Abstract
Hypoglossal-facial anastomosis (HFA) as an end-to-end anastomosis (EEA) has several advantages, and indirect HFA with interposition graft is a safe and excellent method. The extended HFA is the method of choice for all malignant tumors that require extensive resection of the facial plexus, especially when combined with a neck dissection. Facio-facial anastomosis combined with HFA leads to excellent results when resection defect is restricted to the central portion of the facial plexus. Good functional rehabilitation of the musculature of the oral sphincter system is achieved using the hypoglossal nerve. To innervate the musculature of the ocular sphincter system, a facio-facial anastomosis between the nerve trunk and the cranial nerve branches is made using a free nerve transplant. Dynamic reanimation involves nerve repair, nerve transfer, regional muscle transfer, or free-muscle transfer. Dynamic reconstructive techniques can yield improved facial symmetry, spontaneous and symmetrical smile, eye closure and protection, and oral competence.
TopGoals And Limitations Of Reconstruction
Reconstructive nerve surgery must be performed as soon as possible, either as a one-stage operation with tumor resection or, if a histopathological analysis of the specimen is necessary, within 10-14 days at most because of the rapid development of scar tissue. Dynamic and static reconstruction procedures are employed for facial reanimation in patients suffering from facial nerve paralysis (Gordin, Lee, Ducic, & Arnaoutakis, 2015). However, dynamic strategies tend to be more successful and fruitful and should be offered to patients considering reconstruction, unless health risk contraindications exist.
The most common approaches for reconstruction are direct facial nerve repair with or without grafting, nerve transfer, cross-facial nerve grafting, and muscle transfer (regional or free) (Gousheh, 2011; Chan, 2011; Robey, 2011; Meltzer, 2010). Understanding facial nerve anatomy with precise assessment of the patient's paralysis and health status dictate the potential for recovery and the appropriate reconstructive scheme.