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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(03): e222-e228
DOI: 10.1055/s-0040-1718431
Original Article | Artigo Original

Hypoglossal-Facial Anastomosis for Facial Nerve Reconstruction: Outcomes using the Side-to-End Surgical Technique

Anastomose Hipoglosso-Facial para reanimação do nervo facial: Resultados da técnica término-lateral
Leonardo Gilmone Ruschel
4   DFV Neuro Neurology and Neurosurgery Service, São Paulo, Brazil
,
Joel Sanabria Duarte
1   Neurosurgery Department, Instituto de Neurologia de Curitiba (INC), Curitiba, Paraná, Brazil
,
Jonathan De La Cruz
1   Neurosurgery Department, Instituto de Neurologia de Curitiba (INC), Curitiba, Paraná, Brazil
,
Kristel Back Merida
2   Neurology Department, Instituto de Neurologia de Curitiba (INC), Curitiba, Paraná, Brazil
,
Gustavo Fabiano Nogueira
3   Otorhinolaryngology Department, Instituto de Neurologia de Curitiba (INC), Curitiba, Paraná, Brazil
,
Matheus Fernandes de Oliveira
4   DFV Neuro Neurology and Neurosurgery Service, São Paulo, Brazil
5   Neurosurgery Department, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
,
Ricardo Ramina
1   Neurosurgery Department, Instituto de Neurologia de Curitiba (INC), Curitiba, Paraná, Brazil
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Abstract

Introduction The side-to-end hypoglossal-facial anastomosis (HFA) technique is an excellent alternative technique to the classic end-terminal anastomosis, because it may decrease the symptoms resulting from hypoglossal-nerve transection.

Methods Patients with facial nerve palsy (House-Brackmann [HB] grade VI) requiring facial reconstruction from 2014 to 2017were retrospectively included in the study.

Results In total, 12 cases were identified, with a mean follow-up of 3 years. The causes of facial paralysis were due to resection of posterior-fossa tumors and trauma. There was improvement in 91.6% of the patients (11/12) after the HFA. The rate of improvement according to the HB grade was as follows: HB III - 58.3%; HB IV - 16.6%; and HB II - 16.6%. The first signs of improvement were observed in the patients with the shortest time between the paralysis and the anastomosis surgery (3.5 months versus 8.5 months; p = 0.011). The patients with HB II and III had a shorter time between the diagnosis and the anastomosis surgery (mean: 5.22 months), while the patients with HB IV and VI had a longer time of paresis (mean: 9.5 months; p = 0.099). We did not observe lingual atrophy or changes in swallowing.

Discussion and Conclusion Hypoglossal-facial anastomosis with the terminolateral technique has good results and low morbidity in relation to tongue motility and swallowing problems. The HB grade and recovery appear to be better in patients operated on with a shorter paralysis time.

Resumo

Introdução A técnica de Anastomose Hipoglosso-Facial término-lateral é uma técnica excelente alternativa à clássica Anastomose Término-Terminal, pois pode diminuir os sintomas resultantes da transecção do nervo hipoglosso.

Métodos Pacientes com paralisia do nervo facial (grau VI de House-Brackmann) com necessidade de reconstrução facial foram incluídos retrospectivamente de 2014 a 2017.

Resultados Doze casos foram identificados com um seguimento médio de 3 anos. As causas da paralisia facial foram devido à ressecção de tumores da fossa posterior e trauma. Houve melhora em 91,6% dos pacientes (11/12) após a cirurgia. A maioria dos pacientes apresentou melhora com HB III, 58,3%, grau IV 16,6%, grau II 16,6%. Os primeiros sinais de melhora foram nos pacientes com menor tempo entre a cirurgia de paralisia e anastomose (3,5 meses vs. 8,5 meses) (p = 0,011). Pacientes com HB II e III tiveram menor tempo entre o diagnóstico e a cirurgia da anastomose (média de 5,22 meses), enquanto os pacientes com HB IV e VI tiveram um tempo maior de paresia (média de 9,5 meses) (p = 0,099). Não observamos atrofia lingual ou alterações na deglutição.

Discussão e Conclusão A Anastomose Hipoglosso-Facial término-lateral apresenta bons resultados e baixa morbidade em relação à motilidade da língua e problemas de deglutição. O grau (HB) e a recuperação parecem ser melhores em pacientes operados com menor tempo de paralisia.

Keywords

facial-nerve trauma - facial nerve - hypoglossal nerve - facial paralysis - surgical anastomosis

Palavras-chave

trauma do nervo facial - nervo facial - nervo hipoglosso - paralisia facial - anastomose cirúrgica


Publication History

Received: 23 March 2020

Accepted: 05 August 2020

Article published online:
16 October 2020

© 2020. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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