William H Slattery1, Adam M Cassis, Eric P Wilkinson, Felipe Santos, Karen Berliner. 1. *House Clinic and House Research Institute; †Massachusetts Eye and Ear Infirmary, Boston, MA; previously, Clinical Fellow, House Clinic and House Research Institute, Los Angeles; and ‡House Research Institute, Marina del Rey, California, U.S.A.
Abstract
OBJECTIVE: 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." STUDY DESIGN: Retrospective chart review. SETTING: Tertiary neurotologic referral center. PATIENTS: 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. INTERVENTION: Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve (swingdown HFA). MAIN OUTCOME MEASURE: House-Brackmann (H-B) facial nerve grade. RESULTS: 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. CONCLUSION: 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.
OBJECTIVE: 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." STUDY DESIGN: Retrospective chart review. SETTING: Tertiary neurotologic referral center. PATIENTS: 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. INTERVENTION: Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve (swingdown HFA). MAIN OUTCOME MEASURE: House-Brackmann (H-B) facial nerve grade. RESULTS: 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. CONCLUSION: 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.
Authors: Roland Goldbrunner; Michael Weller; Jean Regis; Morten Lund-Johansen; Pantelis Stavrinou; David Reuss; D Gareth Evans; Florence Lefranc; Kita Sallabanda; Andrea Falini; Patrick Axon; Olivier Sterkers; Laura Fariselli; Wolfgang Wick; Joerg-Christian Tonn Journal: Neuro Oncol Date: 2020-01-11 Impact factor: 12.300
Authors: Zdeněk Fík; Josef Kraus; Zdeněk Čada; Martin Chovanec; Alžběta Fíková; Eduard Zvěřina; Jan Betka; Jan Plzák Journal: Eur Arch Otorhinolaryngol Date: 2021-05-25 Impact factor: 2.503
Authors: Steffen Rosahl; Christopher Bohr; Michael Lell; Klaus Hamm; Heinrich Iro Journal: GMS Curr Top Otorhinolaryngol Head Neck Surg Date: 2017-12-18