New techniques for optimum reconstruction of the facial nerve in its extemporal course.

Microsurgery of the facial nerve has resulted in a great progress by regaining, thanks to its various techniques, not only the voluntary movements of the face but in addition also the emotional expressive motility. It has become evident, however, that one disadvantage is always unavoidable even in the most subtle reconstructive measures: the development of mass-movements. It is the aim of our work to reduce these mass-movements, or even better to prevent their occurrence right from the beginning. We have therefore developed the diversification method. The human face is divided into two functional spheres: the upper face and the lower face. Reinnervation of both facial regions is achieved by two nerves: the upper face by means of the original facial nerve (with intercalation of a free nerve transplant), and the lower face by means of a hypoglossofacial anastomosis. The advantages of this combined operation technique and its neurophysiologic basis are described in detail.