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Hypoglossal facial nerve anastomosis

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This procedure allows a straight end-to-side hypoglossal—facial anastomosis without interruption of the 12th cranial nerve or the need for graft interposition. It is technically demanding and time consuming but offers an effective, reliable, and extraordinarily quick means of reinnervating the facial muscles, including the orbicularis oculi muscle, thus avoiding the need for a gold weight in the eyelid or a fascial sling. Drawing illustrating the surgical procedure. The facial nerve is extracted from the fallopian canal, rerouted, and neurotized end to side to the hypoglossal nerve distal to the descending ansa.
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Hypoglossal–Facial Nerve Anastomosis

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Hypoglossal–Facial Nerve Anastomosis | SpringerLink

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.
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End-to-side intrapetrous hypoglossal–facial anastomosis for reanimation of the face

Samii's Essentials in Neurosurgery pp Cite as. Among the various aetiologies, the neurosurgeon is most likely to deal with the traumatic [32] and neoplastic ones. Unable to display preview.
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Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis House-Brackmann grade VI treated with hypoglossal-facial nerve XII-VII anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback. Three years after the anastomosis, Time to reinnervation was associated with the final House-Brackmann grade. Our study demonstrates that patients undergoing XII-VII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The recovery continues for at least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable.
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