Reconstruction of Complex Peripheral Facial Nerve Defects by a Combined Approach Using Facial Nerve Interpositional Graft and Hypoglossal-Facial Jump Nerve Suture

Objectives/Hypothesis: To describe a modified facial nerve reconstruction technique for complex defects of the facial fan after parotid surgery that avoids synkinesis between upper and lower face. Study Design: Retrospective case series. Methods: Patients who had undergone radical parotidectomy with a large defect of the facial fan, reconstruction of the upper face by facial nerve interpositional graft, and reconstruction of the lower face by hypoglossal-facial nerve jump nerve suture were included in this series. Results: Four patients underwent the modified combined approach after tumor resection and prior to postoperative radiotherapy in three of the four cases. Surgery was combined with an upper lid weight implantation. Regeneration of the face was successful in all cases within 12 to 16 months. Most important, the separated reanimation of the upper and lower face circumvented synkinesis of the upper and lower face. This factor was essential for good functional results. Using the hypoglossal jump technique instead of a classical cross-nerve suture technique prevented the sacrifice of ipsilateral tongue function. Conclusions: The presented method offers satisfactory results for facial reanimation and avoids synkinesis between the upper and lower face. Using the jump technique instead of a classic hypoglossal transfer as it was described originally for the combined approach avoids long-term sequelae for the tongue.