xiaobo ◽  
Yuan Zhaoqi ◽  
Wang Xiuxia ◽  
Jin Rui ◽  
...  
Keyword(s):  
Primary Closure ◽  
Donor Site ◽  
Malignant Tumour ◽  
Complete Excision ◽  
Recipient Site ◽  
Lower Face ◽  
Kite Flap ◽  
Facial Wounds ◽  
Surrounding Skin

Objective: The aim of this study was to present our experience with a kite flap in reconstruction of facial wounds after malignant tumour excision. Method: From October 2008 to September 2017, patients with facial malignant tumour were treated in the Xinjiang Uygur Autonomous Region Bazhou People's Hospital with kite flaps after complete excision. The survival rate, colour, cicatrix of the flap and patient satisfaction were recorded after surgery. Results: A total of 95 patients were included in the study. During follow-up, from six months to 8 years, all the kite flaps achieved primary closure and survived well, and the colour and texture were similar to the surrounding skin with no obvious scar. Dysfunction, complications and recurrence had not been reported. Conclusion: The kite flap may be a good option in reconstructing facial wounds after malignant tumour excision (diameters 1–5cm). It is a simple surgical method with sufficient blood supply and extensive adaptability. For patients in this study, no obvious scars were formed and the recipient site matched well with the donor site.

Hemihypoglossal-Facial Nerve Transfer: Technical Description and Key Points: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E53-E54
Author(s):  
Guido Caffaratti ◽  
Sebastián Juan María Giovannini ◽  
Daniel Orfila ◽  
Mariano Socolovsky
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
High Speed ◽  
Hypoglossal Nerve ◽  
Nerve Transfer ◽  
Point Of View ◽  
Detailed Knowledge ◽  
Key Points ◽  
Psychological Point ◽  
Cervical Segment

ABSTRACT Irreversible facial palsy, generally post-traumatic or postsurgical, can have devastating consequences for the patient from a functional, aesthetic, and psychological point of view. Among all of the reconstructive techniques, the hemihypoglossal-facial nerve transfer, which avoids the complete section of the hypoglossal nerve, is preferred by senior authors because of its excellent results and very low morbidity.1-5 This technique can be carried out in any neurosurgical center because it requires only basic instruments of microsurgery and a high-speed drill. However, detailed knowledge of the anatomy of the facial nerve in both its intrapetrosal and extracranial segments and of the hypoglossal nerve in its cervical segment is essential.1,6,7 Thus, previous practice in a cadaveric laboratory is recommended. The purpose of this video is to describe the technical nuances and key points of hemihypoglossal-facial nerve transfer. It was made using the surgical videos of 5 patients with a complete and irreversible facial paralysis who were operated using this technique in our institution between May and September 2019, all of whom consented to the procedure and to use for scientific purposes. The footages were edited, making a film in which the surgical technique is described in a stepwise fashion, emphasizing its most important features. To conclude, we would like to emphasize that the timing of surgery is of utmost importance and that this technique is both effective and reliable. Figures in the video at 00:54 and 01:35 are reprinted by permission from CCC: Springer Nature, Acta Neurochirurgica, Treatment of complete facial palsy in adults: comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihipoglossal-facial neurorrhaphy with grafts, and massater to facial nerve transfer. Socolovsky M, Martins RS, di Masi G, Bonilla G, Siqueira M, vol 158, 945-957, copyright 2016.

Anterior Interosseous–to–Ulnar Motor Nerve Transfers: A Single Center’s Experience in Restoring Intrinsic Hand Function

Hand ◽  
2020 ◽  
pp. 155894472092848
Author(s):  
Graham J. McLeod ◽  
Blair R. Peters ◽  
Tanis Quaife ◽  
Tod A. Clark ◽  
Jennifer L. Giuffre
Keyword(s):  
Outcome Measures ◽  
Motor Nerve ◽  
Hand Function ◽  
Donor Site ◽  
Nerve Transfer ◽  
Secondary Outcome ◽  
No Donor ◽  
Motor Branch ◽  
Nerve Transfers

Background: Transfer of the anterior interosseous nerve (AIN) into the ulnar motor branch improves intrinsic hand function in patients with high ulnar nerve injuries. We report our outcomes of this nerve transfer and hypothesize that any improvement in intrinsic hand function is beneficial to patients. Methods: A retrospective review of all AIN-to-ulnar motor nerve transfers, including both supercharged end-to-side (SETS) and end-to-end (ETE) transfers, from 2011 to 2018 performed by 2 surgeons was conducted. All adult patients who underwent this nerve transfer for any reason with greater than 6 months’ follow-up and completed charts were included. Primary outcome measures were motor function using the British Medical Research Council (BMRC) grading system and subjective satisfaction with surgery using a visual analog scale. Secondary outcome measures included complications and donor site deficits. Results: Of the 57 patients who underwent nerve transfer, 32 patients met the inclusion criteria. The average follow-up and average time to surgery were 12 and 15.6 months, respectively. The overall average BMRC score was 2.9/5, with a trend toward better recovery in patients who received earlier surgery (<12 months = BMRC 3.7, ≥12 months = BMRC 2.2; P < .01). Patients with an SETS transfer had better results that those with an ETE transfer (SETS = 3.2, ETE = 2.6). There were no donor deficits after operation. One patient developed complex regional pain syndrome. Conclusions: Patients with earlier surgery and an in-continuity nerve (receiving an SETS transfer) showed improved recovery with a higher BMRC grade compared with those who underwent later surgery. Any improvements in intrinsic hand function would be beneficial to patients.

scholarly journals Epidemiological Study of Bell's Palsy in patients From Western Nepal

2020 ◽  
Vol 2 (2) ◽  
pp. 41-46
Author(s):  
Krishna Prasad Koirala
Keyword(s):  
Young Adults ◽  
Facial Nerve ◽  
Motor Neuron ◽  
Facial Paralysis ◽  
Bell’S Palsy ◽  
Sudden Onset ◽  
Lower Motor Neuron ◽  
Bell's Palsy ◽  
Short Term ◽  
Early Recovery

 Background: Bell's palsy is defined as idiopathic, sudden onset, unilateral lower motor neuron facial paralysis. The etiology of Bell's palsy is unclear. It affects all age ranges with complete recovery in most cases. However, few patients are left with a considerable permanent functional deficit. The disease has variable progression ranging from few hours to days. Diagnosis is usually made when a patient presents with sudden onset unilateral lower motor neuron facial paralysis without an obvious cause. Different medical therapies such as steroids, antivirals, physiotherapy, acupuncture, etc. have been used to enhance the recovery of Bell's palsy. This study aims to find out the common age of presentation of people with Bell's palsy, and also to report their outcome with the use of steroids. Materials and methods: This study is a prospective observational study carried out in the department of ENT and Head and neck surgery at Manipal College of Medical Sciences, Pokhara, Nepal. Patients of all ages and both sex with the diagnosis of Bell's palsy meeting the inclusion criteria were studied from 1st Jan 2015 to 31st Dec 2018. Data were taken and analyzed with the help of SPSS software and results were published. Results: Out of 45 patients of Bell's palsy enrolled in the study, females outnumbered the males. Bell's palsy was more commonly seen in young adults There was a significant short-term improvement in Bell's palsy with the use of steroids (p=0.00001). There was no difference in early recovery after Bell's palsy regardless of the time of presentation within a week or age of the patient at presentation. Conclusion: Bell's palsy is more common in young adults. Steroids have a definite role in the short-term improvement of facial nerve function. People presenting within a week of facial nerve palsy can be treated with steroids. People of all ages can equally improve with steroid treatment.

Intratemporal Facial Nerve Transfer With Direct Coaptation to the Hypoglossal Nerve

2007 ◽  
Vol 28 (4) ◽  
pp. 546-550 ◽  
Author(s):  
Willem P. Godefroy ◽  
Martijn J. A. Malessy ◽  
Aimee A. M. Tromp ◽  
Andel G. L. van der Mey
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Nerve Transfer
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