ABSTRACT
The classic hypoglossal transfer to the facial nerve invariably results in profound
functional deficits in speech, mastication, and swallowing, and causes synkinesis
and involuntary movements in the facial muscles despite good reanimation. Techniques
such as a hypoglossal/facial nerve interpositional jump graft and splitting the hypoglossal
nerve cause poor functional results in facial reanimation and mild-to-moderate hemiglossal
atrophy, respectively. Direct hypoglossal/facial nerve cross-over through end-to-side
coaptation without tension was done in three fresh cadavers and four patients. The
patients had facial paralysis for less than 7 months. Complete mobilization of the
facial nerve trunk and its main branches beyond the pes anserinus from the stylomastoid
foramen, division of the frontal branch, if necessary, and superior elevation of the
hypoglossal nerve after dividing the descendens hypoglossi, thyrohyoidal branches,
occipital artery, and retromandibular veins were performed. The end of the facial
nerve was hooked up through both a quarter of a partial oblique neurotomy and a perineurial
window at the side of the hypoglossal nerve. Temporalis muscle transfer to the eyelids
and the first stage of cross-facial nerve transfer were performed simultaneously.
None of the patients experienced hemiglossal atrophy, synkinesis, and involuntary
movements of the facial muscles. Regarding facial reanimation, one patient had excellent,
one patient good, and the others fair and poor results after a follow-up of at least
1 year.
