Rehabilitation of Central Facial Paralysis With Hypoglossal-Facial Anastomosis

Objective To evaluate the ability of hypoglossal-facial nerve anastomosis to reanimate the face in patients with complete nuclear (central) facial nerve palsy. Study Design Retrospective case series. Setting Tertiary academic medical center. Patients Four patients with complete facial nerve paralysis due to lesions of the facial nucleus in the pons caused by hemorrhage due to arteriovenous or cavernous venous malformations, stroke, or injury after tumor resection. Intervention All patients underwent end-to-end hypoglossal-facial nerve anastomosis. Main Outcome Measures Facial nerve function using the House-Brackmann (HB) scale and physical and social/well-being function using the facial disability index. Results The mean age of the patients was 53.3 years (range, 32–73). There were 3 female and 1 male patients. All patients had preoperative facial function HB VI/VI. With a minimum of 12 months’ follow-up after end-to-end hypoglossal-facial anastomosis, 75% of patients regained function to HB grade III/VI, and 25% had HB grade IV/VI. Average facial disability index scores were 61.25 for physical function and 78 for social/well-being, comparable to results from complete hypoglossal-facial anastomosis after peripheral facial nerve palsy after acoustic neuroma resection. Conclusion Patients with nuclear facial paralysis who undergo end-to-end hypoglossal-facial nerve anastomosis achieve similar degrees of reanimation compared with those with peripheral facial nerve palsies. This raises the intriguing possibility that reinnervation may also be of benefit in patients with the vastly more common facial dysfunction because of cortical stroke or injury.