American Society for Peripheral Nerve

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Combined Hemihypoglossal and Masseteric Nerve Transfer for Facial Nerve Palsy
Wojciech Kukwa, MD, PhD; Ewa Migacz, MD; Antoni Krzeski, Professor
Medical University of Warsaw, Faculty of Medicine and Dentistry, Warsaw, Poland


Various dynamic surgeries are available for facial nerve palsy. However, when used as isolated procedures, they often provide suboptimal results. Combined hemihypoglossal and masseteric nerve transfer (CHMNT) is a novel technique that may offer more optimal outcomes when compared to isolated hemihypoglossal or masseteric nerve transfer.


56-year-old male with complete left facial nerve palsy following cerebellopontine angle tumor resection underwent CHMNT in 2015. The trunk of facial nerve was innervated with a split hypoglossal nerve, while the buccal branch of facial nerve was innervated by the masseteric branch of trigeminal nerve. The patient was evaluated with the House-Brackmann Classification (HBC) and Sunnybrook Facial Grading System (SFGS) pre- and postoperatively. Review of literature was performed in order to compare our results with other dynamic procedures.


Pre- and 18 months postoperative HBC grade was VI and III, while SFGS score was 0 and 51, respectively. Time to recovery was 11 months for facial tone and 6 months for smile. After 18 months of follow-up, smile symmetry and significant movement of oral commissure were present. No impairment of masticatory function, atrophy of tongue or speech difficulty were noticed. Results of different dynamic procedures vary in literature: from I to III for HBC and from 30 to 54 for SFGS.


Our new technique, which is a combination of two well-known procedures, provides optimal reinnervation of facial nerve. Hypoglossal nerve gives baseline tone to facial musculature and masseteric nerve valuable dynamic smile. The results in HBC and SFGS are similar to the other dynamic procedures, but the use of two different nerves produces less synkinesis.

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