Hypoglossal Facial Nerve Anastomosis for Post-Operative and Post-Traumatic Complete Facial Nerve Paralysis

Amr Abdelmonam Abdelaziz M. Elkatatny; Hany Abdelrahim Abdelrazik Abdallah; Dina Ghoraba; Tarek Ahmed Amer; Tarek Hamdy

doi:10.3889/oamjms.2019.490

Authors

Amr Abdelmonam Abdelaziz M. Elkatatny Department of Neurosurgery, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
Hany Abdelrahim Abdelrazik Abdallah Department of Neurosurgery, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
Dina Ghoraba Department of Plastic Surgery, Kasr Alainy Medical school, Cairo University, Cairo, Egypt
Tarek Ahmed Amer Department of Plastic Surgery, Kasr Alainy Medical school, Cairo University, Cairo, Egypt
Tarek Hamdy Department of Neurosurgery, Kasr Alainy Medical School, Cairo University

DOI:

https://doi.org/10.3889/oamjms.2019.490

Keywords:

Facial hypoglossal, Anastomosis, Facial palsy

Abstract

AIM: This study aims to evaluate the outcome of patients with complete facial paralysis following surgery to cerebellopontine angle tumours or following traumatic petrous bone fractures after reanimation by hypoglossal-facial anastomosis as regards clinical improvement of facial asymmetry and facial muscle contractility as well as complications associated with hypoglossal-facial reanimation procedure.

METHODS: This thesis included a prospective study to be carried out on 15 patients with unilateral complete lower motor neuron facial paralysis (11 patients after cerebellopontine angle tumour resection and 4 patients after traumatic transverse petrous bone fracture) operated upon by end to end hypoglossal-facial nerve anastomosis in Cairo university hospitals in the period between June 2015 and January 2017.

RESULTS: At one year follow up the improvement of facial nerve functions were as follows: Three cases (20%) had improved to House Hrackmann grade II, eleven cases (73.33%) had improved to grade III, and one patient (6.66%) had improved to House Brackmann grade IV.

CONCLUSION: Despite the various techniques in facial reanimation following facial nerve paralysis, the end to end hypoglossal-facial nerve anastomosis remains the gold standard procedure with satisfying results in cases of the viable distal facial stump and non-atrophic muscles. Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.