Combination of hypoglossal-facial nerve jump graft by end-to-side neurorrhaphy and cross-face nerve graft for the treatment of facial paralysis.

The cross-face nerve graft and the interpositional jump graft were performed simultaneously for 13 patients with facial paralysis. The period between the onset of paralysis and surgery ranged from 3 to 32 weeks. In nine patients, surgery was performed within 3 months of the onset of paralysis. The patients in whom reinnervation by both grafts succeeded could smile without closing their eyes by moving the tongue and could close the eye on the affected side without an accompanying oral movement. The expression was natural and included fine muscle movements. Spontaneous recovery of the facial nerve was observed in three patients. Among patients who showed functional recovery without spontaneous recovery, House-Brackman's palsy grade was II in one patient, III in five patients, and IV in one patient. Functional deficits of the tongue were not observed. We recommend that this surgery be performed within 3 months of onset of paralysis.