J Reconstr Microsurg 1998; 14(7): 459-471
DOI: 10.1055/s-2007-1000208
ORIGINAL ARTICLE

© 1998 by Thieme Medical Publishers, Inc.

Gains and Losses of the XII‐VII Component of the “Baby‐Sitter” Procedure: A Morphometric Analysis

Behrooz Kalantarian, Darian C. Rice, David A. Tiangco, Julia K. Terzis
  • Microsurgical Research Center, Eastern Virginia Medical School, Norfolk, Virginia
Further Information

Publication History

Accepted for publication 1998

Publication Date:
08 March 2008 (online)

ABSTRACT

The classic hypoglossal transfer to the facial nerve is invariably followed by complications caused by tongue atrophy. In 1984, Terzis introduced the “baby-sitter” procedure which involved a formal cross-facial procedure, in addition to partial neurectomy of the hypoglossal nerve, and an end-to-side coaptation with the ipsilateral facial nerve. This reported study provides, for the first time, quantification of the number of hypoglossal motor fibers needed to successfully restore eye sphincter function, using an end-to-side coaptation with preservation of the tongue. Thirty adult Sprague-Dawley rats were divided into six groups: control, denervated, perineurial window, 20 percent partial neurectomy (PN), 40 percent PN, and 80 percent PN. The procedure involves interposing a nerve graft (saphenous) between the partially severed XII nerve and the upper zygomatic branch of the facial nerve. Evaluation of the behavioral data (blink reflex) revealed good-to-superb return of the blinking mechanism in the 40 percent group, without significant tongue atrophy. Electrophysiologic data in the 40 percent neurectomy group demonstrated superiority to the other groups. Quantitative axonal morphometry of the coaptation sites and graft, as well as motor end-plates of the orbicularis oculi muscle and tongue showed the 40 percent partial neurectomy group to be the optimal group.

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