Sawamura Y, Abe H
Department of Neurosurgery, University of Hokkaido, School of Medicine, Sapporo, Japan.
J Neurosurg. 1997 Feb;86(2):203-6. doi: 10.3171/jns.1997.86.2.0203.
This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of nerve grafts or hemihypoglossal nerve splitting. Using this technique, the mastoid process is partially resected to open the stylomastoid foramen and the descending portion of the facial nerve in the mastoid cavity is exposed by drilling to the level of the external genu and then sectioning its most proximal portion. The hypoglossal nerve beneath the internal jugular vein is exposed at the level of the axis and dissected as proximally as possible. One-half of the hypoglossal nerve is transected: use of less than one-half of the hypoglossal nerve is adequate for approximation to the distal stump of the atrophic facial nerve. The nerve endings, the proximally cut end of the hypoglossal nerve, and the distal stump of the facial nerve are approximated and anastomosed without tension. This technique was used in four patients with long-standing facial paralysis (greater than 24 months), and it provided satisfactory facial reanimation, with no evidence of hemitongue atrophy or dysfunction. Because it completely preserves glossal function, the hemihypoglossal-facial nerve anastomosis described here constitutes a successful approach in patients with long-standing facial paralysis who do not wish to have tongue function compromised.
本报告描述了一种新的手术技术，用于改善传统舌下神经-面神经吻合术的效果，该技术无需使用神经移植或半舌下神经劈开术。采用这种技术时，部分切除乳突以打开茎乳孔，并通过钻孔至外膝部水平，然后切断其最近端部分，暴露乳突腔内面神经的降支部分。在枢椎水平暴露颈内静脉下方的舌下神经，并尽可能向近端解剖。切断舌下神经的一半：使用不到一半的舌下神经就足以与萎缩的面神经远端残端接近。将神经末梢、舌下神经近端切断端与面神经远端残端接近并进行无张力吻合。该技术用于4例长期面瘫（超过24个月）的患者，获得了满意的面部表情恢复，没有半侧舌萎缩或功能障碍的迹象。由于它完全保留了舌功能，本文所述的半舌下神经-面神经吻合术对于不希望舌功能受损的长期面瘫患者来说是一种成功的方法。
