Hypoglossal-facial nerve (12-7) anastomosis can restore symmetry and voluntary movement on the face in patients with facial nerve paralysis. Traditional 12-7 transfer includes direct end-to-end nerve anastomosis, sacrificing the entire hypoglossal nerve. Contemporary, end-to-side anastomosis, or split anastomosis techniques limit tongue morbidity by preserving some hypoglossal nerve. Direct outcome comparisons between these techniques are limited.
Objective:
To compare reported outcomes of facial movement, tongue, speech, and swallow outcomes among the different types of hypoglossal-facial nerve anastomosis schemes.
Evidence Review:
For this systematic review and meta-analysis, a comprehensive strategy was designed to search PubMed, Scopus, and the Cochrane Database from inception to January 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, reporting guideline yielding 383 results. Any participant who underwent 12-7 transfer using any of the three techniques, with or without an interposition graft, and had documented preoperative and postoperative evaluation of facial nerve function with a validated instrument such as House–Brackmann (HB), was considered for inclusion. Secondary outcomes of synkinesis, tongue atrophy, and speech or swallowing dysfunction were also compared. Forty-nine studies met inclusion criteria, representing data from 961 total patients who underwent 12-7 transfer.
Results:
The proportion of good HB outcomes (HB I–III) did not differ by anastomosis type: End-to-side and end-to-end anastomosis (73% vs. 59%, p = 0.07), split and end-to-end anastomosis (62% vs. 59%, p = 0.88), and end-to-side anastomosis and split anastomosis (73% vs. 62%, p = 0.46). There was no difference in reported synkinesis rates between the anastomosis types. However, end-to-side anastomosis (z = 6.55, p < 0.01) and split anastomosis (z = 3.58, p < 0.01) developed less tongue atrophy than end-to-end anastomosis. End-to-side anastomosis had less speech/swallowing dysfunction than end-to-end anastomosis (z = 3.21, p < 0.01).
Conclusion:
End-to-side and split anastomoses result in similar HB facial nerve outcomes as the traditional end-to-end 12-7 anastomosis. End-to-side anastomosis has decreased complications of tongue atrophy and speech/swallow dysfunction compared to end-to-end anastomosis. In addition, split anastomosis has decreased rates of tongue atrophy compared to end-to-end anastomosis.
Get full access to this article
View all access options for this article.
References
1.
Kiese-HimmelC, LaskawiR, WredeS. Psychosoziale Probleme und Krankheitsverarbeitung von Patienten mit Defektheilung nach Fazialisparese [Psychosocial problems and coping with illness by patients with defective healing after facial paralysis]. HNO. 1993; 41(5):261–267.
2.
IshiiL, GodoyA, EncarnacionCO, et al.Not just another face in the crowd: society's perceptions of facial paralysis. Laryngoscope. 2012; 122(3):533–538.
3.
NellisJC, IshiiM, ByrnePJ, et al.Association among facial paralysis, depression, and quality of life in facial plastic surgery patients. JAMA Facial Plast Surg. 2017; 19(3):190–196.
4.
PouwelsS, BeurskensCHG, KleissIJ, IngelsKJAO. Assessing psychological distress in patients with facial paralysis using the Hospital Anxiety and Depression Scale. J Plast Reconstr Aesthet Surg. 2016; 69(8):1066–1071.
5.
CrossT, SheardCE, GarrudP, et al.Impact of facial paralysis on patients with acoustic neuroma. Laryngoscope. 2000; 110(9):1539–1542.
6.
CoulsonSE, O'DwyerNJ, AdamsRD, et al.Expression of emotion and quality of life after facial nerve paralysis. Otol Neurotol. 2004; 25(6):1014–1019.
7.
SpectorJG.Mimetic surgery for the paralyzed face. Laryngoscope. 1985; 95:1494–1522.
8.
BascomDA, SchaitkinBM, MayM, et al.Facial nerve repair: a retrospective review. Facial Plast Surg. 2000; 16:309–13.
9.
GavronJP, ClemisJD. Hypoglossal-facial nerve anasto-mosis: a review of forty cases caused by facial nerve injuries in the posterior fossa. Laryngoscope. 1984; 94:1447–1450.
10.
Guntinas-LichiusO, StreppelM, StennertE. Postoperative functional evaluation of different reanimation techniques for facial nerve repair. Am J Surg. 2006; 191(1):61–67; doi:10.1016/j.amjsurg.2005.05.054
11.
ConleyJ, BakerDC. Hypoglossal-facial nerve anastomosis for rein- nervation of the paralyzed face. Plast Reconstr Surg. 1979; 63:63–72.
12.
StennertEI.Hypoglossal facial anastomosis: its significance for modern facial surgery. II. Combined approach in extratemporal facial nerve reconstruction. Clin Plast Surg. 1979; 6(3):471–486.
13.
KorteW, BernhardtM. A case of nerve grafting: the facial nerve to the hypoglossal nerve. [In German]. Dtsche Med Wchschr. 1903; 29:293–295.
14.
MayM, SobolSM, MesterSJ. Hypoglossal-facial nerve inter- positional-jump graft for facial reanimation without tongue atrophy. Otolaryngol Head Neck Surg. 1991; 104:818–825.
15.
WangD.Side-to-end hypoglossal-facial nerve anastomosis for facial paralysis: a meta-analysis. Int J Clin Exp Med. 2016; 9(8):15285–15295.
16.
AtlasMD, LowingerDS. A new technique for hypoglossal-facial nerve repair. Laryngoscope. 1997; 107(7):984–991. doi:10.1097/00005537-199707000-00028
17.
ZhangL, LiD, WanH, et al.Hypoglossal-facial nerve ‘side’-to-side neurorrhaphy using a predegenerated nerve autograft for facial palsy after removal of acoustic tumours at the cerebellopontine angle. J Neurol Neurosurg Psychiatry. 2015; 86(8):865–872. doi:10.1136/jnnp-2014-308465
18.
KlebucMJA.Facial reanimation using the masseter-to-facial nerve transfer. Plast Reconstr Surg. 2011; 127(5):1909–1915. doi:10.1097/PRS.0b013e31820e9138
19.
UrbanMJ, EggerstedtM, VarelasE, et al.Hypoglossal and masseteric nerve transfer for facial reanimation: A systematic review and meta-analysis. Facial Plast Surg Aesthet Med. 2022; 24(1):10–17. doi:10.1089/fpsam.2020.0523
20.
LuGN, HanR, LeeE, et al.Predicting resting oral commissure tone outcomes following masseter nerve transfer in facial reanimation. Facial Plast Surg Aesthet Med. 2021; 23(4):249–254. doi:10.1089/fpsam.2020.0195
21.
PepperJP.Dual nerve transfer for facial reanimation. JAMA Facial Plast Surg. 2019; 21(3):260–261. doi:10.1001/jamafacial.2019.0001
PageMJ, McKenzieJE, BossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic 291 reviews. BMJ. 2021; 372:n71.
24.
HigginsJPT, ThomasJ, ChandlerJ, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane. 2022.
25.
MoherD, LiberatiA, TetzlaffJ, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009; 62(10):1006–1012.
26.
ViechtbauerW.Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010; 36(3):1–48; doi:10.18637/jss.v036.i03
27.
GordonM, LumleyT.forestplot: Advanced Forest Plot Using ‘grid’ Graphics_. R package version 3.1.1, 2022. https://CRAN.R-project.org/package=forestplot [Last accessed: January 27, 2023].
28.
AltamamiNM, ZaoucheS, Vertu-CiolinoD. A comparative retrospective study: hypoglossofacial versus masseterofacial nerve anastomosis using Sunnybrook facial grading system. Eur Arch Otorhinolaryngol. 2019; 276(1):209–216. doi:10.1007/s00405-018-5186-y
29.
MalikTH, KellyG, AhmedA, et al.A comparison of surgical techniques used in dynamic reanimation of the paralyzed face. Otol Neurotol. 2005; 26(2):284–291. doi:10.1097/00129492-200503000-00028
30.
SuDY, WanH, LiZ, et al.Analysis of Preoperative Factors Influencing Hypoglossal-facial ‘Side’-to-side Neurorrhaphy for Facial Paralysis after Excision of Acoustic Neuroma. Biomed Environ Sci. 2020; 33(1):30–36. doi:10.3967/bes2020.004
SamiiM, AlimohamadiM, KhouzaniRK, et al.Comparison of direct side-to-end and end-to-end hypoglossal-facial anastomosis for facial nerve repair. World Neurosurg. 2015; 84(2):368–375. doi:10.1016/j.wneu.2015.03.029
33.
Le ClercN, HermanP, KaniaR, et al.Comparison of 3 procedures for hypoglossal-facial anastomosis. Otol Neurotol. 2013; 34(8):1483–1488. doi:10.1097/MAO.0b013e31828dac62
34.
AlbathiM, OyerS, IshiiLE, et al.Early nerve grafting for facial paralysis after cerebellopontine angle tumor resection with preserved facial nerve continuity. JAMA Facial Plast Surg. 2016; 18(1):54–60. doi:10.1001/jamafacial.2015.1558
35.
BrudnyJ, HammerschlagPE, CohenNL, et al.Electromyographic rehabilitation of facial function and introduction of a facial paralysis grading scale for hypoglossal-facial nerve anastomosis. Laryngoscope. 1988; 98(4):405–410. doi:10.1288/00005537-198804000-00010
36.
FerraresiS, GarozzoD, MiglioriniV, et al.End-to-side intrapetrous hypoglossal-facialanastomosis for reanimation of the face. Technical note. J Neurosurg. 2006; 104(3):457–460. doi:10.3171/jns.2006.104.3.457
37.
ClaytonMI, RivronRP, HansonDR, et al.Evaluation of recent experience in hypoglossal-facial nerve anastomosis in the treatment of facial palsy. J Laryngol Otol. 1989; 103(1):63–65. doi:10.1017/s0022215100108047
38.
RochkindS, ShafiM, AlonM, et al.Facial nerve reconstruction using a split hypoglossal nerve with preservation of tongue function. J Reconstr Microsurg. 2008; 24(7):469–474. doi:10.1055/s-0028-1088225
39.
Casas-RoderaP, LassalettaL, GonzálezT, et al.Técnicas reconstructivas del nervio facial [Facial nerve repair techniques]. Acta Otorrinolaringol Esp. 2007; 58(4):133–137.
40.
Tanbouzi HusseiniS, KumarDV, De DonatoG, et al.Facial reanimation after facial nerve injury using hypoglossal to facial nerve anastomosis: the gruppo otologico experience. Indian J Otolaryngol Head Neck Surg. 2013; 65(4):305–308. doi:10.1007/s12070-011-0468-3
41.
CatliT, BayazitYA, GokdoganO, et al.Facial reanimation with end-to-end hypoglossofacial anastomosis: 20 years' experience. J Laryngol Otol. 2010; 124(1):23–25. doi:10.1017/S0022215109991344
42.
HammerschlagPE.Facial reanimation with jump interpositional graft hypoglossal facial anastomosis and hypoglossal facial anastomosis: evolution in management of facial paralysis. Laryngoscope. 1999; 109(2 Pt 2Suppl. 90):1–23. doi:10.1097/00005537-199902001-00001
43.
MatsunagaT, Kanzaki JO-U, chiT, et al.Functional and histological evaluation of the facial nerve in patients who have undergone hypoglossal-facial nerve anastomosis after removal of cerebellopontine angle tumors. ORL J Otorhinolaryngol Relat Spec. 1995; 57(3):153–160. doi:10.1159/000276729
44.
HammerschlagPE, CohenNL, PaluR, et al.Management of facial paralysis with jump interposition graft hypoglossal-facial anastomosis with gold lid weight. Eur Arch Otorhinolaryngol. 1994:S137–S139. doi:10.1007/978-3-642-85090-5_41
45.
HayashiA, NishidaM, SenoH, et al.Hemihypoglossal nerve transfer for acute facial paralysis. J Neurosurg. 2013; 118(1):160–166. doi:10.3171/2012.9.JNS1270
46.
DziedzicTA, KunertP, MarchelA. Hemihypoglossal-facial nerve anastomosis for facial nerve reanimation: case series and technical note. World Neurosurg. 2018; 118:e460–e467. doi:10.1016/j.wneu.2018.06.217
47.
MartinsRS, SocolovskyM, SiqueiraMG, et al.Hemihypoglossal-facial neurorrhaphy after mastoid dissection of the facial nerve: results in 24 patients and comparison with the classic technique. Neurosurgery. 2008; 63(2):310–317. doi:10.1227/01.NEU.0000312387.52508.2C
48.
AraiH, SatoK, YanaiA. Hemihypoglossal-facial nerve anastomosis in treating unilateral facial palsy after acoustic neurinoma resection. J Neurosurg. 1995; 82(1):51–54. doi:10.3171/jns.1995.82.1.0051
49.
ElkatatnyAAAM, AbdallahHAA, GhorabaD, et al.Hypoglossal facial nerve anastomosis for post-operative and post-traumatic complete facial nerve paralysis. Open Access Maced J Med Sci. 2019; 7(23):3984–3996. doi:10.3889/oamjms.2019.490
50.
Gonzalez-DarderJM, Capilla-GuaschP, ExcartinFP, et al.Side-to-end hypoglossal-facial neurorrhaphy for treatment of complete and irreversible facial paralysis after vestibular schwannoma removal by means of a retrosigmoid approach: a clinical and anatomic study. World Neurosurg. 2020; 136:e262-e269. doi: 10.1016/j.wneu.201.12.149
51.
SuD, LiD, WangS, et al.Hypoglossal-facial nerve “side-to-side” neurorrhaphy for facial paralysis resulting from closed temporal bone fractures. Restor Neurol Neurosci. 2018; 36(4):443–457. doi:10.3233/RNN-170794
52.
KunihiroT, KanzakiJ, YoshiharaS, et al.Hypoglossal-facial nerve anastomosis after acoustic neuroma resection: influence of the time anastomosis on recovery of facial movement. ORL J Otorhinolaryngol Relat Spec. 1996; 58(1):32–35. doi:10.1159/000276791
53.
AkH, SanuşGZ, TanrioverN, et al.Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for vestibular schwannoma: retrospective analysis of 13 patients. Turkish Neurosurg. 2006; 16(4):158–162.
54.
SoodS, AnthonyR, HomerJJ, et al.Hypoglossal-facial nerve anastomosis: assessment of clinical results and patient benefit for facial nerve palsy following acoustic neuroma excision. Clin Otolaryngol Allied Sci. 2000; 25(3):219–226. doi:10.1046/j.1365-2273.2000.00348.x
55.
BeutnerD, LuersJC, GroshevaM. Hypoglossal-facial-jump-anastomosis without an interposition nerve graft. Laryngoscope. 2013; 123(10):2392–2396. doi:10.1002/lary.24115
YetiserS.Immediate hypoglossal-facial anastomosis in patients with facial interruption. J Craniofac Surg. 2018; 29(3):648–650. doi:10.1097/SCS.0000000000004150
58.
SamiiM, MatthiesC. Indication, technique and results of facial nerve reconstruction. Acta Neurochir (Wien). 1994; 130(1–4):125–139. doi:10.1007/BF01405512
59.
GodefroyWP, MalessyMJ, TrompAA, et al.Intratemporal facial nerve transfer with direct coaptation to the hypoglossal nerve. Otol Neurotol. 2007; 28(4):546–550. doi:10.1097/mao.0b013e31804301b8
60.
DonzelliR, MaiuriF, PecaC, et al.Microsurgical repair of the facial nerve. Zentralbl Neurochir. 2005; 66(2):63–69. doi:10.1055/s-2004-836226
61.
DarrouzetV, GuerinJ, BébéarJP. New technique of side-to-end hypoglossal-facial nerve attachment with translocation of the infratemporal facial nerve. J Neurosurg. 1999; 90(1):27–34. doi:10.3171/jns.1999.90.1.0027
62.
DonzelliR, MottaG, CavalloLM, et al.One-stage removal of residual intracanalicular acoustic neuroma and hemihypoglossal-intratemporal facial nerve anastomosis: technical note. Neurosurgery. 2003; 53(6):1444–1448. doi:10.1227/01.neu.0000093830.14935.39
63.
MohamedA, OmiE, HondaK, et al.Outcome of different facial nerve reconstruction techniques. Braz J Otorhinolaryngol. 2016; 82(6):702–709. doi:10.1016/j.bjorl.2015.12.010
64.
VenailF, SabatierP, MondainM, et al.Outcomes and complications of direct end-to-side facial-hypoglossal nerve anastomosis according to the modified May technique. J Neurosurg. 2009; 110(4):786–791. doi:10.3171/2008.9.JNS08769
65.
MoriK, NakaoY, YamamotoT, et al.Partial (one-third) side-to-end hypoglossal-facial anastomosis ensures facial reanimation without tongue dysfunction. Neurosurg Q. 2007; 17:180–184.
66.
ManniJJ, BeurskensCH, van de VeldeC, et al.Reanimation of the paralyzed face by indirect hypoglossal-facial nerve anastomosis. Am J Surg. 2001; 182(3):268–273. doi:10.1016/s0002-9610(01)00715-2
67.
CorralesCE, GurgelRK, JacklerRK. Rehabilitation of central facial paralysis with hypoglossal-facial anastomosis. Otol Neurotol. 2012; 33(8):1439–1444. doi:10.1097/MAO.0b013e3182693cd0
68.
MagliuloG, D'AmicoR, ForinoM. Results and complications of facial reanimation following cerebellopontine angle surgery. Eur Arch Otorhinolaryngol. 2001; 258(1):45–48. doi:10.1007/s004059900211
69.
SlatteryWH 3rd, CassisAM, WilkinsonEP, et al.Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve. Otol Neurotol. 2014; 35(3):509–513. doi:10.1097/MAO.0b013e3182936bcf
70.
RebolJ, MilojkovićV, DidanovicV. Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve. Acta Neurochir (Wien). 2006; 148(6):653–657. doi:10.1007/s00701-006-0736-2
71.
ShipchandlerTZ, SethR, AlamDS. Split hypoglossal-facial nerve neurorrhaphy for treatment of the paralyzed face. Am J Otolaryngol. 2011; 32(6):511–516. doi:10.1016/j.amjoto.2010.09.007
72.
KochharA, AlbathiM, SharonJD, et al.Transposition of the intratemporal facial to hypoglossal nerve for reanimation of the paralyzed face: the VII to XII transposition technique. JAMA Facial Plast Surg. 2016; 18(5):370–378. doi:10.1001/jamafacial.2016.0514
73.
LinV, JacobsonM, DorionJ, et al.Global assessment of outcomes after varying reinnervation techniques for patients with facial paralysis subsequent to acoustic neuroma excision. Otol Neurotol. 2009; 30(3):408–413. doi:10.1097/MAO.0b013e31819a8e26
74.
KecskesG, HermanP, KaniaR, et al.Lengthening temporalis myoplasty versus hypoglossal-facial nerve coaptation in the surgical rehabilitation of facial palsy: evaluation by medical and nonmedical juries and patient-assessed quality of life. Otol Neurotol. 2009; 30(2):217–222. doi:10.1097/MAO.0b013e318194f871
75.
SocolovskyM, MartinsRS, di MasiG, et al.Treatment of complete facial palsy in adults: comparative study between direct hemihypoglossal-facial neurorrhaphy, hemihipoglossal-facial neurorrhaphy with grafts, and masseter to facial nerve transfer. Acta Neurochir (Wien). 2016; 158(5):945–957. doi:10.1007/s00701-016-2767-7
76.
BanksCA, BhamaPK, ParkJ, et al.Clinician-graded electronic facial paralysis assessment: the eFACE. Plast Reconstr Surg. 2015; 136(2):223e–230e. doi:10.1097/PRS.0000000000001447
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
