Free Neurovascular Muscle Transplantation for the Treatment of Facial Paralysis Using the Hypoglossal Nerve as a Recipient Motor Source

Seventeen cases of free-muscle transplantation using the hypoglossal nerve as a recipient motor nerve for the treatment of long-standing or irreversible facial paralysis are reported with details of a follow-up study. The muscle, usually the latissimus dorsi muscle, is transferred to the cheek with microvascular anastomoses. The muscle's motor nerve is sutured to the hypoglossal nerve. There are three classifications of hypoglossal nerve sectioning: total section, central section, and lower section. The results were compared on the basis of these three methods, leading to the recommendation that branches of the hypoglossal nerve diverging inferiorly to innervate the suprahyoid muscles be utilized as a recipient motor source. This method permits acceptably natural movement of the grafted muscle without functional disability of the tongue. Good candidates for this procedure are considered to be those patients for whom muscle transplantation combined with a cross-face nerve graft cannot be adopted because of bilateral paralysis or surgical intervention on the healthy side of the face or who are so old that the long two-stage operation holds no hope for them.