Socolovsky Mariano, Páez Miguel Domínguez, Masi Gilda Di, Molina Gonzalo, Fernández Eduardo
Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
Surg Neurol Int. 2012;3:46. doi: 10.4103/2152-7806.95391. Epub 2012 Apr 25.
Idiopathic facial nerve palsy (Bell's palsy) is a very common condition that affects active population. Despite its generally benign course, a minority of patients can remain with permanent and severe sequelae, including facial palsy or dyskinesia. Hypoglossal to facial nerve anastomosis is rarely used to reinnervate the mimic muscle in these patients. In this paper, we present a case where a direct partial hypoglossal to facial nerve transfer was used to reinnervate the upper and lower face. We also discuss the indications of this procedure.
A 53-year-old woman presenting a spontaneous complete (House and Brackmann grade 6) facial palsy on her left side showed no improvement after 13 months of conservative treatment. Electromyography (EMG) showed complete denervation of the mimic muscles. A direct partial hypoglossal to facial nerve anastomosis was performed, including dissection of the facial nerve at the fallopian canal. One year after the procedure, the patient showed House and Brackmann grade 3 function in her affected face.
Partial hypoglossal-facial anastomosis with intratemporal drilling of the facial nerve is a viable technique in the rare cases in which severe Bell's palsy does not recover spontaneously. Only carefully selected patients can really benefit from this technique.
特发性面神经麻痹（贝尔氏麻痹）是一种常见于活跃人群的疾病。尽管其病程通常较为良性，但少数患者可能会遗留永久性严重后遗症，包括面部麻痹或运动障碍。舌下神经至面神经吻合术很少用于为这些患者的表情肌重新建立神经支配。在本文中，我们介绍了一例通过直接部分舌下神经至面神经移植来为上下面部重新建立神经支配的病例。我们还讨论了该手术的适应症。
一名53岁女性，左侧出现自发性完全性（House-Brackmann 6级）面神经麻痹，经过13个月的保守治疗后没有改善。肌电图（EMG）显示表情肌完全失神经支配。进行了直接部分舌下神经至面神经吻合术，包括在面神经管内对面神经进行解剖。术后一年，患者患侧面部的House-Brackmann功能分级为3级。
对于严重贝尔氏麻痹无法自发恢复的罕见病例，颞内面神经钻孔的部分舌下神经-面神经吻合术是一种可行的技术。只有经过精心挑选的患者才能真正从该技术中获益。
