Godefroy Willem P, Malessy Martijn J A, Tromp Aimee A M, van der Mey Andel G L
Department of Otorhinolaryngology, Leiden University Medical Centre, Leiden, The Netherlands.
Otol Neurotol. 2007 Jun;28(4):546-50. doi: 10.1097/mao.0b013e31804301b8.
To evaluate functional recovery after facial-hypoglossal nerve transfer with direct coaptation of the intratemporal part of the facial nerve.
Retrospective study.
University-based tertiary referral center.
Nine patients who underwent facial-hypoglossal transfer surgery between 2001 and 2006 to treat a unilateral complete facial nerve palsy.
The facial nerve is mobilized in the temporal bone, transsected at the second genu, transferred and directly coaptated to a partially incised hypoglossal nerve.
The House-Brackmann grading system was used to evaluate facial nerve reinnervation. Tongue atrophy and movements were documented. Quality of life related to facial function was assessed using the validated Facial Disability Index.
A House-Brackmann Grade III (86%) was achieved in six patients, and Grade IV (14%) in one patient with an average follow-up of 22 months (range, 12-48 mo). Two patients had a follow-up of less than 12 months after surgery, and reinnervation was still in progress. In none of the patients who were operated on was tongue atrophy or impaired movement observed. Postoperative Facial Disability Index scores (mean, 71.8 +/- standard deviation [SD] 10.6) for physical functioning and social functioning (mean, 85.7 +/- SD 9.8) were increased for all patients when compared with preoperative scores (mean, 28.6 +/- SD 9.0; mean, 37.7 +/- SD 14.4, respectively).
The facial-hypoglossal nerve transfer with direct coaptation of the intratemporal part of the facial nerve offers good functional results with low lingual morbidity and improved quality of life. The technique is straightforward, relatively simple, and should be considered as first option for reanimation of traumatic facial nerve lesions.
评估面神经颞内部分直接端端吻合的面-舌下神经吻合术后的功能恢复情况。
回顾性研究。
大学附属三级转诊中心。
2001年至2006年间接受面-舌下神经吻合手术治疗单侧完全性面神经麻痹的9例患者。
在颞骨内游离面神经，于第二膝部切断，转移并直接端端吻合至部分切开的舌下神经。
采用House-Brackmann分级系统评估面神经再支配情况。记录舌肌萎缩及运动情况。使用经过验证的面部残疾指数评估与面部功能相关的生活质量。
6例患者达到House-BrackmannⅢ级（86%），1例患者达到Ⅳ级（14%），平均随访22个月（范围12 - 48个月）。2例患者术后随访时间不足12个月，再支配仍在进行中。所有接受手术的患者均未观察到舌肌萎缩或运动障碍。与术前评分（分别为平均28.6±标准差[SD]9.0；平均37.7±SD 14.4）相比，所有患者术后身体功能（平均71.8±SD 10.6）和社会功能（平均85.7±SD 9.8）的面部残疾指数评分均有所提高。
面神经颞内部分直接端端吻合的面-舌下神经吻合术功能恢复良好，舌部并发症发生率低，生活质量得到改善。该技术操作简单直接，相对简便，应被视为创伤性面神经损伤修复的首选方法。
