Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve

The technique of facial nerve repair with side-to-end hypoglossal-facial anastomosis is presented and evaluated in five patients, who were operated on because of facial nerve paralysis after acoustic neuroma surgery or had cranial base trauma. The classic hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing and speaking. In this new technique, the facial nerve is mobilised in the temporal bone, transacted at the second genu and transposed to the hypoglossal nerve, where a tensionless side-to-end anastomosis is performed. The hypoglossal nerve is transected in oblique fashion to about one third of its circumference. In all patients, we were able to achieve a tensionless anastomosis. The idea is to achieve reinnervation of the previously denervated tissue via the collateral sprouting of axons of the donor nerve through the site of coaptation, without sacrificing the innervation of the original targets of the donor nerve. With side-to-end hypoglossal-facial anastomosis, two patients achieved a House-Brackmann grade of III (one of them with independent movement of eyelids and mouth), one received the grade IV, another grade V and grade VI. No patient had hemilingual atrophy nor any problems associated with swallowing or chewing