Contribution and safety of the side‐to‐end hypoglossal‐to‐facial transfer in multidisciplinary facial reanimation
Teresa Mato PatinoJosé Manuel Morales‐PueblaSusana MoraledaIsabel Sánchez‐CuadradoMiryam CalvinoTeresa González-OteroJulio PeñarrochaB. HernándezJaviér GavilánLuis Lassaletta
4
Citation
35
Reference
10
Related Paper
Citation Trend
Abstract:
This study evaluates facial and tongue function in patients undergoing side-to-end hypoglossal-to-facial transfer (HFT) with additional techniques.Thirty-seven patients underwent a side-to-end HFT. Twelve had additional cross-face grafts, and 9 had an additional masseter-to-facial transfer. Facial was assessed with House-Brackmann (HB), Sunnybrook Facial Grading Scale (SFGS), and eFACE. Martins scale and the Oral-Pharyngeal Disability Index (OPDI) were used to assess tongue function.Ninety-four percent of cases reached HB grades III-IV. Mean total SFGS score improved from 16 ± 15 to 59 ± 11, while total eFACE score from 52 ± 13 to 80 ± 5. Dual nerve transfers were a predictor for a better eFACE total score p = 0.034, β = 2.350 [95% CI, 0.184-4.516]), as well as for a higher SFGS total score (p = 0.036, β = 5.412 [95% CI, 0.375-10.449]). All patients had Martin's grade I. Mean postoperative OPDI scores were 84 ± 17 (local physical), 69 ± 16 (simple and sensory motor components), 82 ± 14 (complex functions), and 73 ± 22 (psychosocial).The side-to-end HFT offers predictable facial function outcome and preserves tongue function in nearly all cases. Dual nerve transfers appear to improve the final outcome.Keywords:
Facial muscles
Hypoglossal nerve
The neural feedback system controlling tongue muscle activities was studied in the decerebrate cat.Spontaneous activities were detected from some muscular fibers of the tongue. The discharges of some fibers in the tongue retractors were increased and those in the tongue protruders were decreased by forward stretch of the tongue. These responses were not affected by anesthesia of the tongue surface. However, the responses completely disappeared after dissection of the lingual or glossopharyngeal nerve.In the lingual and glossopharyngeal nerves, a few fibers were detected to respond to stretch of the tongue. This response was slowly adaptive and the frequency of impulses from the nerve fibers was increased in proportion to the intensity of tongue stretching.The activity of several spots in the sensory nucleus of trigeminal nerve, in the nucleus of solitary tract, in the dorsal nucleus of vagal nerve, in the bulbar reticular formation and in the nucleus of hypoglossal nerve was activated by stretch of the tongue. On the contrary, the activity of some spots in the hypoglossal nucleus was inhibited.
Hypoglossal nerve
Hypoglossal nucleus
Glossopharyngeal nerve
Lingual nerve
Trigeminal Nerve
Cite
Citations (13)
Hypoglossal-pdcial nerve anastomosis was carried out in 20 adult guinea pigs. Horseradish peroxidase (HRP) was applied to the buccal branch of the facial nerve at intervals of 2, 4 and 6 months after the anastomosis operation. HRP labeled neurons and the number of regenerated axons in the buccal branch were counted to determine postoperative nerve regeneration. The number of surviving neurons in the facial and hypoglossal nuclei was also counted to determine postoperative change of these nuclei. Following anastomosis, 97% of the hypoglossal neurons remained surviving, while the facial neurons underwent pronounced degeneration of 65% survival ratio at 2 months and 37% at 6 months after the anastomosis operation. In 80% of the animals, a new nerve bundle regenerated from the proximal stump of the facial nerve to the anastomotic trunk. A linear increase of HRP-labeled neurons in the facial and hypoglossdl nuclei paralleled the increase of the axons in the buccal branch. The HRP-labeled neurons in the facial nucleus were demonstrated to have direct connection with the newly formed bundle and the facial mimetic muscles were dually innervated by both the hypoglossal and facial nerves. Although the present study design might not fully represent the clinical situation, possible advantages of hypoglossal-facial nerve anastomosis are discussed from the view of nerve regeneration.
Hypoglossal nerve
Horseradish peroxidase
Hypoglossal nucleus
Facial muscles
Cite
Citations (5)
The timing of hypoglossal-facial nerve anastomosis is controversial. The present study was performed to clarify the influence of the timing of hypoglossal-facial nerve anastomosis on histological changes in the facial nerve and central nuclei using guinea pigs. The facial nerve was transected first at the labyrinthine portion, and then transected again at the stylomastoid foramen. Hypoglossal-facial nerve anastomosis was carried out immediately or 3 months later. Nerve regeneration and survival of the neurons in the facial and hypoglossal nuclei were evaluated by toluidine blue staining and horseradish peroxidase (HRP). Immediate anastomosis resulted in better nerve regeneration of the facial nerve, but the numbers of surviving neurons in the facial and hypoglossal nuclei were almost the same in both the immediate and delayed anastomosis groups.
Hypoglossal nerve
Cite
Citations (27)
The Effect of Tongue Exercise on Serotonergic Input to the Hypoglossal Nucleus in Young and Old Rats
Breathing and swallowing problems affect elderly people and may be related to age-associated tongue dysfunction. Hypoglossal motoneurons that innervate the tongue receive a robust, excitatory serotonergic (5HT) input and may be affected by aging. We used a rat model of aging and progressive resistance tongue exercise to determine whether age-related alterations in 5HT inputs to the hypoglossal nucleus can be modified. We hypothesized that tongue forces would increase with exercise, 5HT input to the tongue would decrease with age, and tongue exercise would augment 5HT input to the hypoglossal nucleus.Young (9-10 months), middle-aged (24-25 months), and old (32-33 months) male F344/BN rats received tongue exercise for 8 weeks. Immunoreactivity for 5HT was measured in digital images of sections through the hypoglossal nucleus using ImageJ software.Tongue exercise resulted in increased maximum tongue forces at all ages. There was a statistically significant increase in 5HT immunoreactivity in the hypoglossal nucleus in exercised, young rats but only in the caudal third of the nucleus and primarily in the ventral half.Specificity found in serotonergic input following exercise may reflect the topographic organization of motoneurons in the hypoglossal nucleus and the tongue muscles engaged in the exercise paradigm.
Hypoglossal nucleus
Hypoglossal nerve
Genioglossus
Cite
Citations (35)
Intraoperative cranial nerve monitoring has significantly improved the preservation of facial nerve function following surgery in the cerebellopontine angle (CPA). Facial electromyography (EMG) was performed in 60 patients during CPA surgery. Pairs of needle electrodes were placed subdermally in the orbicularis oris and orbicularis oculi muscles. The duration of facial EMG activity was noted. Facial EMG potentials occurring in response to mechanical or metabolic irritation of the corresponding nerve were made audible by a loudspeaker. Immediate (4-7 days after tumor excision) and late (6 months after surgery) facial nerve function was assessed on a modified House-Brackmann scale. Late facial nerve function was good (House-Brackmann 1-2) in 29 of 60 patients, fair (House-Brackmann 3-4) in 14, and poor (House-Brackmann 5-6) in 17. Postmanipulation facial EMG activity exceeding 5 minutes in 15 patients was associated with poor late function in five, fair function in six, and good function in four cases. Postmanipulation facial EMG activity of 2-5 minutes in 30 patients was associated with good late facial nerve function in 20, fair in eight, and poor in two. The loss of facial EMG activity observed in 10 patients was always followed by poor function. Facial nerve function was preserved postoperatively in all five patients in whom facial EMG activity lasted less than 2 minutes. Facial EMG is a sensitive method for identifying the facial nerve during surgery in the CPA. EMG bursts are a very reliable indicator of intraoperative facial nerve manipulation, but the duration of these bursts do not necessarily correlate with short- or long-term facial nerve function despite the fact that burst duration reflects the severity of mechanical aggression to the facial nerve.
Facial muscles
Facial electromyography
Hemifacial spasm
Facial paralysis
Orbicularis oculi muscle
Cite
Citations (26)
Hemifacial spasm
Facial muscles
Antidromic
Microvascular Decompression
Cite
Citations (35)
OBJECTIVE The goal of this study was to determine the various anatomical and surgical relationships between the facial and hypoglossal nerves to define the required length of each for a nerve transfer, either by means of a classical hypoglossal-facial nerve anastomosis or combined with any of its variants developed to reduce tongue morbidities. METHODS Five adult cadaver heads were bilaterally dissected in the parotid and submaxillary regions. Two clinical cases are described for illustration. RESULTS The prebifurcation extracranial facial nerve is found 4.82 ± 0.88 mm from the external auditory meatus, 5.31 ± 1.50 mm from the mastoid tip, 15.65 ± 0.85 mm from the lateral end of C1, 17.19 ± 1.64 mm from the border of the mandible condyle, and 4.86 ± 1.29 mm from the digastric muscle. The average lengths of the mastoid segment of the facial nerve and the prebifurcation extracranial facial nerve are 16.35 ± 1.21 mm and 18.93 ± 1.41 mm, respectively. The average distance from the bifurcation of the facial nerve to the hypoglossal nerve turn is 31.56 ± 2.53 mm. For a direct hypoglossal-facial nerve anastomosis, a length of approximately 19 mm of the hypoglossal nerve is required. For the interposition nerve graft technique, a 35 mm-long graft is required. For the technique using a longitudinally dissected hypoglossal nerve, an average length of 31.56 mm is required. Exposure of the facial nerve within the mastoid process drilling technique requires 16.35 mm of drilling. CONCLUSION This study attempts to establish the exact graft, dissection within the hypoglossal nerve, and mastoid drilling requirements for hypoglossal to facial nerve transfer.
Hypoglossal nerve
Mastoid process
Digastric muscle
Meatus
Facial paralysis
Cite
Citations (35)
Hypoglossal nerve
Lingual nerve
Glossopharyngeal nerve
Cranial nerves
Cite
Citations (38)
Problem We investigated the topographic anatomic characteristics of the human tongue in order to determine the safest location for Coblation® (ArthroCare Corp., Sunnyvale, CA) tongue treatment in patients with obstructive sleep apnea‐hypopnea syndrome (OSAHS) and to provide detailed anatomic data to facilitate the surgery. Methods We dissected 16 lateral tongues from human cadavers and studied the distribution of the hypoglossal nerve and lingual artery and their respective distances. The ratios of those distances to the length and width of the tongue were calculated to establish the safest locations for Coblation tongue treatment. Results The vertical distance from the hypoglossal nerve and lingual artery to the surface of the tongue was invariant near the foramen caecum. The ratio of the horizontal distance from the hypoglossal nerve and lingual artery to the midline of the tongue to its length and the vertical distance to the surface at the foramen caecum and at 10 mm and 25 mm from the apex was obtained. Analysis of the data using ANOVA (analysis of variance) revealed statistically significant differences (p<0.05). Conclusion Low‐temperature radiofrequency tongue treatment (Coblation) offers a safe and effective treatment for patients with retroglossal OSAHS. Recognizing the topographic anatomic characteristics of the tongue and applying the concepts of ratio and individualization, in which consideration is given to each patient's unique anatomy, promotes greater safety and optimal patient outcomes. Significance The data could extend the area of surgery in tongue from before or after caecum to the whole tongue. It could facilitate the coblation tongue treatment which is different from those surgeries in the base of tongue. And coblation tongue channeling (CTC) is very useful to treat hypertrophic tongue in obstructive sleep apnea syndrome (OSAS). We have performed many CTC on the patients with OSAS and give the relative area by proportional view in the tongue based on the data.
Hypoglossal nerve
Epiglottis
Lingual nerve
Cite
Citations (1)
Abstract The morbidity associated with total glossectomy for treatment of base of tongue carcinomas provides the impetus to investigate techniques to salvage the uninvolved normal anterior tongue. This report describes a method of reinnervation of the anterior tongue using a hypoglossal‐lingual transfer. In Cynomologous monkeys, unilateral transfers with and without a subsequent muscle fillet resulted in reinnervation from the base to the tip of the tongue. It is proposed that hypoglossal‐lingual nerve transfers be considered to allow sparing and return of function to the anterior tongue in conjunction with a resection of the tongue base. Additional experiments confirmed that the base of the tongue, like other midline muscles, has bilateral and separate innervation. The presence of a physiological lingual‐hypoglossal reflex in the normal animal was documented.
Reinnervation
Hypoglossal nerve
Glossectomy
Hypoglossal nucleus
Cite
Citations (1)