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Summary
Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis (House-Brackmann grade VI) treated with hypoglossal-facial nerve (XII-VII) anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback.
Reinnervation after XII-VII anastomosis occurred in 29 patients, on average 5.4 months after surgery. Three years after the anastomosis, 23.3% of patients had grade II, 53.3% grade III, 20% grade IV and 3.3% grade VI ratings on the House-Brackmann scale. Time to reinnervation was associated with the final House-Brackmann grade. Our study demonstrates that patients undergoing XIIVII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The recovery continues for at least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable.
KEY WORDS: facial nerve, facial palsy, hypoglossal-facial nerve anastomosis, mirror feedback, rehabilitation
Introduction
Hypoglossal-facial nerve (XII-VII) anastomosis is a surgical procedure that has long been used to restore movement to the facial muscles in cases of paralysis of the seventh cranial nerve (Ozsoy et al., 2011). Many surgical techniques have been reported for this procedure, but clinical series in the literature seem to demonstrate comparable functional recovery for the different approaches (Lin et al., 2009). After surgery, the facial muscles are reinnervated by the twelfth cranial nerve, therefore patients have to learn how to control facial motility through the use of voluntary tongue movements (Rinn, 2007). This use of the new motor circuit is accompanied by a reorganization of brain activation patterns: hypoglossal motor cortex activation is observed when patients perform facial movements (Bitter et al., 2011).
In a 2007 meta-analysis, Yetiser and Karapinar (2007) reported a median improvement of two levels on the House-Brackmann (HB) grading system in patients who underwent surgery alone.
Following XII-VII anastomosis, patients frequently undergo a rehabilitation program to learn how to use the new motor circuit and how to prevent or control synkinesis (Magliulo et al., 2001; Sleilati et al., 2010). Preliminary studies suggest a favorable effect of electromyographic biofeedback rehabilitation (Brudny et al., 1988; Dalla Toffola et al., 1996), but systematic studies assessing patients who have undergone XIIVII anastomosis and rehabilitation are still lacking.
The aim...