Comparison of Hemihypoglossal Nerve versus Masseteric Nerve Transpositions in the Rehabilitation of Short-Term Facial Paralysis Using the Facial Clima Evaluating System

Background: Masseteric and hypoglossal nerve transfers are reliable alternatives for reanimating short-term facial paralysis. To date, few studies exist in the literature comparing these techniques. This work presents a quantitative comparison of masseter-facial transposition versus hemihypoglossal facial transposition with a nerve graft using the Facial Clima system. Methods: Forty-six patients with complete unilateral facial paralysis underwent reanimation with either hemihypoglossal transposition with a nerve graft (group I, n = 25) or direct masseteric-facial coaptation (group II, n = 21). Commissural displacement and commissural contraction velocity were measured using the Facial Clima system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using a paired sample t test. Then, mean percentages of recovery of both parameters were compared between the groups using an independent sample t test. Onset of movement was also compared between the groups. Results: Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I but not in group II. Mean percentage of recovery of both parameters did not differ between the groups. Patients in group II showed a significantly faster onset of movement compared with those in group I (62 ± 4.6 days versus 136 ± 7.4 days, p = 0.013). Conclusions: Reanimation of short-term facial paralysis can be satisfactorily addressed by means of either hemihypoglossal transposition with a nerve graft or direct masseteric-facial coaptation. However, with the latter, better symmetry and a faster onset of movement are observed. In addition, masseteric nerve transfer avoids morbidity from nerve graft harvesting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

[1]  E. Sargent,et al.  Measurement of facial movement with computer software. , 1998, Archives of otolaryngology--head & neck surgery.

[2]  A. Jenny,et al.  Development of a New Documentation System for Facial Movements as a Basis for the International Registry for Neuromuscular Reconstruction in the Face , 1994, Plastic and reconstructive surgery.

[3]  F. Venail,et al.  Outcomes and complications of direct end-to-side facial-hypoglossal nerve anastomosis according to the modified May technique. , 2009, Journal of neurosurgery.

[4]  Caroline van de Velde,et al.  Reanimation of the paralyzed face by indirect hypoglossal-facial nerve anastomosis. , 2001, American journal of surgery.

[5]  R. Zuker,et al.  Smile Reconstruction in Adults with Free Muscle Transfer Innervated by the Masseter Motor Nerve: Effectiveness and Cerebral Adaptation , 2006, Plastic and reconstructive surgery.

[6]  R. Zuker,et al.  The Effects of Gracilis Muscle Transplantation on Speech in Children With Moebius Syndrome , 2003, The Journal of craniofacial surgery.

[7]  B. Hontanilla,et al.  Transposition of the Hemimasseteric Muscle for Dynamic Rehabilitation of Facial Paralysis , 2012, The Journal of craniofacial surgery.

[8]  J. Terzis,et al.  Efficacy of the "baby-sitter" procedure after prolonged denervation. , 2000, Journal of reconstructive microsurgery.

[9]  D. Labbé,et al.  Lengthening Temporalis Myoplasty and Lip Reanimation , 2000, Plastic and reconstructive surgery.

[10]  Linstrom Cj,et al.  Facial-motion analysis with a video and computer system: a preliminary report. , 2000 .

[11]  R. Zuker,et al.  A Comparison of Commissure Excursion following Gracilis Muscle Transplantation for Facial Paralysis Using a Cross-Face Nerve Graft versus the Motor Nerve to the Masseter Nerve , 2006, Plastic and reconstructive surgery.

[12]  B. Hontanilla,et al.  Masseter nerve as “baby sitter” procedure in short-term facial paralysis , 2010, European Journal of Plastic Surgery.

[13]  N. Surgery.  [Facial nerve grading system]. , 2006, Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery.

[14]  S. Morley,et al.  Topographic anatomy of the nerve to masseter: an anatomical and clinical study. , 2011, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[15]  M. Samii,et al.  Management of 1000 Vestibular Schwannomas (Acoustic Neuromas): The Facial Nerve-Preservation and Restitution of Function. , 1997, Neurosurgery.

[16]  C. Aubá,et al.  Automatic three-dimensional quantitative analysis for evaluation of facial movement. , 2008, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[17]  G. Borschel,et al.  The motor nerve to the masseter muscle: an anatomic and histomorphometric study to facilitate its use in facial reanimation. , 2012, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[18]  R. Zuker,et al.  Facial Animation in Children with Möbius Syndrome after Segmental Gracilis Muscle Transplant , 2000, Plastic and reconstructive surgery.

[19]  M. Socolovsky,et al.  HEMIHYPOGLOSSAL–FACIAL NEURORRHAPHY AFTER MASTOID DISSECTION OF THE FACIAL NERVE: RESULTS IN 24 PATIENTS AND COMPARISON WITH THE CLASSIC TECHNIQUE , 2008, Neurosurgery.

[20]  Gonzalo Rodríguez-Losada,et al.  Bilateral reconstruction of smile through muscular transplants neurotized to masseter nerves. , 2011, The Journal of craniofacial surgery.

[21]  J. Terzis,et al.  Outcomes of Mini-Hypoglossal Nerve Transfer and Direct Muscle Neurotization for Restoration of Lower Lip Function in Facial Palsy , 2009, Plastic and reconstructive surgery.

[22]  F W Pirruccello,et al.  Plastic and reconstructive surgery. , 1967, IMJ. Illinois medical journal.

[23]  A. Banič,et al.  Comparative objective and subjective analysis of temporalis tendon and microneurovascular transfer for facial reanimation. , 1999, British Journal of Plastic Surgery.

[24]  U. Fisch,et al.  Objective scaling of facial nerve function based on area analysis (OSCAR). , 1998, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[25]  E. Laws.  Facial reanimation. , 1993, Journal of neurosurgery.

[26]  C. Linstrom,et al.  Facial-motion analysis with a video and computer system: a preliminary report. , 2000, The American journal of otology.

[27]  R. Ramsden,et al.  A Comparison of Surgical Techniques Used in Dynamic Reanimation of the Paralyzed Face , 2005, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[28]  M. Klebuc.  Facial Reanimation Using the Masseter-to-Facial Nerve Transfer , 2011, Plastic and reconstructive surgery.

[29]  K. Harii,et al.  FREE GRACILIS MUSCLE TRANSPLANTATION, WITH MICRONEUROVASCULAR ANASTOMOSES FOR THE TREATMENT OF FACIAL PARALYSIS: A Preliminary Report , 1976, Plastic and Reconstructive Surgery.

[30]  R. Zuker,et al.  Muscle Transplantation by Fascicular Territory , 1984, Plastic and reconstructive surgery.