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15.03.2016 | Clinical Article - Neurosurgical Techniques | Ausgabe 5/2016

Acta Neurochirurgica 5/2016

Treatment of complete facial palsy in adults: comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihipoglossal-facial neurorrhaphy with grafts, and masseter to facial nerve transfer

Zeitschrift:
Acta Neurochirurgica > Ausgabe 5/2016
Autoren:
Mariano Socolovsky, Roberto S. Martins, Gilda di Masi, Gonzalo Bonilla, Mario Siqueira
Wichtige Hinweise
This original material has never been presented or published previously

Comment

A well done study that confirms that facial reanimation, as assessed by either a standard (House-Brackmann) or newly developed as yet unverified grading system by the authors, gets better results when either a direct hemihypoglossal-to-facial nerve or masseter-to-facial nerve transfer is performed compared to the former combined with a nerve graft. In addition, the results are better when the nerve repair procedure is done within 2 years of the initial injury. Although these results are neither new or surprising, the data is believable and well presented.
Michel Kliot
Illinois, USA

Abstract

Background

The hypoglossal (with or without grafts) and masseter nerves are frequently used as axon donors for facial reinnervation when no proximal stump of the facial nerve is available. We report our experience treating facial nerve palsies via hemihypoglossal-to-facial nerve transfers either with (HFG) or without grafts (HFD), comparing these outcomes against those of masseteric-to-facial nerve transfers (MF).

Method

A total of 77 patients were analyzed retrospectively, including 51 HFD, 11 HFG, and 15 MF nerve transfer patients. Both the House-Brackmann (HB) scale and our own, newly-designed scale to rate facial reanimation post nerve transfer (quantifying symmetry at rest and when smiling, eye occlusion, and eye and mouth synkinesis when speaking) were used to enumerate the extent of recovery.

Results

With both the HB and our own facial reanimation scale, the HFD and MF procedures yielded better outcome scores than HFG, though only the HGD was statistically superior. HGD produced slightly better scores than MF for everything but eye synkinesis, but these differences were generally not statistically significant. Delaying surgery beyond 2 years since injury was associated with appreciably worse outcomes when measured with our own but not the HB scale. The only predictors of outcome were the surgical technique employed and the duration of time between the initial injury and surgery.

Conclusions

HFD appears to produce the most satisfactory facial reanimation results, with MF providing lesser but still satisfactory outcomes. Using interposed grafts while performing hemihypoglossal-to-facial nerve transfers should likely be avoided, whenever possible.

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